Physical trauma and fibromyalgia--is there a true association?]

A total of 25-50% of fibromyalgia patients (FM) report the occurrence of physical trauma that preceded the onset of their symptoms by several weeks to several months. Yet, there is still no agreement among experts as to whether physical trauma can cause FM. The severity of the injury varies, but is usually milder than that seen in patients with post-traumatic stress syndrome. Road accidents, and, in particular, whiplash injuries, or accumulated injury inherent in some occupations have been described as causes of fibromyalgia. 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. Possible mechanisms for the development of the syndrome following trauma have not been elucidated sufficiently to date. Stressful conditions are also known to contribute to the appearance of the syndrome. In most likelihood, there is no significant difference between idiopathic fibromyalgia and post traumatic fibromyalgia in terms of clinical course, symptom severity and prognosis, although some investigators have reported a worse prognosis in post-traumatic cases. In Israel, there is an increase in the number of suits filed against private insurance companies and the National Insurance system for post-traumatic fibromyalgia. According to the literature, it is probable that the number of cases that involve malingering or secondary gain is low. The ongoing controversy among medical experts as to whether there is an association between FS 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.