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 …