During the process of my creation, I think God (or whoever it was that led the design team alongside the sum total of millennia of evolutionary process), played a bit of a joke on me. I have dubbed the affliction That Joke! I do have to add an aside at this point because I do not believe in higher-order processes of creation, a top-down causality. Central to the whole argument of the next few posts (the need to blur the dualism that so dogs being able to think constructively about conditions like fibromyalgia), is the dissolution of hierarchical intelligent creators. All I will say at this point is that we have to take heed of Darwin's insight that all design in the living world:- '..can be, must ultimately be, the product of blind, uncomprehending, purposeless processes of natural selection'. Hold this thought, and you'll see why this is so important later, but for now (somewhat inconveniently) it ruins my story. So please put the suggestion of a top-down creation process 'down' to artistic license and forgive the philosophical inconsistency at this point. So, back to That Joke which has plagued me since witnessing the moon landing on a tiny black and white TV at the age seven. At that moment, like many other kids of the time, I wanted to be an astronaut! Even then, though, I realised being an astronaut was not an especially realistic idea and that it required a prior career as a test pilot in the US air force! What I did sus out was that a career in physics would take me in the right direction and maybe towards a job as a flight director at NASA's mission control - following in the footsteps of the great Gene Kranz, Glynn Lunney, Gerald Griffin, and Clifford Charlesworth. A far more realistic ambition, I'm sure you'll agree!! However, I soon found that is was not the physics itself I liked but the look of the mathematics that went with the physics that appealed to me. I quickly realised that mathematics is the language of the universe and to understand it would open the doors of my mind to travelling anywhere in the universe without having first to be a test pilot or to do astronaut training, or even leave my room! It was from this realisation that a life long, frustrating, and often secret, love affair with mathematics started.

As a hormonal teenager, I found mathematical equations sexy (I know, I know, how sad is that?). They looked so good on the page, the feeling of copying them out on to a piece of squared paper with a Staedtler pencil (you know those yellow and black ones - 'a mathematician's pencil'!) was, and still is, sensual to me. I watched BBC Horizon, got hold of mathematical texts books, and spent many evenings alone in my bedroom copying out equations! The bookshelf in my study, to this day, is testament to this pathological passion (see figure 1). But, here's the thing. Here's The Joke. Whatever it is that created me to have this desire, this appreciation of the beauty and importance of mathematics, forgot to give me the ability actually to do it! The Joke goes like this: ALMIGHTY: 'Who's next on the list, Aaron?' AARON: 'We've got this chap who is going to be called Gaz: We've sorted most of it, quite tall, skinny, big nose, but we need to give him a couple hang-ups and source of life-long frustration. What d'ya think My Lord?' 'ALMIGHTY; 'I like the big nose, that's a good start. But it might be fun if we make him love mathematics. All kinds of mathematics, pure, applied, even statistics. This is an uncommon love; he will not share it with many people' ARRON: 'But, My Lord, the love of mathematics is a great gift, if not a little dodgy at parties, and is unlikely to lead to any fun hang-ups we can giggle at!' ALMIGHTY: 'Ah but here's the thing Arron, to really mess him up we will give him the gift of appreciation, as passion and delight in the subject, but not the ability - we will make him crap at mathematics!'. Yes, that's it, that's The Joke; I love it, but I'm crap at it! Damn those top-down creators! I've been plagued by this 'Joke' for over 50 years, and subtly, it permeates every aspect of my life. The whole business is a long story, but does mean that any chance I get to make something look mathematical, I will and enjoy doing so. I have especially fallen in love with the greek letter Lamda (𝝀). It is the 11th letter of the Greek alphabet sitting between Kappa and Mu (also beautiful symbols). For those of you informed on these things, there is some debate about the spelling - with or without a 'b' (lamda/lambda) - a discussion I am not going to get into right now. In physics it is often used in relation to wavelengths, in matrix algebra is can represent eigenvalues, or a non-specific function in computer programming. It even has its own area of mathematics named after it - Lamda Calculus. Lamda (my spell check is trying to add the B) Calculus is a formal system in mathematical logic for expressing computation based on function abstraction and application using variable binding and substitution. Do I understand what that all means? No, damn, but I love it! So why is this relevant to my long interest in fibromyalgia and other complex conditions? Well, I am crap at it for sure. However, still, it has influenced how I think and how mathematics can represent complex natural phenomena and processes in a concise and elegant form (see, for example, Dirac's beautiful equation in figure 2 - which I don't really understand).

I often use a kind of pseudo-mathematical symbolism to show how things might fit together. My 'equations' (many of you might have seen them) are nothing more than ways of putting different concepts together, relationships between ideas, and to provide a framework for thinking and to stimulate questions. I do this often, not just because it partly quenches my thirst for Lam(b)da, but because I find it genuinely helpful. These are, of course, heuristics and not real equations. Heuristics, by the way, if you're not familiar with the term, is a way of cheating, a technique that allows shortcuts to solving problems. I think of it as a kind of mental recipe (mental cooking for one sort of idea). It also gives a potential common narrative to share ideas with or explain principles. Back in 2012, after many years of working with people who suffer fibromyalgia, patterns started to emerge which I put together in one of these pseudo equations. It has been a guide to my thinking since and, indeed, some more esteemed researchers have used similar ideas over the years that have added more detail. Today, I am only going to introduce it and define its different elements. Over the next few weeks, I will write about each of those elements in more detail and suggest the implications for research and clinical practice. There is also a broader considering that underpins all my ideas over the years, which is much more philosophical. At first, this drift to the more metaphysical might seem unhelpful to the battlefield of every day clinical work. Still, I sincerely believe it to be a necessary diversion and why I see conditions like fibromyalgia as so important to understand. A couple of initial assumptions to declare: First, I see the group of people currently diagnosed with fibromyalgia as probably made up of different actual causal routes and therefore actual diagnoses. At the moment, the diagnostic process is descriptive and based on exclusion (although it has become a little my dynamic recently). One day, when we understand thing better, if we take 1000 people diagnosed with FM today, we will find they are made up of lots of different actual conditions. Second: I do not believe fibromyalgia is caused by one thing, but a combination of factors that have to come together to equal FM. This is the notion of polyaetiology or even more of a groovy phrase polyaetiologcalgenesis... but basically means lots of different bits cause it. There are many more assumptions which I'll come on to.. but here is my t-shirt equation for fibromyalgia.

## (𝝀+𝝀1)(*Ev)+(tg)+e = FM (CS)*

*There are two parts to this, the first (𝝀+𝝀1)(Ev) should be considered as vulnerability factors. 𝝀 = your genetics, your genome, the basic building blocks of you, and 𝝀1 are epigenetic factors these are factors that influence the expression of those basic building blocks (of your genes), and can take many forms from the kind of life you have had, through to your exposure to infections. Ev is environmental factors, external factors that influence internal factors. Genetic, epigenetic and environmental factors, constitute the elements that make up vulnerability to developing FM among other conditions. But, for those vulnerabilities to develop into fibromyalgia I think they need a trigger of some that is (tg). Triggers can be multiple, subtle or very obvious in nature or, indeed, can overlap with Ev factors like infection for example. e is probably the most important factor here in that is represents error. Error is made up of the myriad of factors we have not considered! FM is clearly fibromyalgia but CS is central sensitivity which will will talk about later.*

*Each part of this 'equation' is a tome by itself, for now I just wanted to present the idea and, as I said about, wrap more detail around it as we go on. I also like the idea of this generate a debate and some discussion so please do add comments. I shall write the bit over the following week.*

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*I'm off now to venture in to the Oncology department at Royal Sussex Hospital with my mum - she's doing well, but both she and I will be pleased when her radiotherapy is over. All stay safe and indoors. I think there are vulnerability factors even with COVID-19 so assume you have lots of them and stay safe... take care Gary*