Objectives: The primary objective is to review current research with respec
t to the role of trauma in fibromyalgia (FM). A secondary objective is to h
ypothesize which steps need to be taken, first to determine whether such an
association truly exists, and second to clarify what such an association m
ight mean.
Methods: An extensive literature review was undertaken, including Medline f
rom 1979 to the present.
Results: The strongest evidence supporting an association between trauma an
d FM is a recently published Israeli study in which adults with neck injuri
es had greater than a 10-fold increased risk of developing FM within 1 year
of their injury, compared with adults with lower extremity fractures (P=.0
01), Several other studies provide a hypothetical construct for such an ass
ociation. These include studies on (1) postinjury sleep abnormalities; (2)
local injury sites as a source of chronic distant regional pain; and (3) th
e concept of neuroplasticity. There are, however, several primary arguments
against such an association: (1) FM may not be a distinct clinical entity;
(2) FM may be a psychological, rather than physical, disease; (3) the evid
ence supporting any association is limited and not definitive; (4) the Isra
eli study, itself, has some methodological limitations; and (5) other facto
rs may be more important than the injurious event in determining chronic sy
mptoms after an acute injury.
Conclusions: Although there is some evidence supporting an association betw
een trauma and FM, the evidence is not definitive. Further prospective stud
ies are needed to confirm this association and to identify whether trauma h
as a causal role. Semin Arthritis Rheum 29:200-216. Copyright (C) 2000 by W
.B. Saunders Company.