To the editors:
I wish to compliment you on a fine article regarding RSD by Robert McClory which appeared in your April 30 issue [“An Incredible Pain”]. Mr. McClory did a fine job of taking a complex medical issue and making it accessible to the layperson. I must however express alarm at the extensive copy you devoted to the opinions of Dr. Pawl as if he had some unique qualification to expound on the issue of RSD. For some 100-plus years it has been accepted by everyone in medicine that RSD is a true physical ailment. Animal research has produced this entity in animal subjects. Are we to believe that these animals have a “psychological disorder” and “secondary gain”? Rather I would suggest it is Dr. Pawl who has the secondary gain.
It is a matter of public record that Dr. Pawl derives a significant percentage of his income from performing evaluations on behalf of insurance companies defending worker-compensation and personal-injury lawsuits. What would be more convenient to the insurance industry (not currently noted for its altruism) than to have its own self-anointed “expert” who can declare this terrible condition to be just a figment of the imagination of these unfortunate people?
As a specialist in this field for 15 years, I can assure you that RSD is not a psychological disorder. I have treated patients and have been able to observe them before and after injuries which produce RSD. The personality changes cited as being indicative of a preexisting psychologic disorder are in fact the result of sleep deprivation induced by unremitting pain. It is more appropriate to compare these patients to individuals who have been subjected to torture than to impugn their integrity by attributing their misery to “secondary gain.” By printing Dr. Pawl’s misleading assertions, you give some currency to the lies the insurance industry would like us all to believe. Mr. McClory gamely tried to get Dr. Pawl to confront the absurdity of his statements. But I believe your readers need to know whence these particular opinions come.
Michael F. Gonzales, M.D.,