Patients With Fibromyalgia Must Be Treated Fairly (AMA ARTICAL)

Discussion in 'Fibromyalgia Main Forum' started by allhart, Nov 12, 2002.

  1. allhart

    allhart New Member

    Patients With Fibromyalgia Must Be Treated Fairly


    The recent article in the ARCHIVES by Goldenberg1 concerning fibromyalgia (FM) is an attempt to review the medical literature on this fascinating condition, but it has shortcomings, especially in the areas of causation and disability. This is a selective review omitting many important studies whose conclusions disagree with those of the author. For example, Goldenberg writes that "Evidence to determine whether there is a causal relationship between trauma and FM is currently inadequate." To support this statement, he cites 3 articles, 1 by Wolfe,2 another by Bennett,3 and a third by Buskila et al4 (Wolfe is a coauthor). Goldenberg neglects to mention that Buskila et al4 conclude their article with the statement that "Thus, trauma may cause FM, but it does not necessarily cause work disability." In addition to citing other reviews and opinion pieces in the medical literature, Goldenberg should have also referred to actual patient studies designed to determine if trauma was indeed a causal factor in the development of FM. Every study that has examined the relationship between trauma and fibromyalgia has revealed that trauma can indeed be a potential cause of this painful and frustrating problem.4-8 In fact, Bennett9 has described the most likely scenario of how a local muscle injury can progress to the development of FM and was one of the coauthors of an article in which he attests that in the medical/legal setting, where causation is "to a reasonable degree of medical probability," trauma is likely to be the cause of FM in some patients.10 Goldenberg advocates the abandonment of the term posttraumatic fibromyalgia. What is the justification? Even Wolfe11 has authored an article with posttraumatic fibromyalgia in the title! The term posttraumatic fibromyalgia further defines the syndrome and is useful in conveying information regarding causation.

    Patients with FM deserve our help. They truly suffer and many cannot work.12 They should not be discriminated against by any entity or group, least of all by the medical profession. Physicians must not yield to bias or innuendo. We have a duty to our patients to resist the urge to ignore this problem or wish it away, as many third-party payers appear to be doing and are pressuring us to do. Patients with FM have been found to have decreased magnesium levels,13 muscle abnormalities on phosphorus 31 nuclear magnetic resonance spectroscopy,14 altered immune function,15 and other objectively verifiable abnormalities. We must not add to these problems by treating patients with FM differently than any other patients with chronic pain.

    With regard to the disability issue, if a patient cannot function and perform the necessary tasks of his or her occupation, and cannot be retrained because of a chronic pain problem, shouldn't the patient be granted disability benefits? It should not matter what is causing the impairment if the impairment is sufficient to cause disability; the decent thing to do is to provide disability benefits for that impaired patient.16 Is Goldenberg overly concerned with money? Cost is referred to 11 times in his article. Yes, good medical care and disability benefits can be costly, but what are the costs to society of ignoring this problem and thereby allowing it to wreak havoc with patients' marriages, other interpersonal relationships, and their overall quality of life? How does withholding disability benefits from those who are truly unable to work benefit society?

    Because of the explosion of FM research in the past decade, it is hard to find fault with Goldenberg in failing to incorporate all of the above studies in his review article. However, to be fair, especially when it comes to such important issues as disability and causation, all sides of these issues should have been explored.



    Thomas J. Romano, MD, PhD
    Wheeling, WV 26003


  2. allhart

    allhart New Member

    Patients With Fibromyalgia Must Be Treated Fairly


    The recent article in the ARCHIVES by Goldenberg1 concerning fibromyalgia (FM) is an attempt to review the medical literature on this fascinating condition, but it has shortcomings, especially in the areas of causation and disability. This is a selective review omitting many important studies whose conclusions disagree with those of the author. For example, Goldenberg writes that "Evidence to determine whether there is a causal relationship between trauma and FM is currently inadequate." To support this statement, he cites 3 articles, 1 by Wolfe,2 another by Bennett,3 and a third by Buskila et al4 (Wolfe is a coauthor). Goldenberg neglects to mention that Buskila et al4 conclude their article with the statement that "Thus, trauma may cause FM, but it does not necessarily cause work disability." In addition to citing other reviews and opinion pieces in the medical literature, Goldenberg should have also referred to actual patient studies designed to determine if trauma was indeed a causal factor in the development of FM. Every study that has examined the relationship between trauma and fibromyalgia has revealed that trauma can indeed be a potential cause of this painful and frustrating problem.4-8 In fact, Bennett9 has described the most likely scenario of how a local muscle injury can progress to the development of FM and was one of the coauthors of an article in which he attests that in the medical/legal setting, where causation is "to a reasonable degree of medical probability," trauma is likely to be the cause of FM in some patients.10 Goldenberg advocates the abandonment of the term posttraumatic fibromyalgia. What is the justification? Even Wolfe11 has authored an article with posttraumatic fibromyalgia in the title! The term posttraumatic fibromyalgia further defines the syndrome and is useful in conveying information regarding causation.

    Patients with FM deserve our help. They truly suffer and many cannot work.12 They should not be discriminated against by any entity or group, least of all by the medical profession. Physicians must not yield to bias or innuendo. We have a duty to our patients to resist the urge to ignore this problem or wish it away, as many third-party payers appear to be doing and are pressuring us to do. Patients with FM have been found to have decreased magnesium levels,13 muscle abnormalities on phosphorus 31 nuclear magnetic resonance spectroscopy,14 altered immune function,15 and other objectively verifiable abnormalities. We must not add to these problems by treating patients with FM differently than any other patients with chronic pain.

    With regard to the disability issue, if a patient cannot function and perform the necessary tasks of his or her occupation, and cannot be retrained because of a chronic pain problem, shouldn't the patient be granted disability benefits? It should not matter what is causing the impairment if the impairment is sufficient to cause disability; the decent thing to do is to provide disability benefits for that impaired patient.16 Is Goldenberg overly concerned with money? Cost is referred to 11 times in his article. Yes, good medical care and disability benefits can be costly, but what are the costs to society of ignoring this problem and thereby allowing it to wreak havoc with patients' marriages, other interpersonal relationships, and their overall quality of life? How does withholding disability benefits from those who are truly unable to work benefit society?

    Because of the explosion of FM research in the past decade, it is hard to find fault with Goldenberg in failing to incorporate all of the above studies in his review article. However, to be fair, especially when it comes to such important issues as disability and causation, all sides of these issues should have been explored.



    Thomas J. Romano, MD, PhD
    Wheeling, WV 26003



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