Fibromyalgia and car accidents

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Fibromyalgia is a common rheumatic disorder that affects 2-4% of the population.

It is characterized by chronic muscular pain, early morning stiffness, extreme fatigue, and unrefreshing sleep. People with fibromyalgia often have headaches, concentration and memory problems, dizziness, numbness, and sometimes abdominal camping. Fibromyalgia is diagnosed by pain in at least 11 out of 18 soft tissue areas known as "trigger points." When these trigger points are pressed, people with fibromyalgia feel intense pain. People with other rheumatic conditions feel no pain or only a slight tenderness when these trigger points are pressed. Fibromyalgia sometimes coexists with other diseases and disorders.

Most people who have fibromyalgia develop it between the ages of 20 and 50. However, sometimes children and teenagers develop fibromyalgia. More females than males are diagnosed with this disorder.

Fibromyalgia often develops after periods of illness, car accidents, injury, or surgery.

From 1990 to 1995, 2,000 records of fibromyalgia patients from one medical practice were reviewed. 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; included in this category were sports injuries, recreational injuries, fractures, surgical procedures, head injuries and pregnancy. Of the post-traumatic patients involved in motor vehicle accidents, whiplash injury was the most common type of trauma.

There have been various studies published on soft tissue injuries and pain. A recent study done by Buskila, et al. published in Arthritis and Rheumatism, March 1997, specifically studied persons with trauma to determine if fibromyalgia developed after the trauma. Buskila and colleagues 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 13 times more likely to occur following neck injury then following a leg injury.

Patients with fibromyalgia that develops after a trauma 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 problem with ongoing pain and was in perfect health until the trauma occurred. Within a short while after the accident, the person develops pain that persists. There may be a history of visits to the emergency room, x-rays and evaluations, medications, and other medical treatments. Some or these treatments may help, but the pain never disappears.

When this person is examined, 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 are 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 palpated.

There is no single testing procedure that is diagnostic of post-traumatic fibromyalgia. Routine labs and other tests are normal in fibromyalgia. 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. However, various treatments can help individuals with post-traumatic fibromyalgia and the goals of the treatment are to help one get to the best possible level, even if the condition does not completely disappear or become cured. Each person's treatment program needs to be individualized, and what works for some may not work for others. Hopefully the person will find some treatment that is helpful in dealing with the pain.

Fibromyalgia is a lifelong disorder. A cure has not been found. Most people do not experience long periods of remission.

Fibromyalgia may be aggravated by cold damp weather. Rain, snow, and even fog often exacerbate symptoms. Some people find hot tubs helpful. A dry, desert climate may also have a therapeutic effect.

Artificial lighting, noise, and emotional stress can contribute. Sources of sress should be avoided or eliminated when possible. Symptoms are sometimes treated by antidepressants. Aspirin and ibuprofen may reduce pain. Massage and heat may help flare-ups.

Caffeine is best avoided as it tends to disrupt sleep, and increase muscle pain. (However, withdrawal from caffeine should be slow and gradual.) Some people find that their symptoms are alleviated by eliminating or reducing intake of certain foods.

One of the most effective treatments is exercise. Most people with fibromyalgia benefit from moderate exercise several times a week. Walking, biking, water exercise, and gentle aerobic dance usually help if done on a regular basis. People who are poorly conditioned should begin exercising slowly. Exercise should be gradually increased until it is done three or four times each week for about 30 minutes each session. Each exercise session should be preceded by stretching.

The cause of FM remains unknown but appears to be multifactorial.

Certain biologic variables may contribute to the development and persistence of FM. Inheritance: Altered serotonin metabolism in at least 1 subgroup of patients with FM has been felt to be a genetic link.

Female gender and dysregulation of the stress response system are clearly important since FM has a female-to-male ratio of 9:1.

In clinical and experimental studies comparing males and females, females have more pain at all sites, use more analgesic medications, are more sensitive to pain stimuli, and have central pain modulatory systems that are influenced by phasic alterations in reproductive hormone levels.

Adverse stimuli and stressful tasks more likely affect the sympathetic nervous system and hypothalamic pituitary adrenal gland axis and psychologic responses are involved more in females compared to males.

Whether such gender differences are genetic or learned remains to be established.

Almost all patients with FM sleep poorly, and the frequent complaint that a night of poor sleep is followed by a more painful day is supported in the research. Abnormal sleep affects both limbs of the stress response system and contributes to negative mood and cognitive difficulties.

Trauma as a trigger of FM is a highly contentious and medicolegally charged issue in American society today. Patients who attribute their FM to trauma are disabled more than patients with primary FM. These patients also have more perceived disability, self-reported pain, life interference, and affective distress than patients with idiopathic onset.

A large body of data suggests FM, chronic fatigue syndrome, regional chronic pain syndromes, and certain emotional disorders that frequently coexist with FM all involve central dysregulation of the stress response system. Here, various forms of stress function as initiators or perpetuators of functional alterations in the corticotropin-releasing hormone (CRH) neuron, with associated effects on the HPA axis, other neuroendocrine axes, and the SNS.

Subtle abnormalities in the stress response system, which cannot be detected by routine clinical and laboratory assessments, may contribute to the diverse clinical manifestations in this spectrum of illnesses.

The extremely high prevalence of stress-related disorders in society may reflect maladaption of the stress response system in the face of chronic unrelieved stress and distress in modern life.

Neurally mediated hypotension is demonstrated in patients with FM by tilt-table testing, which, in turn, provokes pain. While still poorly understood, current investigations are focusing on a role for inhibition of arterial baroreceptors in the setting of hypotension, or some other type of baroreceptor dysfunction, in the cause of increased pain and anxiety.

Neurotransmitter abnormalities/neuronal activation leading to central sensitization, low calcium levels, low serotonin levels, elevated levels of substance P, elevated levels of cerebrospinal fluid (CSF) nerve growth factor, elevated levels of CSF dynorphin A, elevated levels of CSF calcitonin gene-related peptide, and various other antinociceptive molecules may be seen.

Functional brain activity abnormalities (decreased regional blood flow in thalamus and caudate nucleus)- those involved in abnormal central nociceptive processing and functional brain abnormalities- may also be part of the pathophysiology of FM .

Viruses or other infections may contribute to exacerbation of symptomatology via cytokine-vagus nerve stimulation of the CRH neuron/stress response system in bidirectional brain-immune system communication.

Cognitive-behavioral variables may be pivotal in the development and maintenance of persistent pain and functional disability. They may have antecedents in earlier life (eg, childhood abuse, parental alcoholism, learned behaviors from living as children with dysfunctional or chronically ill parents). By early adulthood, a failure in goal-oriented behavior may develop, leading to lower self-efficacy, the inability to achieve goals, and a fear of failure. In turn, this may presage reporting of chronic pain as a socially acceptable excuse for failure to achieve goals in later life.

Certain data support a hypervigilance model of pain in patients with FM. Heightened sensitivity to pain occurs, at least in part, because of increased attention to external stimuli and a preoccupation with pain sensations.

A consensus is emerging that depression is a common denominator in chronic pain and fatigue. Also, unrelieved stress is believed to be the underlying element linking depression, pain, and fatigue. As discussed above, neurohumoral dysfunction consequent to chronic stress provides, at least in part, a biologic explanation for mood disorders and subjective pain and fatigue in patients with FM and related disorders.

Some studies show that two thirds of patients with chronic pain have first-degree relatives with chronic pain, one third have a family member with an affective illness, and one third have a family member with alcohol abuse.

Childhood physical, emotional, or sexual abuse appears to be a common antecedent of anxiety, somatization, and chronic pain in many adults.

In this regard, biologic vulnerability may derive from persisting effects of early life stresses on the stress response system.

Spousal and family support can either mitigate or adversely impact the various dimensions of chronic pain.

Spousal reinforcement of pain behaviors can lower experimentally determined pain thresholds.

Job satisfaction and a healthy work environment lessen the emotional distress associated with chronic pain.

Conversely, job dissatisfaction strongly predicts the progression of acute back pain to chronic low back pain. Similarly, workers' compensation and disability benefits can be significant disincentives for recovery from chronic pain.

Get more information about fibromyalgia and car accidents and related issues as well as...

• Insider arthritis tips that help you erase the pain and fatigue of rheumatoid arthritis almost overnight!

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• Ignored remedies that eliminate fibromyalgia symptoms quickly!

• Obsolete treatments for knee osteoarthritis that still are used... and may still work for you!

• The stiff penalties you face if you ignore this type of hip pain...

• 7 easy-to-implement neck pain remedies that work like a charm!

• And much more...

Click here Second Opinion Arthritis Treatment Kit

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