Saturday, February 16, 2013

Fred Wolfe, trigger points, fibro

Today I was very pleased to read a blogpost from a blog that is new to me - The Fibromyalgia Perplex, by Fred Wolfe:

Travell, Simons and Cargo Cult Science, Feb 14 2013:

An excerpt:

"David Simons, who with Janet Travell were the authors of Myofascial Pain and Dysfunction: The Trigger Point Manual (TPM),2was a remarkable physician. At his death in 2010, he was memorialized in a long New York Times obituary that included this: ` David G. Simons, whose ascent more than 19 miles above the Earth in an aluminum capsule suspended from a helium balloon set an altitude record in 1957 and helped put the United States on the road to manned space flight died April 5 at his home in Covington, GA’ [a record that still stands (FW)]. Janet Travell was equally famous. President Kennedy’s physician, the first woman physician at the New York Hospital, she was also the author of an illuminating autobiography. If trigger points needed a mother, she was it. In fact, the Travell and Simons drawing of trigger points and their radiations began as a poster presentation at an American Medical Association meeting that was later published as an ‘exhibit.’3 
But if there ever was need for examples of PP-EBM, these authors provided it. In a book that was filled with extraordinary anatomic drawings, Travell and Simons provided figures of locations of trigger points, radiation of pain, injection and `spray and stretch’ techniques.  In one 61-page chapter, the authors provided detailed information about perpetuating factors for myofascial pain (MFP) and trigger points, including 317 references. The book was an enormous success—a bible of trigger points. It found it way into academic libraries and practitioner’s offices through several editions. In a perfect example of science by citation and PP-EBM, it was repeatedly cited as an authoritative reference. Many, like me, trying to understand trigger points, read deeply in the book. But the more I read the more I doubted. The book represented opinion, not science. None of the trigger points or their treatments were validated; none were tested for reliability. There were almost no studies in the Travell-Simons book, just testaments. Most of the perpetuating factors were plain wrong, and represented outdated, overthrown junk science."

1. Dr. Frederick Wolfe, his picture, profile
2. He is named as author or co-author in 400 papers.
3. He came up with the idea of treating fibromyalgia as a disease, then later regretted doing so.
From Drug Approved. Is Disease Real? in the NYT, 2008: 

"Dr. Frederick Wolfe, the director of the National Databank for Rheumatic Diseases and the lead author of the 1990 paper that first defined the diagnostic guidelines for fibromyalgia, says he has become cynical and discouraged about the diagnosis. He now considers the condition a physical response to stress, depression, and economic and social anxiety.
“Some of us in those days thought that we had actually identified a disease, which this clearly is not,” Dr. Wolfe said. “To make people ill, to give them an illness, was the wrong thing.”"
And to make such a big deal out of imaginary nouns called "trigger points" was clearly the wrong thing in the first place. People have been gouging away at them ever since, with needles, with elbows, with thumbs.

Previous posts by me about so-called "trigger points"
1.Yet another "trigger point" discussion Jan 27/2012
2.Trigger point model deconstruction, models in general Jan 8/2012
3. Why I don't buy the idea that "trigger points" are in muscle  July 4/2011
4. Letter to a biomechanically-minded therapist July 9/2011

I want to stand up and clap my hands off. I really do. Thank you for this, Dr. Wolfe.


Anonymous said...

wish I had known I didn't have anything wrong with me...geez, I wonder how I tell my body to stop hurting now.....

Diane Jacobs said...

You may well have pain - but the triggerpoint notion was just not a very good way for pain science to have tried to conceive it.
All the best.