Posttraumatic Fibromyalgia

Fibromyalgia (FM) has a long reputation for being a controversial diagnosis. Some healthcare providers (HCPs) feel FM is a legitimate condition that warrants treatment and research while others feel it’s a “garbage can diagnosis” that HCPs throw patients into when they’re not sure what diagnostic label to use to describe a patient’s condition. Regardless of the personal beliefs of individual HCPs, there have been two general classifications of FM: primary and secondary. Primary FM occurs when there is no underlying health condition participating in the patient’s overall health status and the onset of FM. Secondary FM results from an underlying condition that contributes significantly to the patient’s health status, such as irritable bowel syndrome and over time, gives rise to the onset of FM.

Posttraumatic FM belongs to the secondary FM classification when the trauma-related injury results in the patient developing FM. A Canadian study reported that 25-50% of FM patients reported a traumatic event just before their FM symptoms began. This study surveyed different specialty physician groups to determine which issues were most important in causing the onset of widespread chronic pain after a motor vehicle trauma. Five factors were studied to determine how important each was to the HCP in arriving at a FM diagnosis in a case study of a 45-year-old female with a whiplash injury who developed chronic generalized pain, fatigue, difficulties in sleeping, and diffuse muscle tenderness. These five factors included:

1. The number of FM cases diagnosed weekly by the HCP.
2. The patient’s gender.
3. The force of the initial impact.
4. The patient’s psychiatric history before the trauma.
5. The initial injury severity.

The researchers also considered the patient’s pre-injury health status, fitness level, and psychological health to be important as well. All HCP groups were reluctant to blame the car accident as causing FM, but rather placed more importance on the patient attitude, personality, and level of emotional stress. The least important of the five points were numbers 3 and 5. The orthopedic group also included “ongoing litigation” as a cause but as a group, they were the least likely to agree on the FM diagnosis (29%) in this particular case study. Rheumatologists were the most likely to diagnose FM at 83%, followed by general practitioners at 71%, and physiatrists at 60%. A most interesting observation was that once the data was analyzed, ONLY the patient’s pre-accident psychiatric history remained in the model of predicting agreement or disagreement with the FM diagnosis.

Posttraumatic FM can result from any type of trauma, not just motor vehicle collisions. Other “secondary” FM causes besides trauma can include systemic conditions such as irritable bowel syndrome, chronic fatigue syndrome, and other internal disorders that in part, alter the person’s ability to obtain restorative sleep. Hence, an important focus of treatment should be placed on helping the FM patient obtain restful sleep. Chiropractic management strategies have included manipulation, mobilization, soft tissue therapies, physiological therapeutic agents such as electrical stimulation, ultrasound, the training for home use of traction, the use of nutritional counseling and supplementation, and exercise training. Many studies support success with this multidimensional approach to treating FM as chiropractic attacks the FM condition from multiple directions, often yielding highly satisfying results.