Fibromyalgia – the challenges of diagnosis and building a medico legal case
Fibromyalgia, or Fibromyalgia Pain Syndrome, is a chronic and widespread musculoskeletal pain and fatigue disorder. It is defined as a long-term, body-wide pain in muscles, ligaments and tendons (the soft fibrous tissues in the body). It is typically characterised by widespread aches and pains, restless sleep, feeling tired on waking, fatigue, anxiety, depression and disturbances of bowel function.
It is a difficult condition to diagnose because of the variety of complaints that, on the surface, might seem unrelated: sleep disturbance, migraines, pain or fatigue. A lack of concrete evidence in the form of laboratory values* and x-rays does not help with swift diagnosis. Concerningly, according to a survey conducted in Canada and reported in Medscape (Dec 2017), “Many doctors, even specialists, don’t adhere to fibromyalgia diagnostic criteria”. Almost half of the physicians surveyed did not have “adequate” or “homogeneous” knowledge of the criteria, which could increase delays in diagnosis or misdiagnoses.
What are the diagnostic criteria?
The American College of Rheumatology 1990 criteria for classification of fibromyalgia states that the patient should have “history of widespread pain that has been present for at least three months” and considers pain as widespread when all of the following are present:
- Pain in both sides of the body
- Pain above and below the waist. In addition axial skeletal pain (cervical spine, anterior chest, thoracic spine or low back pain) must be present.
The patient should also experience pain (not just “tenderness”) in at least 11 of 18 tender point sites when palpated (pushed).
How can it be treated?
Multi-disciplinary treatment tailored to the individual patient’s needs is recommended to help relieve some of the symptoms and make the condition easier to live with. Treatment tends to be a combination of medication, including anti-depressants and pain relief, talking therapies (such as Cognitive Behavioural Therapy and counselling) and lifestyle changes (such as graded and paced exercise programmes and relaxation techniques).
What are the medico legal challenges associated with fibromyalgia?
The number of legal cases of fibromyalgia and medico legal reports for fibromyalgia is on the rise, as is the incidence of fibromyalgia symptoms starting after a trauma such as a road traffic accident. What challenges will you face in a medico legal case?
Challenge of establishing a cause:
Difficulty can arise when the original trauma, for example a road traffic accident, caused limited or relatively minor damage at the time. However, when the expected improvement does not happen and a range of other symptoms occur, which may include fatigue and disturbed sleep, it can result in a fibromyalgia diagnosis to be missed for some time or challenged.
Subjectivity of assessment:
The assessment and diagnosis of disability in chronic pain conditions, including fibromyalgia, is notoriously difficult due to its subjectivity. While fibromyalgia is accepted as a medical condition, the diagnosis is susceptible to misuse due to the subjectivity of the symptoms. Furthermore, chronic pain can be particularly challenging for the courts to understand in terms of the prototypical perception of disease that associates pathogenesis with tissue damage or dysfunction.
Appointing a pain expert is crucial
Assessment by a pain expert can assist in establishing the level of resulting disability, if any. A pain expert will also be able to provide a tangible assessment and diagnosis of the symptoms suffered by the patient, based on their experience and knowledge of this specialist field of medicine.
About Medicolegal Partners
Established experts, quality reports, quick turnaround
Our aim is to assist the court to achieve a fair outcome by providing thorough, impartial information. We organise a medical examination within 7 days of instruction and our reputable, medical experts provide their reports within 4 weeks. Our experts are also experienced expert witnesses, should you require their presence in court. We accept instructions on personal injury and clinical negligence claims for a range of reports including screening reports to condition and prognosis reports, causation and joint instructions. Our experts are trained to act for either the claimant or defendant and viewing a case from both sides makes for a robust report and conclusion. We make the process of commissioning an expert medico legal report easy and efficient for you and your client. You will find we are responsive, flexible and very professional.
Please get in touch for more information, to book an appointment at a clinic, or to arrange to speak to our experts about your case.