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Editor's Correspondence |

Patients With Fibromyalgia Must Be Treated Fairly

Thomas J. Romano, MD, PhD
Arch Intern Med. 1999;159(20):2481-2482. doi:.
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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.48 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.

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