Fibromyalgia is common in women, whether or not they are pursuing personal injury claims. Although the pathological basis for the lowered pain threshold is better understood than previously, medical causation remains unknown. Nevertheless, legal causation can be analysed with greater consensus than before.
Some symptoms are more resistant than others to Multidisciplinary Therapy, and how much an individual client will benefit can be incompletely predicted.
From the medicolegal perspective, Fibromyalgia is best considered as a particular variety of Chronic Pain.
Fibromyalgia is common in women, whether or not they are pursuing personal injury claims. According to the 1990 American College of Rheumatology criteria and the 1990 census data, out of every 200 females in the US, 7 suffer from Fibromyalgia Syndrome (FMS), the prevalence generally increasing with age. The equivalent figure for men is 1 in 200 1.
Although the pathological basis for the lowered pain threshold is better understood than previously, medical causation remains unknown. Fibromyalgia is not a Disease but a Syndrome, a recognisable collection of symptoms and clinical signs. That is to say, the medical causation neither is unique nor is understood in pathological terms.
Nevertheless, legal causation can be analysed with greater consensus than before. In our current state of ignorance, a recently publicised model 2 may nevertheless help litigators analyse legal causation.
Predisposing factors can be summarised as (acute or chronic) stressful life events, psychiatric illness, personality factors, particularly somatisation, and constitutional (chronic physical illness and allergy).
Precipitating events are generally severe infectious illness, physical trauma (surgery, accidental) and severe emotional stress.
Perpetuating factors may be unrecognised by clients and inadequately treated by their caregivers.
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PRACTICE POINT Perpetuating Factors 1. untreated psychiatric illness |
Apart from low-dosage antidepressants, prescription medication has little demonstrable benefit in FMS. However, a third of patients appear to have a correctable reduction in the production of Growth Hormone (GH) from the pituitary gland.
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PRACTICE POINT Symptoms of FMS clients who may eventually have a better treated prognosis: 1.
low energy |
A recent double-blind trial 3 in which GH-deficient sufferers injected either replacement hormone or placebo, found a significant improvement in both symptoms and numbers of positive tender points some 6-9 months after starting therapy. These findings are presently experimental, preliminary and unconfirmed, but GH-replacement may in time alter the treated prognosis for a significant minority of FMS patients.
Some symptoms are more resistant than others to Multidisciplinary Therapy, and how much an individual client will benefit can be incompletely predicted. A recent contribution 4 to the research on treated prognosis assessed the persistence of improvement after a 4 week multidisciplinary outpatient course of treatment. The significant improvements in severity of pain, interference with life activities, sense of control, emotional health (distress, depression and anxiety), and self-evaluated disability were maintained six months later.
However, the therapy did not achieve even short-term gains in interpersonal relationships or general activities, and fatigue had already at 6 months returned to pretreatment levels.
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PRACTICE POINT Symptoms either not or only transiently responsive to Multidisciplinary Therapy:
1. interpersonal relationships |
The researchers commented on the
great variability in response between patients but were able to identify only
some of the predictors of treated improvement in pain severity.
Evidence Based Medicine does not yet
support accurate prediction of individual prognosis.
Copyright © 2008 Electronic Handbook of Legal Medicine