Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
To the Editor: The Clinical Review on management
of the fibromyalgia syndrome (FMS) by Dr Goldenberg and colleagues1 omitted 1 major diagnostic and therapeutic modality.
Chiari I malformations have been associated with the vague symptoms that lead
generalists to classify a patient as having FMS.2- 4 A
subpopulation of patients who consult with a neurosurgeon is likely to be
select, often having unsuccessfully been observed by pain specialists, neurologists,
physiatrists, and chiropractors, and told that there is no organic cause for
their symptoms. Nevertheless, I believe that it is appropriate for these patients
to have a magnetic resonance imaging (MRI) of the brain or cervical spine,
which may show that it is not “all in their head” but rather that
their brain (or more precisely, the cerebellar tonsil) is down in their spine.
Although an appropriate decompression does not eliminate all symptoms, it
can profoundly reduce the level of symptoms to a more manageable level. By
not including this in the differential diagnosis for FMS symptoms, there is
the possibility of missing a treatable condition.
Jenkins AL. Management of Fibromyalgia Syndrome. JAMA. 2005;293(7):796–797. doi:10.1001/jama.293.7.796-b