Does trauma cause fibromyalgia? (Pro And Con).

YES

Of the almost 1,000 fibromyalgia patients in my practice, I would estimate that half have fibromyalgia associated with trauma. Of those, three-quarters have had head or neck trauma.

A growing body of evidence, while not exactly proving that musculoskeletal injury can cause fibromyalgia, gives us that picture as well as some ideas of what mechanisms might result in fibromyalgia.

One of the most convincing studies to link fibromyalgia and trauma suggests that head and neck trauma are more strongly associated with fibromyalgia than are other types of trauma. The investigators in Israel assessed 102 patients with traumatic neck injury and 59 control patients with leg fractures. The patients were evaluated for tender points, interviewed about the presence and severity of neck or fibromyalgia-related symptoms, and diagnosed using the 1990 American College of Rheumatology criteria.

The neck-trauma patients were 13 times more likely to have fibromyalgia than were the controls (Arthritis Rheum. 40[3]:446-52, 1997). This would appear to make sense. Injuries dose to the head and central nervous system would be more likely to cause generalized symptoms or a generalized syndrome.

Of course, assessing pain and determining how much pain or injury a particular trauma might inflict are problematic, particularly with head and neck trauma. Therein lies the rub of associating fibromyalgia and trauma.

Autopsy studies indicate that even when x-rays of the cervical spine are negative, there can be occult fractures and injury to the cord itself. Also, patients with neck injuries have more sleep difficulties than patients with other types of injuries. It is during sleep--specifically stage IV non-REM sleep--that human growth hormone is released. Human growth hormone abets healing, and good stage IV non-REM sleep appears necessary for patients with fibromyalgia to improve.