JOHN QUINTNER, DAVID BUCHANAN, MILTON COHEN and ANDREW TAYLOR SIGNIFICATION AND PAIN: A SEMIOTIC READING OF FIBROMYALGIA ABSTRACT. Patients with persistent pain who lack a detectable underlying disease challenge the theories supporting much of biomedical body-mind discourse. In this context, diagnostic labeling is as inherently vulnerable to the same pitfalls of uncertainty that beset any other interpretative endeavour. The end point is often no more than a name rather than the discovered essence of a pre-existent medical condition. In 1990 a Committee of the American College of Rheumatology (ACR) formulated the construct of Fibromyalgia in an attempt to rectify a situation of diagnostic confusion faced by patients presenting with widespread pain. It was proposed that Fibromyalgia existed as a “specific entity”, separable from but curiously able to co-exist with any other painful condition. Epistemological and semiotic analyses of Fibromyalgia have failed to find any sign, clinical or linguistic, which could differentiate it from other diffuse musculoskeletal pain states. The construct of Fibromyalgia sought to define a discernable reality outside the play of language and to pass it off as a natural phenomenon. However, because it has failed both clinically and semiotically, the construct also fails the test of medical utility for the subject in persistent pain. KEY WORDS: fibromyalgia, medical epistemology, persistent pain, semiotics INTRODUCTION The practice of modern Western Medicine is in large part based upon the biomedical model of disease. The assumptions underpinning this model are that symptoms are an expression of underlying disease and that there is a reliable connection between pathological changes and clinical features. It also presumes that each disease has a determinate cause. As Foucault suggests, this model ... gave to the clinical field a new structure in which the individual in question was not so much a sick person as the endlessly reproducible pathological fact to be found in all persons suffering in a similar way. 1 When the relationship between symptoms and signs is uncertain and the cause is not apparent, recurring clinical patterns of disturbed bodily function are assigned the status of syndromes. 2 Syndromes are valuable conceptual instruments that permit a degree of diagnostic flexibility as well as constituting the necessary first step to further investigation. This Theoretical Medicine 24: 345–354, 2003. © 2003 Kluwer Academic Publishers. Printed in the Netherlands.