Author: Richard H. Adler

A recently published retrospective research paper addressed the link between physical trauma and fibromyalgia syndrome. The study, "A case-control study examining the role of physical trauma in onset of fibromyalgia syndrome," was published in Rheumatology 2002; 41:450-453.

The aim of the study was to "investigate whether physical trauma precipitates the onset of fibromyalgia syndrome." 136 fibromyalgia syndrome patients and 152 controls were recruited as part as this hospital-based retrospective, case-control study relating perceived trauma to the onset of fibromyalgia syndrome. 53 out of the 136 fibromyalgia patients (39%) gave a positive history of trauma in the 6 months prior to the onset of their disease, compared with just 36 out of the 152 control subjects (24%). Statistically, this difference was highly significant.

The authors have noted that their findings were consistent with other studies corrobating the incidence of reported trauma prior to fibromyalgia onset:

“Our finding that 39% of FMS patients reported trauma before the onset of FMS was consistent with some studies in which the incidence of reported trauma prior to FMS onset was reported as between 25 and 50%,1 However, our figure of 39% was higher than that reported by other studies.2 Aaron et al. found that 21.1% our their FMS patients, who had been referred to their out-patient clinic, had a history of physical trauma compared with 15.2% of community FMS patients, who had not been referred to the out-patient clinic. However, their study did not include non-FMS controls.

Buskila et al.3 found that 21.6% of adults with neck injuries develop FMS within one year of their injury. ..."

The authors were very clear in their conclusion that physical trauma is significantly associated with the onset of fibromyalgia syndrome and encouraged others to research the connection further. They state:

"In conclusion, our study suggest that physical trauma in the six months before the onset of symptoms is significantly associated with the onset FMS in patients attending a rheumatology out-patient clinic. Further prospective studies are needed to confirm this association and to determine whether trauma has a causal role or if there are more important factors-in the development of FMS."

Conclusion
Fibromyalgia is now recognized as a common chronic pain syndrome, although its diagnosis has proven to be equally as frustrating as its treatment. Achieving a better understanding of the fibromyalgia diagnosis by the physician and counsel may help patients avoid extensive and time-consuming workups only to learn that they have been misdiagnosed and have a chronic permanent condition.

If one of your patients suffers in physical trauma and presents with chronic pain symptoms, rather than second-guessing yourself or the patient, it is recommended that you refer your patient to a specialist who is familiar with fibromyalgia. Moreover, if the cause of the fibromyalgia stems from physical trauma caused by someone else (such as in a motor vehicle accident), then it is recommended that your client seek the advice of an attorney who specializes in personal injury law and is familiar with fibromyalgia.

1 Greenfield S, Fitzcharles MA, Esdaile JN. Reactive fibromyalgia syndrome. Arthritis Rheum 1992;35:678-81; and White KP, Speechly M, Harth M, Ostbye T. The London Fibromyalgia Epidemiology Study (LFES): Comparing the demographic and clinical characteristics in 100 random community cases of fibromyalgia syndrome (FMS) versus control. J Rheumatol 1999;26:1577-85

2 Aaron LA, Bradley, Alarcon GS et al. Perceived physical and emotional trauma as precipitating events in fibromyalgia. AM J Arthritis Rheumatol 1997; 40:453-60

3 Buskila D. Neumann L, Vaisberg G. Alkalay D, Wolfe F. Increased rates of fibromyalgia following cervical spine injury. Am J Arthritis Rheumatol 1997;40:446-52