Expert Witness Journal Issue 66 April 2026 - Flipbook - Page 53
Fibromyalgia in the courtroom
– a fresh approach?
by Charles Heppenstall, Partner at Weightmans.
when this label is used, and the perception it creates
for both the patient and the clinician, that is of
concern for defendants.
The complexities of 昀椀bromyalgia, a condition marked
by widespread pain and subjective symptoms.
The Royal College of Physicians de昀椀nes 昀椀bromyalgia
(hereafter “FM”) as “a condition characterised by
persistent and widespread pain that is associated
with fatigue, sleep disturbance, impaired cognitive
and physical function and psychological distress.”
However, the truth is there is no widely accepted
de昀椀nition of FM. Usually in cases where the diagnosis
is given claimants complain of debilitating symptoms
limiting most aspects of life, and in extreme cases
can leaving claimants virtually bedridden. It follows,
therefore, that where personal injury compensation
is an option, claims for long term pain–related loss
of earnings, care and treatment are common. The
di昀케culty faced by defendants when dealing with
such claims is that symptoms are almost entirely
subjective on account of the stark absence of clear
objective biomarkers or de昀椀nitive diagnostic testing.
This in turn creates a fertile environment for
causation disputes and credibility challenges.
At a recent seminar at Weightmans’s London o昀케ce
expert psychiatrist Dr Christopher Bass, whose 2024
Journal of Personal Injury Law paper “Fibromyalgia
in the Courtroom” presented the 昀椀ndings of a ten
year clinical study into the condition, argued that
the diagnosis can indeed be damaging, potentially
turning an individual with treatable physical and/
or psychological distress into to a long-term patient.
It is this iatrogenic e昀昀ect of misdiagnosis, caused
unintentionally by medical treatment, that misserves both the claimant and (as paying party) the
defendant.
Therefore, Dr Bass advocates against FM as a
diagnosis in a medico-legal context on the grounds
of:
I.
the absence of a causal link between physical
injury and the development of FM;
II. the prevalence of pre-existing pain and
functional issues in the vast majority of FM
claimants; and
III. the potential in medico-legal cases of claimants
“buying into” the diagnosis.
As a “diagnosis of exclusion”, FM is widely
contentious within the medical profession, with
some clinicians arguing that it is not an actual
“disease” but an “illness construct”, a label used
to explain reported chronic pain without organic
cause. The subjective nature of the condition can
lead claimants to “catastrophise” what objectively
would be seen as manageable “general aches, pains
and misery” , and so the psychological dimension is
very much front and centre.
Broadly, this re昀氀ects the present approach by the
judiciary: accepting FM as a label for reported
di昀昀use and disabling pain without organic cause,
whilst being reluctant to fully accept FM as a formal
diagnosis in the absence of a de昀椀ning test.
Dr Fred Wolfe, rheumatologist and leading authority
on clinical FM, makes a case that the condition would
be better understood as “polysymptomatic distress”,
in the presence of di昀昀use somatic symptoms and
an often disproportionate emotional response,
but however general the label it does describe a
recognised condition. In genuine cases it is how and
EXPERT WITNESS JOURNAL
Dr Bass is in favour of “demedicalising” FM claimants
by avoiding formal diagnostic titles and using instead
more general terms such as “disproportionate
pain and disability.” This would prevent claimants
adopting invalid roles and becoming victims of
their own emotional states, empowering them to
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APRIL 2026
