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Editor's Correspondence
November 8, 1999

Patients With Fibromyalgia Must Be Treated Fairly

Arch Intern Med. 1999;159(20):2482-2483. doi:

In reply

Romano comments that I have omitted many important studies regarding the relationship of fibromyalgia (FM) to causation and disability in my recent review article1 published in the ARCHIVES. If such studies existed, I would have been pleased to comment on them. The studies that Romano refers to are observational, and selected bias of the patient and/or the author argue for cautious interpretation of any cause-effect statements. We do not know what causes FM.1 The term cause should be reserved for illnesses that follow accepted pathophysiological pathways. According to patient recall, physical trauma, along with emotional trauma and flulike infections, may precipitate the onset of FM.2 As discussed in my ARCHIVES article, Bennett and others have outlined potential scenarios in which trauma, as well as other stressors, may be triggers for fibromyalgia. There is no more or no less validity in the concept of posttraumatic fibromyalgia than there is in the concepts of posttraumatic stress disorder or posttraumatic repetitive strain injury. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia stated that secondary fibromyalgia, whether called posttraumatic or postinfectious, does not exist as an entity apart from fibromyalgia.3 Until investigators document a discrete cause for fibromyalgia or discover that posttraumatic or postinfectious fibromyalgia is different than primary fibromyalgia, such terms are speculative.

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