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How should we manage fibromyalgia?
  1. ROBINA LLOYD
  1. Arthritis Care
  2. 18 Stephenson Way
  3. London NW1 2HD, UK
    1. P A REILLY
    1. Frimley Park Hospital
    2. Portsmouth Road
    3. Frimley, Camberley
    4. Surrey GU16 5UJ, UK

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      We read with interest your leader, “How should we manage fibromyalgia?”.1 We were puzzled by Paul Reilly's statement that a comprehensive pain management programme...has the best chances of success, although even rheumatologists can practise amateur cognitive behavioural therapy in the clinic”. Is Dr Reilly really suggesting that a rheumatologist's amateur efforts offer the best outcome for people with fibromyalgia?

      Dr Reilly offers no evidence to support this statement. He does, however, find evidence to raise questions as to the value of patient self help groups. Dr Reilly cites a 1992 paper that reports an association between membership of such a group and worse prognosis in chronic fatigue syndrome.2 As the authors emphasised the caution with which the results should be interpreted, it is surprising that Dr Reilly has used this evidence to inform his clinical practice.

      Firstly, this is ancient research. Things have moved on. Although we would agree that some so called self help groups can end up as a circular review of symptoms, self management courses, which we at Arthritis Care espouse, are a very different matter.

      Challenging Arthritis is a self management programme—and that title was chosen very deliberately. It is run by people with arthritis for people with arthritis. It gives people the skills to take control of their lives and their arthritis. It is practical and positive, and it works. The effectiveness of similar programmes in the USA is well recorded.3

      Experience in the United Kingdom shows similar results, including better understanding of symptoms, improved communication with medical staff, and increased use of exercise and relaxation techniques. Probably most importantly of all, self management programmes significantly decrease pain, fatigue, and anxiety.4

      So it is extremely important to differentiate between navel gazing self help systems and courses such as ours, which encourage people to take control for themselves—and which work.

      Similar courses run on the Challenging Arthritis model are now available to people with other chronic conditions.

      Given Dr Reilly's desire to disabuse patients of the notion that their fibromyalgia is his problem alone, shouldn't effective courses which encourage people to take control for themselves be a welcome adjunct to his treatment, even if it is run by a patient self management group?

      References

      Author's reply

      I am surprised that Ms Lloyd has chosen to be rather negative about an editorial that was designed to combine optimism with realism. Although one might be optimistic that every patient with fibromyalgia, and similar functional pain syndromes, might have access to professional psychological advice and management, reality dictates that this is not the case, at least not within the health service as it operates in the United Kingdom. As cognitive behavioural therapy sets out to influence the manner in which patients with fibromyalgia think and behave in an attempt to decrease the impact of their disorder, I have merely pointed out that an interested rheumatologist can employ communication and motivational skills, which in many cases will serve the same purpose as formal psychological management.

      Ms Lloyd makes much of the “Challenging Arthritis” self management programme run by Arthritis Care. Fibromyalgia, of course, is not a form of arthritis but a form of non-articular rheumatism. I have little doubt that an appropriately run education programme can help people with fibromyalgia cope more effectively with their symptoms. However, self help groups often work to a different agenda than treating clinicians. They function as a lobby to increase recognition and acceptance of a particular disorder, and sometimes such a campaign has financial rewards through litigation and compensation. Not only the objectives but also the objectivity of such a group can be called into question. However, I am delighted to learn from Ms Lloyd that the “Challenging Arthritis” programme is so good and so effective.

      Finally, to accuse a paper published in 1992 of being “ancient research” is not only insulting to the authors but also inaccurate. High quality research has a longer shelf life than eight years.

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