Fibromyalgia is a painful, complex medical condition. It is characterized by stiffness and tender points that occur in the muscle areas of the hips, shoulders, neck and spine. It is complex because in addition to causing general and specific pain, its symptoms include fatigue, difficulties with sleep, anxiety and stomach related (gastrointestinal) problems.
A few basic facts:
A Fibromyalgia diagnosis is made upon having 11 out of 18 identifiable tender points.
Many patients with fibromyalgia have short-term memory retention problems.
Most patients of fibromyalgia are between the ages of 20 and 60.
Fibromyalgia is occasionally mistaken for lupus.
Fibromyalgia is diagnosed more often in women than in men.
Fibromyalgia is often classified among rheumatoid disorders. However, it does not seem to involve joint destruction or deformation of joints like rheumatoid arthritis.
Many patients have symptoms of fatigue which may be caused by inadequate amounts of deep-level sleep.
There are many studies published about fibromyalgia and soft tissue injuries and the pain associated with fibromyalgia. A recent study done by Dr. Buskila and published in "The Arthritis and Rheumatism", March 1997, studied people who had trauma to determine how fibromyalgia develops in people who have had trauma. Dr. Buskila followed 161 people with traumatic injury. 102 of them had neck injuries (i.e. the typical whiplash injury) and 59 people had leg fractures. The follow-up evaluations determined that people who had the neck injuries developed fibromyalgia 22% of the time whereas people with the leg injuries developed fibromyalgia only 2% of the time. This means that post-traumatic fibromyalgia is thirteen times more likely to occur following neck injury than following a leg injury.
Most people with trauma induced fibromyalgia will have a "typical history". The person reports severe pain as the chief complaint with the pain commonly in the neck, shoulders and back areas. Usually, the person had no previous problems and was in perfect health until the trauma occurred. Shortly after the accident, the person develops pain that persists beyond what would be typical for similar types of trauma. There may have been visits to the emergency room, x-rays and evaluations, medications and other medical treatments. Some of these treatments may have helped, but the pain never disappears and continues to be severe.
When this person is examined by a physician, certain abnormalities such as tender points can be detected. Tender points are areas in the soft tissues, especially the muscles, which are very sensitive and painful when pressed. These tender points are in distinct locations of the body. The presence of tender points is the main criteria used to diagnose fibromyalgia. If they are widespread in numerous distinct locations, then fibromyalgia is considered to be generalized. If they are more localized, i.e. involving upper body only or low back only, they could indicate a more regional or localized fibromyalgia. Typically, the muscles in individuals with post-traumatic fibromyalgia will have an abnormal consistency where the muscle is tight or nodular and has localized spasms that can be felt.
There is no single diagnostic test for post-traumatic fibromyalgia. Routine labs results and other tests are normal in fibromyalgia patients. There are specialized tests for fibromyalgia which are abnormal but these tests are not considered routine and are often done only in specialized labs or research centers. However, specialized lab tests or x-rays are NOT needed to diagnose fibromyalgia. The key diagnostic finding is the characteristic tender points on the physical examination.
There is no single treatment that eliminates or cures post-traumatic fibromyalgia. Pain management is the most common treatment. Each person's treatment program needs to be individualized. What works for some people may not work for others.
Health care professionals of all specialties are involved in treating fibromyalgia patients. Rheumatologists, Pain Management specialists and primary care physicians are all part of a team of doctors to help people who suffer from fibromyalgia.
The cause of fibromyalgia includes trauma, genetics, infections and connective tissue diseases. Post-traumatic fibromyalgia is very common due to seemingly minor accidents. Doctors who treat large numbers of fibromyalgia patients report that the majority of patients say that their fibromyalgia was caused by an injury.
Of those, 65% reported the onset of their symptoms of fibromyalgia after a traumatic event. Of this group, 52% of them were involved in a motor vehicle accident, 31% had work injuries and the remaining 17% had another type of trauma. Of the post-traumatic patients involved in motor vehicle accidents, whiplash injury was the most common type of trauma leading to fibromyalgia.
Post-traumatic fibromyalgia symptoms usually do not occur immediately after an injury. In addition, it usually takes several weeks or months before symptoms appear and as traumatic muscle injuries can take up to four months to heal, fibromyalgia cannot be diagnosed until several months after injury.
Several obstacles to fibromyalgia treatment are common. Other accident victims who have sustained more obviously debilitating problems, such as the loss of a limb, blindness or multiple-organ system trauma, are easily diagnosed and treatment begins immediately. One obstacle for fibromyalgia victims is the delay in diagnosis. The longer chronic pain exists the more difficult the treatment. The hope of full recovery diminishes with time. With better recognition of fibromyalgia in the early stages, diagnosis can be made quickly and appropriate treatment started immediately.
Another roadblock confronting fibromyalgia patients is the perception that they are making it up or are exaggerating their symptoms. There is no doubt that such exaggeration exists, but it is rare. The insurance companies suggest that they are faking it so they can avoid paying the medical bills associated with this painful syndrome.
Patients with fibromyalgia are in pain and want relief from this pain.
The physical examination by a doctor is with an instrument called a Dolorimeter. A Dolorimeter is a machine that measures the amount of pressure they can put on the patients muscle until the patient feels pain. After testing hundreds of fibromyalgia patients, the doctors report that patients demonstrated a very distinct and definable soft-tissue rheumatism disorder and that there was no evidence of faking it by the patient. Patients with fibromyalgia are typically very helpful to their examiners because they can accurately and consistently identify the specific tender points that fulfill the diagnostic criteria for fibromyalgia as required by the American College of Rheumatology.
A consensus conference regarding the diagnosis of fibromyalgia took place in Copenhagen on August 20, 1992, by the Second World Congress on Myofascial Pain and Fibromyalgia. They defined Fibromyalgia as:
First: Patients must have a history of widespread pain.
Pain is considered widespread when all of the following are present: pain in both sides of the body and pain above and below the waist. In addition, axial skeletal pain must be present.
Second: Patients must have pain in 11 of 18 tender point sites on digital palpation. (See the chart) and the tender points are:
Occiput: at the suboccipital muscle insertions.
Low cervical: at the anterior aspects of the intertransverse spaces at C5-C7.
Trapezius: at the mid-point of the upper border.
Supraspinatus: at origins, above the scapular spine near the medial border.
Upper Rib: upper lateral aspects of the second costochondral junction.
Lateral Epicondyle: two centimeters distal to the Epicondyle.
Gluteal: in upper outer quadrants of buttocks in anterior fold of muscle.
Greater Trochanter: posterior to the trochanter at the prominence.
Knees: at the medial fat pad proximal to the joint line.
Digital palpation should be performed with the approximate force of 8 pounds of pressure. A tender point has to be painful at palpation, not just "tender."
Post-traumatic fibromyalgia. A long-term follow-up.
Published in: Am J Phys Med Rehabil. 1994 Nov-Dec;73(6):403-12.
By: Waylonis GW, Perkins RH.
Department of PM&R, Riverside Methodist Hospitals, College of Medicine, Ohio State University, Columbus 43214.
Abstract:
This report describes a follow-up study of 176 individuals seen between 1980 and 1990, in whom a diagnosis of post-traumatic fibromyalgia was made. Sixty-seven people completed a lengthy questionnaire and underwent a confirmatory physical examination using the American College of Rheumatology Criteria to confirm or deny the presence of fibromyalgia at the time of follow-up. A total of 60.7% noted the onset of symptoms after a motor vehicle accident, 12.5% after a work injury, 7.1% after surgery, 5.4% after a sports-related injury and 14.3% after other various traumatic events. 56 of 67 individuals had 11 or more tender points (average, 13.5), 3 had 10 tender points, and 7 had fewer than 10 or no tender points. Study subjects were asked to compare the use of the following for the first 2 years after onset as well as the year preceding the current evaluation: biofeedback, medications, physical therapy, manipulation, massage therapy and tender point injections. In addition, we asked detailed questions regarding symptoms commonly seen in association with fibromyalgia (fatigue, sleep disturbance, etc.). Symptoms of traumatically induced fibromyalgia are quite similar to spontaneous fibromyalgia. There was a dramatic reduction in the use of all forms of physical treatments. Fifty-four percent continued to use over-the-counter pain medications, and 39% were on antidepressants. Eighty-five percent of the patients continued to have significant symptoms and clinical evidence of fibromyalgia.
This full article can be obtained through PubMed.gov at:
http://www.ncbi.nlm.nih.gov/pubmed/7993614
A Case-Control Study Examining the Role of Physical Trauma in the Onset of Fibromyalgia Syndrome (concluding that the results of the study suggested "that physical trauma was significantly associated with the onset" of fibromyalgia)
Published in: 41 Rheumatology 450, 452 (2002)
By: A.W. Al-Allaf et al.
Abstract:
Objective. To investigate whether physical trauma may precipitate the onset of fibromyalgia syndrome (FMS).
Design. A case–control study was carried out to compare fibromyalgia out-patients with controls attending non-rheumatology out-patient clinics.
Method. One hundred and thirty-six FMS patients and 152 age- and sex-matched controls completed a postal questionnaire about any physical trauma in the 6 months before the onset of their symptoms.
Results. Fifty-three (39%) FMS patients reported significant physical trauma in the 6 months before the onset of their disease, compared with only 36 (24%) of controls (P<0.007). There was no significant difference between FMS patients who had a history of physical trauma and those who did not have physical trauma with regard to age, sex, disease duration, employment status and whether their job at onset was manual.
Conclusion. Physical trauma in the preceding 6 months is significantly associated with the onset of FMS.
This article can be found at:
http://www.rheumatology.oxfordjournals.org/content/41/4/450.abstract
Increased Rates of Fibromyalgia Following Cervical Spine Injury (concluding that "trauma to the neck is associated with a higher incidence of FMS")
Published in: Arthritis & Rheumatism 446, 451 (1997)
By: Dan Buskila et al.
Abstract:
Objective. To study the relationship between cervical spine injury and the development of fibromyalgia syndrome (FMS).
Methods. One hundred two patients with neck injury and 59 patients with leg fractures (control group) were assessed for nonarticular tenderness and the presence of FMS. A count of 18 tender points was conducted by thumb palpation, and tenderness thresholds were assessed by dolorimetry at 9 tender sites. All patients were interviewed about the presence and severity of neck and FMS-related symptoms. FMS was diagnosed using the American College of Rheumatology 1990 criteria. Additional questions assessed measures of physical functioning and quality of life (QOL).
Results. Although no patient had a chronic pain syndrome prior to the trauma, FMS was diagnosed following injury in 21.6% of those with neck injury versus 1.7% of the control patients with lower extremity fractures (P = 0.001). Almost all symptoms were more common and severe in the group with neck injury. FMS was noted at a mean of 3.2 months (SD 1.1) after the trauma. Neck injury patients with FMS (n = 22) had more tenderness, had more severe and prevalent FMS-related symptoms, and reported lower QOL and more impaired physical functioning than did those without FMS (n = 80). In spite of the injury or the presence of FMS, all patients were employed at the time of examination. Twenty percent of patients with neck injury and 24% of patients with leg fractures filed an insurance claim. Claims were not associated with the presence of FMS, increased FMS symptoms, pain, or impaired functioning.
Conclusion. FMS was 13 times more frequent following neck injury than following lower extremity injury. All patients continued to be employed, and insurance claims were not increased in patients with FMS.
This article can be found at:
http://www.onlinelibrary.wiley.com/doi/10.1002/art.1780400310/abstract
Fibromyalgia Syndrome: Canadian Clinical Working Case Definition, Diagnostic and Treatment Protocols-A Consensus Document ( "There is strong consistency in documentation that physical trauma such as a fall or motor vehicle accident, particularly a whiplash or spinal injury, can trigger FMS in some patients.")
Published in: 11 J. Musculoskeletal Pain 3, 44 (2003)
By: Anil Kumar Jain et al.
This article can be found at:
http://sacfs.asn.au/download/consensus_overview_fms.pdf
Fibromyalgia After Motor Vehicle Collision: Evidence and Implications ("There is no disagreement regarding a close temporal association between [a motor vehicle collision] and the development of [fibromyalgia].")
Published in: 6 Traffic Injury Prevention 97, 99 (2005)
By: Samuel A. McLean et al.
This article can be found at:
http://www.psychosomaticmedicine.org/cgi/content/full/67/5/783
Fibromyalgia Pain: Do We Know the Source (recognizing physical trauma as one of the
"triggers" associated with fibromyalgia)
Published in: 16 Current Opinion in Rheumatology, 157, 158 (March 2004)
By: Roland Staud
This article can be found at:
http://www.medscape.com/viewarticle/470556_13
Fibromyalgia Consensus Report: Additional Comments ("[I]t seems more than 51% likely that trauma does play a causative role in some FMS patients....")
Published in: 3 J. Clinical Rheumatology 324, 325 (1997)
By: Muhammad B. Yunus et al.
This article can be found at:
http://www.prohealth.com/library/showarticle.cfm?libid=6585
Pain in Fibromyalgia ("The argument in favor of a connection between trauma and fibromyalgia is based on the experience of certain clinicians that trauma and fibromyalgia are associated....").
Published in: 25 Pain Management in the Rheumatic Diseases 55, 63 (1999)
By: John B. Winfield
This article can be found at:
http://www.sciencedaily.com/releases/2010/05/100524143427.htm
