Session Title: Fibromyalgia and Soft Tissue Disorders
Session Type: Abstract Submissions (ACR)
Background/Purpose: Up to 40% of persons report onset of fibromyalgia (FM) following a “triggering event”. Injuries, which may occur in the workplace, may be implicated in some, hence linking FM to compensation. In Ontario, Canada, work injury causing physical abnormality is compensated according to the American Medical Association guides, with apportionment for pain, whereas injury without body changes, ie soft tissue, is compensated according to a chronic pain policy. FM, without tissue damage, falls under this policy. The Workplace Safety and Insurance Appeals Tribunal (WSIAT) is the final level of appeal for workers who request compensation for a work-related injury as causation for FM, with decisions available in the public domain.
Methods: Between June 2006 and December 2011, 150 Tribunal decisions relevant to FM were examined by predetermined search protocol. Twelve did not meet inclusion criteria; FM was not the central issue in 4, and 8 were for increased awards. New onset FM was appealed in 123, and aggravation of pre-existing FM in 15. Information in the aggravation cases was limited.
Results: All injuries were of a soft tissue nature, without any persistent physical findings to explain continued symptoms. Of the 15 cases pleading aggravation of FM (14 female, mean age 50 ± 8 years), 5 were manual, 3 clerical, 7 health care or education workers. Thirteen injuries were acute, 2 occurred gradually, with low back or neck identified in 13, and the Tribunal accepted 10/15 (67%). In the 123 new onset FM, (104 female, mean age 52 ± 9 years), 60 were manual, 29 clerical, 30 health care or education workers, 4 unknown, with 32% reporting repetitive work activity. Time from injury to diagnosis of FM (available for 117) was 4.3 ± 4.1 years, with 6.3 ± 2.8 physicians cited for each worker. Previous psychological illness, injuries, neck pain or back pain were recorded as present for 17%, 22%, 10%, and 13% respectively, whereas there was no statement of previous health status for 39%. Injuries were a single event in 68%, and gradual in 32%, with location of injury in low back for 44%, and shoulder/upper limb in 40%. The FM diagnosis was based on report by a rheumatologist in 74%, and family physician in 13%, with 73 (59%) appeals accepted by the Tribunal.
Conclusion: Over half of appeals for aggravation or causation of FM following a work related soft tissue injury were upheld by the Tribunal. Claimants were demographically similar to other FM cohorts, although healthcare utilization was very high. Low back and upper limb injuries predominated as causation, with over two thirds reporting FM following a single incident. The attribution of causation of FM to a single workplace traumatic event is contentious and requires further examination.
M. A. Fitzcharles,
Pfizer Inc, Lilly, Purdue, Valeant,
P. A. Ste-Marie,
Astra-Zeneca, Janssen, Paladin, Pfize Inc, Purdue,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/work-related-injuries-causing-or-aggravating-fibromyalgia-in-the-medicolegal-arena-a-jurisprudential-analysis/