Dr John Quintner has asked that I post his article on this site. I welcome the opportunity to facilitate constructive discussion and debate on this issue!
See also references to Dr Quintner’s work on thetipssite
Here is the article:
FIBROMYALGIA AND NEW ZEALAND’S ACCIDENT COMPENSATION SCHEME
Since 1974 the New Zealand Accident Compensation scheme has provided the only form of workers’ compensation available. It replaced the separate workers’ compensation legislation and the common law right to sue for personal injury.
Despite its name, the Accident Compensation Act provides cover for personal injury resulting from work-related accidents and work-related gradual process conditions.
In 2003, the Accident Compensation Corporation (ACC) obtained a High Court decision (Teen v ARCIC, unreported, High Court, Wellington CIV 2003-485-1478, Wild J) that a pain syndrome developed by an office worker whose tasks included intensive data entry did not constitute personal injury and was therefore excluded from ACC cover.
Varying medical opinions were offered for the appellant’s symptoms: that the claimant had developed fibromyalgia syndrome, implying pain without tissue injury as a result of prolonged repetitive mouse and keyboard use “with the adoption of constrained statically loaded postures inducing tension and lactic acid overload in the muscles”; “regional pain syndrome” of the upper body related to psychosocial risk factors including “fear avoidance behaviour” and “catastrophising” beliefs about pain; and a chronic pain syndrome that could probably be subclassified as fibromyalgia [“FMS”].
The Teen case involved a telecommunications worker. Her symptoms were extensively canvassed in an earlier District Court decision (Teen v ACC and Telecom NZ Ltd  NZACC 244 3 September 2002) which defined fibromyalgia as “abnormal pain and tenderness of normal tissue involving abnormal pain perception in the central nervous system, a condition in which treatment directed at (non-existent) tissue damage in the arms, such as physiotherapy, rest and anti-inflammatory medication, failed to effect a cure; recovery did not occur in the expected time-frame as there was no damaged tissue to recover”.
The case-law following the Teen decision has therefore followed the view that a pain syndrome which developed in the context of repetitive work under stress in an office situation may occur without a discrete physical injury, and is not covered by the ACC. The term “fibromyalgia” is no longer used to describe the constellation of symptoms developed by office workers using computers. The current term is “regional pain syndrome”.
The Courts of Law in Teen and similar cases involving telecommunications workers were not advised of the extensive debate that had occurred in Australia in the 1980s over the so-called “RSI epidemic”. Nor were they advised that the view put forward by the ACC was based on conjectures promulgated by Dr Geoffrey Littlejohn, an Australian rheumatologist. Interestingly, Dr Littlejohn had given a keynote presentation at a consensus meeting of ACC officials and medical professionals held in February 1998 .
Perhaps even more significantly, the New Zealand courts were not advised that NIOSH investigators in the United States had published their findings on telecommunications workers in terms of discrete musculoskeletal conditions . There was a striking similarity between the types of symptoms described in the 2002 District Court decision in Teen and the physical findings described by Hales et al , namely “rotator cuff tendinitis, bicipital tendinitis, epicondylitis, proximal tendinitis, distal tendinitis, deQuervain’s disease, trigger finger, cervical root syndrome, thoracic outlet syndrome, radial tunnel syndrome, carpal tunnel syndrome, Guyon tunnel syndrome, ganglion cysts, probable joint-related, muscle-related (tension neck syndrome and neck trigger points).”
In a Viewpoint article , Professor Des Gorman, a New Zealand occupational physician, stated that there were “no objective data to show that mechanical work process alone can cause any of the chronic pain syndromes. Current epidemiological data show that while keyboard workers have an increased prevalence of neck, shoulder and elbow pain, there is no dose relationship between this pain and their work process and they do not have an increased prevalence of any discrete musculoskeletal disorder. The end result is a group of patients who will be “in limbo” – neither acceptable to the ACC as a domestic, recreational, or motor vehicle accident, nor able to prove to the insurance company concerned that a mechanical work process has caused their problem.”
Again Gorman made no reference to the report by Hales et al, or to NIOSH’s collection of epidemiological literature relating to video display terminals (NIOSH 99-135 at www.cdc.gov), or even to NIOSH’s publications on ergonomics (NIOSH 97-117 at www.cdc.gov). Nor did he make any mention of other epidemiological reviews concluding that there was indeed a relationship between musculoskeletal disorders and computer use.
In my opinion, the views expressed by Drs Littlejohn and Gorman reflected their limited understanding of the “RSI” phenomenon in Australia [4,5]. There were indeed competing hypotheses, a fact that may not have been made known to the ACC, nor to the New Zealand Courts of Law.
The end result of this tragic omission has been that New Zealand workers who are diagnosed with “fibromyalgia” or “regional pain syndrome” or similar nebulous types of pain syndrome have no legal entitlement to any other compensation if their claims are declined by ACC.
If they are unable to work, they may or may not be able to qualify for subsistence-type social welfare benefits, but they do not have access to ACC-provided medical investigations, treatments, rehabilitation, retraining, or earnings-related compensation. Finally, if the symptoms do happen to be work-related, there is no means of identifying, minimising or preventing hazardous workplace factors to protect future workers from the relative risk of developing these conditions.
- Rankin DB. Viewpoint: The Fibromyalgia Syndrome: A Consensus Report, Accident, Rehabilitation and Compensation Corporation, Wellington. NZ Med J 1999; 112: 18-19.
- Hales et al, Musculoskeletal disorders among visual display terminal users in a telecommunications company, Ergonomics 1994, Vol. 37 No. 10, 1603-1621.
- Gorman D. Viewpoint: The Accident Insurance Act – a desirable reform or market madness? NZ Med J 2000; 113: 62-63.
- Quintner JL, Elvey RL. The neurogenic hypothesis of RSI. In: Bammer G, ed. Working Paper No. 24. Canberra: Australian National University, 1991.
- Cohen ML, Arroyo JF, Champion CD, Browne CD. In search of the pathogenesis of refractory cervicobrachial pain syndrome. Med J Aust 1992; 156: 432-436.