Rheumatology 2004; 43: 257
British Society for Rheumatology 2004; all rights reserved
Letter to the Editor |
Comment on ‘Fibromyalgia and the therapeutic domain. A philosophical study on the origins of fibromyalgia in a specific social setting.’ by Hazemeijer and Rasker
St Joseph's Health Care London, London, Ontario, Canada
Correspondence to: M. Harth, St Joseph's Health Care London, P.O. Box 577, 268 Grosvenor Street, London ON N6A 4V2, Canada. E-mail: Manfred.harth{at}sjhc.london.on.ca
SIR, We are perplexed by Hazemeijer's and Rasker's review of the fibromyalgia syndrome (FMS) [1]. We agree that FMS is controversial, but they present mainly one side of the controversy. They cite with approval Hadler's belief that FMS is ‘a form of illness behavior’ [2]; readers familiar with the scientific literature on FMS will recognize that there are no studies to support this. Hazemeijer and Rasker present a detailed philosophical analysis ending with the suggestion that philosophy, not science, can provide "the solution of treating and preventing ‘syndromes’ like fibromyalgia".
We assume that when they state that physicians are unable to demonstrate FMS as a visible disease they mean a condition in which the diagnosis is based largely on the patient's history of distress. In this respect FMS is similar to such conditions as migraine, trigeminal neuralgia, polymyalgia rheumatica (especially in those with low sedimentation rates) [3], or idiopathic small-fibre painful sensory neuropathy. Are these entities also to be elucidated by invoking memes, therapeutic domains, matrices and looping effects? Does dynamic nominalism explain the high levels of substance P and nerve growth factor in the cerebrospinal fluid of patients with FMS [4, 5]? How does phenotypic iatrogenesis induce decreased production of growth hormone or increased somatostatin tone in FMS [6]?
Labelling may provide FMS sufferers with ‘social legitimacy’. Although this has not been our usual experience, we have found that, at least, it does not worsen their function or symptoms [7]. There may be a taboo about considering contributory psychological factors in the minds of some health professionals, but we and others have actually used psychological treatment in hundreds of patients for more than a decade [8]. We agree that FMS can severely affect the patient's quality of life and result in increased health-care costs. That is not a good enough reason to catastrophize (‘we may have created a monster’) [9], but rather should motivate a search for better treatment. As for the suggested intervention of media and politicians in preventing the ‘spread’ of FMS, we are reminded that similar measures to legislate control of disease were proposed by Samuel Butler in Erewhon [10]; we were, however, under the impression that this work is a satire.
References
- Hazemeijer I, Rasker JJ. Fibromyalgia and the therapeutic domain. A philosophical study on the origins of fibromyalgia in a specific social setting. Rheumatology 2003;42:507–15.
[Abstract/Free Full Text] - Hadler NM. Fibromyalgia, chronic fatigue, and other iatrogenic diagnostic algorithms. Do some labels escalate illness in vulnerable patients? Postgrad Med 1997;102:161–77.[Medline]
- Helfgott SM, Kieval RI. Polymyalgia rheumatica in patients with a normal erythrocyte sedimentation rate. Arthritis Rheum 1996;39:304–7.[Medline]
- Russell IJ, Orr MD, Littman B et al. Elevated cerebrospinal fluid levels of substance P in patients with the fibromyalgia syndrome. Arthritis Rheum 1994;37:1593–601.[ISI][Medline]
- Giovengo SL, Russel IJ, Larson AA. Increased concentrations of nerve growth factor in cerebrospinal fluid of patients with fibromyalgia. J Rheumatol 1999;26:1564–9.[Medline]
- Paiva ES, Deodhar A, Jones KD, Bennett R. Impaired growth hormone secretion in fibromyalgia patients: evidence for augmented hypothalamic somatostatin tone. Arthritis Rheum 2002;46:1344–50.[CrossRef][ISI][Medline]
- White KP, Nielson WR, Harth M, Ostbye T, Speechley M. Does the label ‘fibromyalgia’ alter health status, function, and health service utilization? A prospective, within-group comparison in a community cohort of adults with chronic widespread pain. Arthritis Care Res 2002;47:260–5.
- Nielson WR, Harth M, Bell DA. Out-patient cognitive–behavioural treatment of fibromyalgia: impact on pain response and health status. Pain Res Manage 1997;2:145–50.
- Reilly PA. How should we manage fibromyalgia? Ann Rheum Dis 1999;58:325–6.
[Free Full Text] - Butler S. Erewhon in Erewhon and Erewhon revisited. New York; Modern Library Updated, 1955.
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  I. Hazemeijer and J. J. Rasker The fibromyalgia problem. A Latin American point of view: reply Rheumatology, October 1, 2004; 43(10): 1313 - 1314. [Full Text] [PDF]
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