Lawrence J. Leventhal, MD
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Leventhal L.; Management of Fibromyalgia. Ann Intern Med. 2000;132:1005. doi: 10.7326/0003-4819-132-12-200006200-00022
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Published: Ann Intern Med. 2000;132(12):1005.
Dr. Wolfe is surprised that I did not mention his study (1), but my review focused on controlled trials. Although Wolfe and colleagues' study yielded important information, the authors stated that they did not test specific treatments in fibromyalgia and that the patients' conditions may have worsened over time had the patients not sought conventional treatment. Additionally, concern should be raised on how information on treatment failures at tertiary care centers gathered by fibromyalgia experts translates to patient responses in community settings.
Dr. Wolfe indicates that I do not define “what works” and that it is “fundamentally wrong to extrapolate short-term data to long-term outcomes.” This is a problem common to therapeutic trials for most chronic conditions. I agree that uniform criteria for improvement must be established for fibromyalgia clinical trials. Up to this point, however, this has not occurred. As a review of the available literature, my paper relied on definitions of improvement as given by the researchers and as approved by the journals publishing these studies. I endorse the idea that an organization such as the American College of Rheumatology establish and validate uniform criteria for improvement in fibromyalgia. I acknowledged in my review that in fibromyalgia, “pharmacologic therapies show only limited success … .”
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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