Physical Trauma and Fibromyalgia

No one doubts the complexity of the fibromyalgia syndrome (FMS). Though research has indicated there are possible triggers, it has proved difficult to identify the specific cause. If you asked researchers and medical professionals what they consider to be the cause of fibromyalgia, you would receive a variety of answers. They would no doubt cite certain factors like an impaired immune response, genetics, emotional trauma, the environment and a chemical imbalance.

If this leaves you confused as to what exactly causes fibromyalgia, you are not alone. For doctors, a lack of definitive knowledge as to the cause of fibromyalgia makes it difficult to determine the best types of intervention and treatment. Despite the ongoing controversy among experts in various fields as to what causes fibromyalgia, one strong factor that research has uncovered is physical trauma.

The words “physical trauma” can mean anything that causes physical stress. Trauma can be the result of physical abuse or injuries from a car accident. In fact, vehicle accidents and abuse against women are two categories of physical trauma that researchers have focused on as possible causes of fibromyalgia. Whiplash, in particular, has been studied because of possible nerve damage that is incurred in this type of injury for a variety of reasons.

Defining Physical Trauma

Physical trauma has become an interesting area of research in the study of fibromyalgia. The results have been mixed and sometimes even counter-indicatory. The theory that physical trauma may be the cause of fibromyalgia has resulted in the exploration of different events that can result in physical trauma.

For example, serious injuries can result from a fall, a horrific accident at home or work, or accidents occurring while traveling on some form of transit – public or private. It is necessary to rely on global studies on fibromyalgia since so little is still known about causes. In a study of train injuries resulting from a crash in Israel, data indicate fibromyalgia was found in high incidence among those who had undergone severe emotional and physical stress. Research indicates that the prevalence was significant enough to link the factors of physical trauma with fibromyalgia.<!–[if !supportFootnotes]–>[1]<!–[endif]–>This is supportive of earlier research and is further validated by later research on the close association between trauma and fibromyalgia. One study investigating the cause of fibromyalgia found that among women, the clear-cut predicator was having experienced a physically painful traumatic event.<!–[if !supportFootnotes]–>[2]<!–[endif]–> 

Whiplash consists of mainly soft tissue damage. It is well documented that trauma in a car accident can act as a trigger for chronic pain problems. Research studies on the relationship of whiplash and fibromyalgia indicates that the physical trauma may be a causal factor for fibromyalgia and thus the chronic pain problems.<!–[if !supportFootnotes]–>[3]<!–[endif]–> Yet, the opposite opinion has also been expressed. In an earlier study<!–[if !supportFootnotes]–>[4]<!–[endif]–> and its follow-up, findings indicated that there was no association between whiplash injuries, vehicular crashes and fibromyalgia. Furthermore, it states that research and methodology need to be better integrated to ensure that there is no over reporting of fibromyalgia.

In studying the possible relationship between fibromyalgia and forms of trauma not involving accidents, researchers focused on 2 specific types of traumatic events or experiences. The events were physical assault or abuse and sexual assault or abuse. In self-reports from those who had fibromyalgia, there seems to be a significant relationship between the syndrome and physical and sexual trauma. Although the researchers admitted there were certain limitations that may have affected the study, they believed strongly that there was a link between fibromyalgia and physical trauma that requires further study.<!–[if !supportFootnotes]–>[5]<!–[endif]–> Rape, a more violent physical trauma is also related to those who self-report fibromyalgia. <!–[if !supportFootnotes]–>[6]<!–[endif]–> Overall, long term functional somatic syndromes (FSS), including fibromyalgia, were found in several other studies to be associated with a physical traumatic event such as sexual assault.

The same co-relationship is found for adults who develop fibromyalgia as adults after a childhood event involving physical assault or abuse. The results indicated a significant association between physical assault and FMS.<!–[if !supportFootnotes]–>[7]<!–[endif]–>

Ongoing Debate

There is need for further research on the relationship between physical assault and the onset of fibromyalgia for a couple of reasons. The inability of studies to identity a definitive cause based on the relationship of physical trauma and fibromyalgia is one reason. The other major reason is that the evidence for the relationship is supportive in certain instances but not in others.  Some researchers claim there is a distinct lack of specific and objective guidelines to clarify the exact relationship between physical trauma and fibromyalgia. There are researchers who also question the ability to identify the cause of fibromyalgia after the time of the actual trauma extends beyond 3 months and whether confusion may exist between fibromyalgia and similar functional somatic syndromes.

In the end, the evidence is not yet clear enough to specifically state whether or not physical trauma like from a car accident is contributory or causal in triggering fibromyalgia. In the instance of other forms of trauma, notably spousal abuse, the evidence seems less disputable.

A Theory About the Relationship between FMS and Physical Trauma

There is essentially one major theory that connects fibromyalgia and physical trauma. It focuses on the central nervous system (CNS). If there is damage to areas like the spinal cord and the neck, the injury can affect how neurotransmitters send signals to the brain. The injury can also impact how the brain receives and sends the response back to the body. An accident impacting the basic functions of the brain in regards to pain sensitivity, sleep patterns and cognitive thoughts may contribute to fibromyalgia.

While not all researchers consider physical trauma to be a cause of fibromyalgia, many do believe it is a trigger. It may not be the primary cause, but it can trigger the individual’s symptoms.  It is a reminder to all physicians that, in instances where fibromyalgia is suspected, it is absolutely vital that they extend their examination beyond the obvious (or not so obvious) symptoms of pain.

Clearly it is important to consider the patient’s history in its entirety. This includes asking for information about past traumatic incidents. These should include not only a car or vehicular accident but also a possible past or present history of sexual and/or physical abuse. This may not indicate the success of a specific treatment at this point, but it can help the doctor to prepare a specific approach that extends beyond medication and includes psychological therapy.

References

<!–[if !supportFootnotes]–>[1]<!–[endif]–> Buskila, DAblin, JNBen-Zion, IMuntanu, DShalev, ASarzi-Puttini, P; and Cohen, H. (2009). “A Painful Train of Events: Increased Prevalence of Fibromyalgia in Survivors of a Major Train Crash.” Clinical and Experimental Rheumatology, 27(5, Sup56): S79-S85.

<!–[if !supportFootnotes]–>[2]<!–[endif]–> Przekop, P; Haviland, MG; Morton, KR; Oda, K; and Fras.” Clinical and Experimental Rheumatology, 27(5, Sup56): S79-S85.er, GE (2010). “Correlates of Perceived Pain-Related Restrictions among Women with Fibromyalgia.” Pain Med, 11(11):1698-1706.

<!–[if !supportFootnotes]–>[3]<!–[endif]–> Robinson, JP;Theodore, BR: (Jones, Nicholl and McBeth)Wilson, HD;Waldo, PG; andTurk, DC (2011). “Determination of Fibromyalgia Syndrome after Whiplash Injuries: Methodologic Issues.” Pain, 152(6):1311-6.

<!–[if !supportFootnotes]–>[4]<!–[endif]–>Tishler, M; Levy, O; Maslakov, I; Bar-Chaim, S; and Amit-Vazina, M (2006). “Neck Injury and Fibromyalgia– Are they really associated?” The Journal of Rheumatology, 33(6): 1183-1185.

<!–[if !supportFootnotes]–>[5]<!–[endif]–> Haviland, MG; Morton, KR; Oda, K; and Fraser, GE (2010). “Traumatic Experiences, Major Life Stressors, and Self-Reporting a Physician-Given Fibromyalgia Diagnosis.”  Psychiatry Research, 177(3): 335–341.

<!–[if !supportFootnotes]–>[6]<!–[endif]–> Ciccone, DS; Elliott, DK; Chandler, HK; Nayak, S; and Raphael, KG (2005). “Sexual and Physical Abuse in Women with Fibromyalgia Syndrome: A Test of the Trauma Hypothesis.” Clinical Journal of Pain, 21(5)378–386.

<!–[if !supportFootnotes]–>[7]<!–[endif]–> Fuller-Thomson, E; Sulman, J; Brennenstuhl, S; and Merchant, M (2011). “Functional Somatic Syndromes and Childhood Physical Abuse in Women: Data From a Representative Community-Based Sample.” Journal of Aggression, Maltreatment and Trauma, 20(4):445-469.

This article was originally published on July 11, 2012 and last revision and update of it was 9/7/2015