FIBROMYALGIA 1995-6
A Canadian judge[1] preferred the evidence of a psychiatrist that Fibromyalgia was a form of Hysterical Conversion[2]. She discounted the opinion of a rheumatologist because of his "personal and perhaps financial interest in perpetuating the existence of this condition."
Another rheumatologist and a specialist in physical medicine and rehabilitation have argued that Post-Traumatic Fibromyalgia is not a disease entity because it fails all eight rules of medical causation[3]. They proposed rather that the symptoms are an expression of psychosocial distress.
The 1990 report[4] of the American College of Rheumatology criteria for Fibromyalgia did not address the role of trauma. The first recommendation of much the same working group in their 1994 Consensus Report[5] was that the terms "reactive" and "post-traumatic" be eliminated.
PRACTICE POINT While the biochemical mechanisms producing the symptoms of Fibromyalgia are being clarified, a causal connection with trauma is becoming more tenuous.
A long-term study[6] of 39 patients found that symptoms of Fibromyalgia Syndrome improved somewhat in the majority but persisted at least 15 years on average.
Meantime, laboratory researchers have been clarifying the disturbances of neurotransmitter[7] hormones, and the development of antibodies[8] which might attack the patient's own tissues. Are these side-effects, or are they part of the causal mechanism of symptoms, perhaps as a result of chronic stress?
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Robert Bennett, M.D. Oregon Health Sciences University
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Colorado Health Net
Frederick Matsen III MD Chairman, Department of Orthopaedics, University of Washington
BCFMS
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