Fibromyalgia Syndrome and physical trauma

There is still no agreement among experts as to whether physical trauma can cause Fibromyalgia Syndrome (Fibro) say a group of Israeli researchers in a recent article. [1]

According to the researchers, from Soroka Medical Center, Ben Gurion University, Israel, 25-50% of Fibro patients report the occurrence of a physical trauma that preceded the onset of their symptoms by anything from several weeks to several months. The severity of the injury described varies, but is usually milder than that seen in patients with post-traumatic stress syndrome. The researchers note in the article that road accidents, and, in particular, whiplash injuries, or accumulated injury inherent in some occupations have been described as causes of Fibro. [1]

However, the only two prospective studies that assessed the incidence of Fibromyalgia Syndrome following accidents, such as whiplash injuries, were conducted by Israeli researchers and they reported opposite results. [1][2]

The researchers note that, although possible mechanisms for the development of the syndrome following trauma have not been elucidated sufficiently to date, stressful conditions are known to contribute to the development of Fibro. The researchers gone on to say that, although some investigators have reported a worse prognosis in post-traumatic cases, in most likelihood, there is no significant difference between idiopathic Fibro (Fibro from no known cause) and post traumatic Fibro in terms of clinical course, symptom severity and prognosis. [1]

According to the article, Israel has seen an increase in the number of suits filed against private insurance companies and the National Insurance system for post-traumatic Fibromyalgia Syndrome. [1]

The researchers say that it is probable that the number of cases that involve malingering or secondary gain is low, but conclude that:

"[the] ongoing controversy among medical experts as to whether there is an association between [Fibro] and physical trauma has made it very difficult, in the absence of guidelines and objective tools, for the legal and administrative systems to deal with this difficult issue." [1]

According to another article published this month by a different group of researchers also at Soroka Medical Center:

"Environmental and genetic factors play a role in the pathogenesis of [Fibro]. Various triggers including trauma and stress as well as infections, may precipitate the development of [Fibro]." [3]

FibroAction Professional Advisory Board member, Daniel Clauw MD, was one of the authors of an article published 3 years ago, which said that:

"Contemporary evidence supports a model of chronic symptom development [after motor vehicle collision] that incorporates the potential for interactions between past experience, acute stress responses to trauma, post-[motor-vehicle-collision] behavior, and cognitive/psychosocial consequences to alter activity within brain regions which process pain and to result in persistent pain, as well as psychological sequelae, after [motor vehicle collision]." [4]

Possibly factors such as genetic pre-disposition, past experience, acute stress responses to trauma, post-[motor-vehicle-collision] behavior, and cognitive/psychosocial consequences have such an effect that larger studies of patients post-whiplash injury are needed. In the meantime, the evidence for a direct link between whiplash injury and Fibro remains unclear.

References:

1. Sukenik S, Abu-Shakra M, Flusser D. [Physical trauma and fibromyalgia--is there a true association?] Harefuah. 2008 Aug-Sep;147(8-9):712-6, 749.
2. Tishler M, Levy O, Maslakov I, Bar-Chaim S, Amit-Vazina M. Neck injury and fibromyalgia-- are they really associated? J Rheumatol. 2006 Jun;33(6):1183-5. Epub 2006 May 1.
3. Buskila D, Atzeni F, Sarzi-Puttini P. Etiology of fibromyalgia: The possible role of infection and vaccination. Autoimmun Rev. 2008 Oct;8(1):41-3. Epub 2008 Aug 13.
4. McLean SA, Clauw DJ, Abelson JL, Liberzon I. The development of persistent pain and psychological morbidity after motor vehicle collision: integrating the potential role of stress response systems into a biopsychosocial model. Psychosom Med. 2005 Sep-Oct;67(5):783-90.