Trauma, chronic pain and FMS

Twenty-nine of 127 patents (23%) with FMS reported having trauma, surgery or a medical illness before the onset of FMS, and were classified as having reactive fibromyalgia .

Waylonis and Perkins provided a follow-up study of patients with post-traumatic fibromyalgia. A total of 60.7% noted the onset of symptoms after a motor vehicle accident (MVA) and 12.5% after a work injury.

Buskila et al. assessed 102 patients with neck injury and 59 patients with leg fractures (control group) for non-articular tenderness and presence of FMS. FMS was 13 times more frequent following neck injury than following lower-extremity injury. FMS was noted at mean of 3.2 months (SD 1.1) after the trauma .

Approximately 70% of 238 patients diagnosed with diffuse/specific myofascial pain syndrome attributed the beginning of their chronic pain to some form of trauma .

Al-Alaf et al. provided a case-control study examining the role of physical trauma in the onset of FMS.

Approximately one-third (39%) of FMS patients reported significant physical trauma in the 6 months before the onset of their disease, compared with only 24% of controls. It was concluded that physical trauma in the preceding 6 months is significantly associated with the onset of FMS .

A wide variety of operations have been shown to be associated with chronic pain syndromes .

A 2-year prospective study among cohorts of newly employed workers demonstrated that the prevalence of new-onset widespread pain was high but among this young, newly employed workforce, both physical and psychosocial factors played an important role .

McLean et al. assessed currently available evidence regarding the ability of a motor vehicle collision (MVC) to trigger the development of FMS. They used consensus standards developed by the American College of Rheumatology Environmental Disease Study Group to assess the ability of an MVC to trigger FMS.

They concluded that the evidence that MVC trauma may trigger FMS meets established criteria for determining causality, and has a number of important implications, both for patient care, and for research into the pathophysiology and treatment of these disorders .

McLean et al. proposed a model in which the acute physical and emotional effects of MVC involve an interaction between the direct effects of tissue injury and the emotional responses to the experimental threat.

Tishler et al. reported that whiplash injury and road-accident trauma were not associated with an increased rate of FMS after more than 14.5 months of follow-up. However, in this study, the prevalence of diffuse pain in the subjects, who were diagnosed as experiencing whiplash injury, was 0.6%; this is 20 times less than the prevalence of chronic widespread pain (CWP) in the general population, approximately 10% in different studies including those from Israel, even without trauma . No data were presented on ‘whiplash-associated symptoms’, such as neck pain, pain radiating to the chest or arm as well as the severity of these symptoms.

Wynne-Jones et al. reported that the rate of onset of widespread pain after a motor vehicle crash is low and, at most, there is a modest increase in risk, particularly after adjusting for levels of psychological distress. The authors stress, however, that the number of new-onset pain episodes was small, a fact that limits the power of the study. Furthermore, just over 50% of the participants returned a questionnaire, raising questions about the external validity of the study, and, finally, the authors argue that the precise role of psychological distress was difficult to determine in this study .

Several months later, these authors reported that among persons free of widespread pain, who were involved in an MVC, approximately 8% developed widespread pain in the subsequent 12 months . The strongest predictors of new-onset widespread pain were factors relating to pre-collision health, the number of physical symptoms in the month following the collision and self-rating of initial injury . Interestingly, when these authors referred to their previous study , they state that it was demonstrated that the risk of new-onset widespread pain at 6 months was twice as high in persons exposed to MVCs compared with non-exposed individuals and also that even after adjusting for psychological distress and somatic symptoms’ reporting, individuals involved in MVCs experienced a 40% increase in the risk of widespread pain .

Sterling , commenting on this study , concludes that “motor vehicle collisions cost the community dearly both in personal and economic losses associated with the development of persistent musculoskeletal pain.”

Bennett et al. conducted an Internet survey of 2596 people with FMS. Over 73% of those who responded indicated some triggering events for the onset of their symptoms, and made attributions to emotional trauma or chronic stress. The next most-common attribution was acute illness followed by physical stressors (surgery, MVCs and other injuries). Thus, 17.1% attributed their symptoms to physical injury (non-MVA), 16.1% to surgery and 16.1% to MVA .

Recently, we evaluated the prevalence of FMS in survivors of a major train crash in Israel, 3 years after the event .

FMS was found to be highly prevalent (15%), 3 years after the train crash, among these individuals exposed to the combination of physical injury and extreme stress. We concluded that our findings are in accordance with previous data regarding the association of FMS with both physical and emotional trauma .