RE:Post-Traumatic Fibromyalgia

[Guest guest]

Cant seem to get the longggg URL to work so I decided to just post

the article..hope it helps..buslady...Kathi in OK

Post-Traumatic Fibromyalgia

Mark J. Pellegrino MD

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Fibromyalgia is a common condition causing painful muscles. The pain

is severe and involves many muscles as well as tendons, ligaments,

and other soft tissue areas. Distinct areas of tenderness in

specific locations called " tender points " are characteristic

findings. Fibromyalgia can be generalized, affecting the whole body,

or regionally affecting specific areas of the body. In recent years,

increased awareness of what previously was a mysterious and

controversial condition has made fibromyalgia a well-recognized and

legitimate syndrome.

Health care professionals of all specialties are involved in

treating fibromyalgia patients. We have recognized a variety of

factors that are important in causing fibromyalgia including

genetics, infections, connective tissue diseases and trauma. Post-

traumatic fibromyalgia is a special type of fibromyalgia that is

caused by an injury.

Doctors who treat large numbers of fibromyalgia patients report that

the majority of patients say that their fibromyalgia was caused by

an injury. In my own private practice, I analyzed patients with the

diagnosis of fibromyalgia to determine the cause. From 1990 to 1995,

2,000 records of fibromyalgia patients were reviewed. Of those, 65%

reported the onset of their symptoms of fibromyalgia after a

traumatic event. Of this group, 52% of them were involved in a motor

vehicle accident, 31% had work injuries, and the remaining 17% had

another type of trauma; included in this category were sports

injuries, recreational injuries, fractures, surgical procedures,

head injuries and pregnancy. Of the post-traumatic patients involved

in motor vehicle accidents, whiplash injury was the most common type

of trauma.

There have been various studies published on soft tissue injuries

and pain. A recent study done by Dr. Buskila published in " The

Arthritis and Rheumatism, March 1997, specifically studied persons

with trauma to determine if fibromyalgia developed after the trauma.

Dr. Buskila followed 161 people with traumatic injury, 102 of them

had neck injuries (i.e. the typical whiplash injury), and 59 people

had leg fractures. The follow-up evaluations determined that people

who had the neck injuries developed fibromyalgia 22% of the time

whereas people with the leg injuries developed fibromyalgia only 2%

of the time. This means that post-traumatic fibromyalgia is 13 times

more likely to occur following neck injury then following a leg

injury. This study shows that fibromyalgia is caused by trauma.

Patients with fibromyalgia that developed after a trauma will have

a " typical history. " The person reports severe pain as the chief

complaint with the pain commonly in the neck, shoulders and back

areas. Usually, the person had no previous problem with ongoing pain

and was in perfect health until the trauma occurred. Within a short

while after the accident, the person developed pain that persisted

ever since. There may have been a visit to the emergency room, x-

rays and evaluations, medications, and other medical treatments.

Some or these treatments may have helped, but the pain never

disappeared and continued to be described as severe.

When this person is examined by a physician, certain abnormalities

such as tender points can be detected. Tender points are areas in

the soft tissues, especially the muscles which are very sensitive

and painful when pressed. These tender points are in distinct

locations of the body. The presence of tender points are the main

criteria used to diagnose fibromyalgia; if they are widespread in

numerous distinct locations, then fibromyalgia is considered to be

generalized. If they are more localized, i.e. involving upper body

only or low back only, they could indicate a more regional or

localized fibromyalgia. Typically, the muscles in individuals with

post-traumatic fibromyalgia will have an abnormal consistency where

the muscle is tight or nodular and has localized spasms that can be

palpated.

There is no single testing procedure that is diagnostic of post-

traumatic fibromyalgia. In fact, routine labs and other tests are

normal in fibromyalgia. There are specialized tests for fibromyalgia

which are abnormal but these tests are not considered routine and

are often done only in specialized labs or research centers.

However, specialized lab tests or x-rays are NOT needed to diagnose

fibromyalgia; the key diagnostic finding is the characteristic

tender points on the physical examination.

There is no single treatment that eliminates or cures post-traumatic

fibromyalgia. However, various treatments can help individuals with

post-traumatic fibromyalgia and the goals of the treatment are to

help one get to the best possible level, even if the condition does

not completely disappear or become cured. Each person's treatment

program needs to be individualized, and what works for some may not

work for others. Hopefully the person will find some treatment that

is helpful in dealing with the pain.

Mark J. Pellegrino, M.D. is a physical medicine specialist in

Canton, Ohio, who focuses his practice on treating patients with

fibromyalgia. The above excerpt is from Dr. Pellegrino's new

book, " The Fibromyalgia Survivor. " For more, information, call

Anadem Publishing, Inc., Columbus, Ohio at 1-800-633-0055.

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