If Physical Injury Does Not Trigger Fibromyalgia What Does?

[sue la-la]

"The same general factors show up in people with chronic widespread pain (CWP). One study found that being female, having a long duration of pain and a high rate of psychosomatic symptoms was a risk factor for CWP. Another found that people with CWP as opposed to localized pain were more likely to be female, to have been in pain for a longer time, to have more comorbid illnesses and "psychosomatic symptoms", and to suffer from "permanent pain" instead of transient attacks of pain."

those studies list 'female' and 'psychosomatic symptoms' as two separate factors.
surely that's a mistake - all symptoms experienced by females are, a priori, hysterical and psychosomatic.

 

[JennyJenny]

Several summer's of several bouts of swimmers ear and a case of Mumps, ages 7-9. Horrific violence in my household although I was never a victim of it. Very bad 2nd grade teacher always yelling at everyone (old bat). 4th grade (9) the fastest runner of all girls and all but one boy, Stretch Flemming. Anyway, by 5th grade I could no longer run. It was as if my leg muscles were jamming and I could not dig in and spring off my feet. By 7th grade I was in a lot of back pain and my mom bought me a new mattress. By 8th I was in PT for sonar waves and massage for all over upper, lower back pain and shoulder and neck. High School horrible insomnia.

But I think since it runs in my family, an aunt and her son, the answer for us is Genetic. Because so many people go through so many of the same viruses, injuries, disc problems, viruses, emotional and physical abuse, I just feel that something genetic is in Fibro patients and it comes out with life events.

 

[Phil Hayward]

Cort, I think you should have a category for "chronic stress" as an FM onset trigger. That is the one I would give my vote to.

The naturopath Gary Moller is one who argues strongly that an unrecognised and undiagnosed infection somewhere in the body, is the cause; or possibly a toxic substance that will show up on a hair mineral analysis test. This could well be right - trouble is, the very fact that it is undiagnosed means that no-one with FM can pick it as the cause. Gary has had several cases where a HMAT showed severe levels of a toxic substance like arsenic, and appropriate treatment has been part of reducing FM symptoms. Other success stories include people discovering a deep-seated dental infection, experiencing improvement in FM symptoms once the infection was treated.

But I believe that whatever the trigger, and it may well be several things cumulatively, different things in different people, the "disease" that one ends up with is very similar in all cases, and not automatically reversible merely by diagnosing and treating or eliminating the "trigger". The damaged amygdala, the chronic vascular constriction, the damaged small muscle fibers, the body fluid imbalances and intersticial flow blockages, the defective mitochondria, etc do not seem to predictably come right in response to any treatment protocol yet known.

 

[Phil Hayward]

I would add a corollary to what I just said, based on my own experience. If you do find a protocol that "works", which will probably include a whole lot of ingredients and strategies, then gradually, more and more things become helpful that were not before, because the whole system was so far out of whack that most supplements and strategies were like "water off a duck's back". I presume that the new-found benefits from more and more supplements and strategies are because numerous damaged parts of the system are in fact "healing" and are capable of taking in and responding to the supplements, when they previously had not been. For example, I am noticing antioxidant supplements are now giving me a bit of added insurance against post-exertion malaise - but years ago they were just one of many things that I regarded as having been a waste of money.

 

[Carolyn]

The one thing all these triggers have in common is living on adrenaline etc to get though a life situation. I've noticed sufferers were overachievers, type A personalities or had to cope with prolonged stress. Perhaps living with high levels of stress hormones is enough to reset brain function unfavourably?
Personally, I'm in the UK and was called a lot of names 40 years ago, so I have only been diagnosed 6 years. I wonder if pushing through pain and fatigue is why I'm barely mobile now and can sleep most of each day.
My mother was told she had fibrositis in the 50's though my father was told it was all in her mind. So I agree there is a genetic link (a.k.a. learned behaviour according to my local pain management program!)

 

[Gareth]

the only thing I can link it to is working shifts, doing a few years where I would be getting up for work at 3am for up to 4 nights a week

A long term depression with anxiety was also around

 

[Leila Gary]

I strongly believe physical trauma has a lot to do with triggering FM symptoms. I am not sure when it all started for me but at age 43 I was in a car accident and my life as I knew it before was gone. I was active and didn't slow down until the accident. I had whiplash. I went unconscious for 5-10 minutes. I direct hit the car tgat pulled out in front of me at 30-35mph. For 5 days after accident I felt better than I had in a long time. On day 6 I awoke and felt like every inch of my body was badly bruised. That was in 2005. 2007 I got a diagnosis of primarily CFS. In 1986 I had a bad case of Mono and that is when I first started experiencing fatigue (not pain) that seemed to come out of nowhere. There is more of a history but I am too tired to remember all of it (imagine that!). Stress plays a huge a role I am sure but I functioned 'well' under it until the car accident (I am sure there is a relation between the HPA axis and CFS and/or FM. I believe in whiplash the nerves can get torn??) My Chiropractor was concerned that my body stayed in shock for 5 days after the car accident. I began ecperiencing memory problems, vertigo, balance problems and much more. My regular doctors simply said "It's age related" with a smirk. CFS and FM are different but can exist together. I still believe I had CFS long before car accident but the accident triggered FM. Sorry if this doesn't make a lot of sense.

Leila

 

[Robert Christ]

Because of the overwhelming numbers of suffer's (not enough trauma victims) and the predominant association with ibs I can't help but wondering if there might be a connection with oral sex CFS, & IBS related conditions like crohns disease, & sbio. I always associated my CFS which came on in a matter of months with occupational exposure to chemicals and pesticides. But try not to get too fixated on the exclusivity of this one theory. I also had a really bad problem with mold in my house but lived with it for 14 years before onset. Also had 3 hour surgery on my hip 7 years before I came down with CFS. When I came down with it I was under highly stressful work situation. Owned my own lawn business and was working roughly 60 hour weeks. Did a little bit of welding and painting of old cars. Practically bathed in solvents between my hobbies and working on lawn equipment.

 

[Katie]

It's all so confusing, I'll try not to bore you unmercifully.
- perfectly healthy just (typical childhood stuff, like chicken pox, measles. etc.) until diagnosed with scoliosis at about 12 (no mention of treatment)
- both parents were mentally unstable & abusive, anxiety followed by migraines before puberty
- infectious mononucleosis at 14 (that means EBV, right?)
- sexual abuse at my first job as a secretary at 18 (it was the 1970's, baby), beginning of chronic insomnia
- relocated every 3-4 years for spouse's promotions (repetitious traumas)
- 2 C-sections; I discovered postpartum depression (Surgery #1 and Surgery #2)
- December 8, 1994 I had to put my 16-year-old dog down. Cried hysterically for a week--suddenly lost my peripheral vision for a month. Blind, except for a small circle in the middle; kinda the opposite of macular degeneration. Neurologist dx: 'conversion disorder,' not uncommon in people with abusive childhoods. I'd say so far that was the epitome of trauma in my life, losing my constant companion
- bi-lateral carpal tunnel surgery, late 1990's (Surgeries #3 and #4)
- major insomnia: I was sleeping 2-3 hours/night for years (unaware its source was anxiety), not realizing the future consequences
- 2005: lumbar spinal fusion due to worsening scoliosis (Surgery #5)
- after flu vaccine in 2009, I felt my health really take a downturn; the flu that never went away
- February 2011 broke my neck due to a fall from an extension ladder; scans revealed nodules on my thyroid, bloodwork revealed Hashimoto's thyroiditis
- after 5 doctors, an unusually informed rheumatologist diagnosed fibromyalgia, cfs, and joint-disfiguring OA), later recommends right thumb basal joint replacement in near future (steroid injections are staving that off for now)
- hip replacement, May of 2015 (Surgery #6). Left hip pain relieved; the rest of my body not so much
- Now mostly homebound due to pain and fatigue, so rheumatologist sent me for more X-rays a few weeks ago, thinking it was the other hip. Hip was fine--I was shocked when comparing my 2005 X-ray with last week's--above the hardware at L-4 and L5, my spine is turning into an 'S' shape. Explained how I went from 4'11" to 4'9" over 10 years. I'm 60, so more fusion is not probable (thank the gods). Confusion over the source of the pain--referred degenerative pain or fibromyalgia pain?
- Husband has been transferred once again--we'll see if I survive this one

wow Sally, that's a load of hurt

 

[Katie]

After skiing and cycling accidents, a lot of stress at work and a trip to Mayanmar to take a terminally ill patient to his family the year before and a life long hx of emotional abuse, mono when I was 16 and chicken pox when I was 28 it isn't hard to see that there are many factors that led me to being diagnosed, (dx) after suffering and consistently getting worse for five years, with FM then myofascial syndrome then finally ME/CFS and FM.
Whew
Oh and IBS, POTS, hypothyroidism and on and on...

 

[Celeste Cooper]

Like the new format Cort.

Look at the person who made the comment. Dr. Frederick Wolfe is not respected by many of his peers. Some of his studies claim to use approved psychological testing tools that in fact, are NOT approved by the APA. He has a goal and look at who funds his studies. As a matter of fact, in his criteria ihe and his co-authors suggest there is no comorbidity with pain disorders, while the ACR recognizes comorbidity with migraine, chronic pelvic pain, painful bladder syndrome (used to be IC), IBS, GERD, and TMJ/TMD.

Dr. Robert Bennett, on the other hand, says fibromyalgia patients do have another chronic pain disorder and should be considered when applying his, et. al. diagnostic criteria.

Also of note, the American College of Rheumatology does not approve any diagnostic criteria, and I have that straight from the horses mouth. As for whiplash, that is only one patient population. There have been other studies that suggest cervical spine disease is associated with onset of FM.

Certain neurochemicals are askew in FM, ME/CFS, chronic pain, and depression, so it is possible there can be many triggers. There is evidence that FM is an inherited disorder, like migraine disease, but we need more research on the genealogy. It's possible that unless you have the gene, you will not develop FM, period. I have often thought neck injury and FM may, or may not, be what is going on because so many people, including researchers, are clueless about the differences between FM and myofascial pain syndrome. The severity of the injury is also important.

Just my two cents. ProHealth just published my blog regarding the many folks who have been openly critical of the Wolfe criteria (which he erroneously named the ACR Preliminary and Modified criteria). It was my response to a med student who contacted me because he was writing a paper for his abnormal psych class. The ACR will be publishing, or may have already, a redaction because the peer review for Arthritis Care and Research, approved publication with that title. It was indeed not preliminary anything that the ACR was considering. It has done a great deal of harm to the fibromyalgia community. Dr. Wolfe and his "fibromyalgianess" is not someone I would rely on for unbiased research, and he should be reprimanded for suggesting the ACR was supporting his criteria!

The CDC, the NIH, and the ACR all recognize chronic pain comorbidity and both the CDC and the ACR say there is a higher prevalence in people with rheumatological autoimmune diseases.

 

[Shannon]

My Fibro came on after I had lost 60 lbs, with a new job plus a promotion in a fairly stressful job. It could have been the stress but everything that was happening with that job, in my mind, was positive. Though I didn't "like" the job at all, I was good at it.

I have a history of long term depression and anxiety. Enough to be on anti-depressants the majority of my adult life. However, I had low grade lower back pain and chronic headaches for years. I played a lot of sports with minor injuries. One in 1995/96 where I broke my right pinky finger playing slo-pitch, now have a plastic knuckle and had to relearn how to write and type.

• 2 significant whiplashes - one in 1991 (skiing) and another in 1996 (I t-boned a bigger truck than mine, not my fault).
• 2000 - Went through a traumatic break-up with my ex, had been together 6-7 years
• 2001 moved across Canada
• 2001 - dealt with agoraphobia, severe depression until 2005
• Diagnosed with obstructive sleep apnea in 2006
• I was diagnosed with plantar faciitis and had to buy orthopedic inserts
• My mother passed away in 2008
• In 2008 I became aware of having a mild scoliosis, my whole life, from my chiropractor
• 2008 - The pain from plantar faciitis became too much and I had to quit a job I had had for many years that I really liked, working with a fantastic group of people.
• Started a new job that I loved more than any other in my entire life - no standing for 8-10 hrs a day required
• I had to quit the job I loved in 2009 - too high stress for me
• In late 2009 I had to take another job, one I did very well at but did not like. Got the promotion shortly after starting.
• Started getting intense chest pains (severe costochondritis I still have) in 2010
• Had to give up that job too, in 2010
• Diagnosed with FM in 2011
• Have been unable to work since then

High stress has been a constant in my life. Anxiety was so bad in the early 2000s (dealing with a traumatic break-up with my ex) that I was agoraphobic for a while. Suffered panic attacks for years and had a very dark time with severe depression. I swore to myself "never again" for that kind of depression or anxiety and I have been better, off anti-depressants until 2011 beginning with Cymbalta for FM.

So, for me, I think high stress and anxiety was a major part of bringing on FM. The severe costochondritis could be a result of years of sitting in front of a computer - I still experience a lot of pain from it, especially after sitting at my computer for a few hours.

However, I also suffered some major traumas both physically and emotionally. So I'm sure it is very difficult to say what caused my FM. Though I am of a mind that it takes a significant amount of things to bring it in. I also think people are per-desposed to become FM patients. Whether stress + physical trauma or even emotional trauma brings it on, I think years of suffering with either can eventually result in FM.

 

[LisaR]

My FM symptoms started after 18 months of unrelenting emotional stress. During that time, I was slammed with several life crises -- my son was struggling with college and dropped out and got diagnosed with depression, my bipolar sister spun out of control, was in and out of mental hospitals and ERs and eventually killed herself, and our city and house were devastated by a flood. This is when my sleep problems and back pain started, eventually diagnosed as FM. This fits with the theory of FM being caused by an autonomic nervous system that is in the "on" position for so long that it doesn't know how to shut off. (My son is back in college now and doing well, by the way!).

 

[Dan Neuffer]

Hi Cort.
Well, I think that it's clear that people who are at risk of developing Fibromyalgia Syndrome are often triggered by a physical injury. I think the problem with most research here is that it comes at from a specific angle without the necessary background information and experience with the illness. But of course, people get the syndrome from range of triggers and don't have to have a physical injury at all. I have also seen many people who have the illness (ME/CFS), develop the extra symptom of pain following a physical trauma. And yes, of course it is the CNS that is involved. It still seems odd to me that much literature clearly identifies ME/CFS/FMS as a neurological based illness and that the pain is due to central sensitisation, whilst some researchers still suggest it is all a big mystery. This kind of thing doesn't really occur in non-medical science, where once things are established, everyone is on the same page - no physicist would argue with Newtonian formula and suggest gravity is not what causes things to hit the ground - not sure why medicine is so different!
Dan

 

[Cort]

"The same general factors show up in people with chronic widespread pain (CWP). One study found that being female, having a long duration of pain and a high rate of psychosomatic symptoms was a risk factor for CWP. Another found that people with CWP as opposed to localized pain were more likely to be female, to have been in pain for a longer time, to have more comorbid illnesses and "psychosomatic symptoms", and to suffer from "permanent pain" instead of transient attacks of pain."

those studies list 'female' and 'psychosomatic symptoms' as two separate factors.
surely that's a mistake - all symptoms experienced by females are, a priori, hysterical and psychosomatic.

 

[Cort]

I've always said that. Poor Morgan Freeman.

I don't associate anything with my Fibro onset, although looking back while telling my story to my Dr. I realize I had GI issues pior to the FMS... I don't think I can call it IBS but it is the closest thing I could find as a relation.

Actually GI problems - mild GI problems - were about the only discernible possible problem I had as well....hmm

 

[Cort]

In the summer of 1954 when I was 10 year old, I started feeling very tired with aching limbs. My Doctor said it was "Growing Pains" I continued to feel unwell and was having problems getting to sleep at night. My mother took me back to see another Doctor in the practise and he said I had "Muscular Rheumatism" and I had to stay in bed for a month. never really recovered from it and when I was about 13 I fell really sick again. Another Doc said I had Rheumatic Fever and again I was in bed for a month. Going back to school I had to stop all physical activity. I lost a lot of schooling as I felt so unwell. When I was 17 I had another attack of "Rheumatic Fever" I have suffered with pain and exhaustion all my life. I had 3 babies - the last one I was so exhausted I didn't know what sex it was and woke up in the Maternity Ward! I had several auto immune conditions and am hypothyroid. I was finally diagnosed with M.E/CFS at the end of 1988 after going through CBT and GET I have been in a wheelchair ever since and am unable to do any housework or cooking. My Husband does everything. I get so angry when people- especially Doctors- say its "All in the mind"

What a story Mojo! I imagine that it all started with "muscular rheumatism" and I wonder if it was bug of some sort...It's just amazing...

 

[Cort]

I was in a accident in 2005 severe whiplash, Couldn't sleep since. Fast forward to 2006 almost 1 year to date I contacted MRSA at work, again very hard to treat, ended up being operated on after many Iv antibiotics...December 2006 started to feel over stressed no amount of anti anxiety or anti depression couldn't suppress it. This is why my chronic fatigue and fibromyalgia took over. Though I later found I had Cavus equines in both feet, multi level spondylitis, multi level stenosis in my neck. So there were clear reasons for pain, Emg positive for carpal tunnel and left side nerve. And possible early signs Als. Today my pain is a 4 and not constant my biggest complaints are lack of sleep. App noted interrupted Rem sleep 205 times one night alone? Fatigue and weakness but also have pituary deficiencies and depression. Who wouldn't be when you go from a productive self reliant happy person to depending on Ssdi..the quality of life and the moods of your doctors. The loss of control is by the self worse system of these deaseases, Rita

Interesting...so the whiplash effected your sleep. That was the first straw. Then the MRSA (scary stuff!) and then you had all this other stuff going on as well.
I don't know how anybody can be well who can't get good sleep....

 

[Cort]

Hi Cort, had it been just one operation but the same amount of time on crutches I think the outcome would have been the same. That is so weird how yours just happened - I wonder how often that occurs?

Well in that one study about 3/4's of the people could not identify a trigger. I felt good about that

 

[Dan Neuffer]

Actually GI problems - mild GI problems - were about the only discernible possible problem I had as well....hmm

Me too - and I often hear people having IBS like symptoms leading up start of ME/CFS/FMS - in my view, they lie on the same spectrum.