The pervasiveness of the illness suffered by workers seeking compensation for disabling arm pain

Disability from work-related arm pain has become prevalent in several countries in recent years. Many of these individuals present with chronic musculoskeletal symptoms that, for lack of a more specific diagnosis, are often labeled as a repetitive strain injury or cumulative trauma disorder. Indemnity for such conditions can be contentious; many of these sufferers are involved in litigation in their quest for financial compensation for temporary or permanent disability. This article describes our experience with 103 patients referred to a Health Reference Center for Workers for the management of repetitive strain injury. Their illness is far more global than the work-related arm pain that such labeling implies. From the total group, 73 fulfilled the American College of Rheumatology Criteria for the Classification of Fibromyalgia Syndrome. This means that they were suffering pain above and below the diaphragm, far from the arm pain for which they were referred. These 73 patients were clinically and psychologically indistinguishable from 165 patients followed in our clinic at the Federal University of São Paulo, Rheumatology Division, who also fulfilled these criteria but did not consider their illness work-related. This observation calls for longitudinal investigations that might offer insights as to whether the more global aspects of the illness are antecedent, coincident, or confounding aspects of the illness experience labeled repetitive strain injury or cumulative trauma disorder.