Perspectives on posttraumatic fibromyalgia: A random survey of Canadian general practitioners, orthopedists, physiatrists, and rheumatologists

Objective. To determine which factors physicians consider important in pati ents with chronic generalized posttraumatic pain. Methods. Using physician membership directories, random samples of 287 Cana dian general practitioners. 160 orthopedists, 160 physiatrists, and 160 rhe umatologists were surveyed. Each subject was mailed a case scenario describ ing a 45-year-old woman who sustained a whiplash injury and subsequently de veloped chronic, generalized pain, fatigue, sleep difficulties. rind diffus e muscle tenderness. Respondents were asked whether they agreed with a diag nosis of fibromyalgia (FM), and what factors they considered to be importan t in the development of chronic, generalized posttraumatic pain. Results. More-recent medical school graduates were more likely to agree wit h the FM diagnosis. Orthopedists (28.8%) were least likely to agree, while rheumatologists (83.0%) were most likely to agree. On multivariate analysis , 5 factors predicted agreement or disagreement with the diagnosis of FM: ( 1) number of FM cases diagnosed by the respondent per week (p < 0.0001): (2 ) patient's sex (p < 0.0001); (3) force of initial impact (p = 0.003): (4) patient's, pre-collision psychiatric history (p = 0.03); and (5) severity o f initial injuries (p = 0.03). The force of initial impact and the patient' s pie-collision psychiatric history were both negatively correlated with ag reement in diagnosis. Patient related factors (personality, emotional stres s, pre-collision physical, mental health) were considered more important th an trauma related Factors in the development of chronic, widespread pain. Conclusion. Future studies of the association between trauma and FM should identify potential cases outside of specialty clinics, and baseline assessm ents should include some measurement of personality, stress, and pre-collis ion physical and mental health.