Posted by MERM on 6/21/2008, 11:04 am
Trauma and fibromyalgia: is there an association and what does it mean?
Semin Arthritis Rheum. 2000 Feb;29(4):200-16.
OBJECTIVES: The primary objective is to review current research with respect to the role of trauma in fibromyalgia (FM). A secondary objective is to hypothesize which steps need to be taken, first to determine whether such an association truly exists, and second to clarify what such an association might mean.
METHODS: An extensive literature review was undertaken, including Medline from 1979 to the present.
RESULTS: The strongest evidence supporting an association between trauma and FM is a recently published Israeli study in which adults with neck injuries had greater than a 10-fold increased risk of developing FM within 1 year of their injury, compared with adults with lower extremity fractures Several other studies provide a hypothetical construct for such an association. These include studies on
(1) postinjury sleep abnormalities;
(2) local injury sites as a source of chronic distant regional pain; and
(3) the 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 evidence supporting any association is limited and not definitive;
(4) the Israeli study, itself, has some methodological limitations; and
(5) other factors may be more important than the injurious event in determining chronic symptoms after an acute injury.
CONCLUSIONS: Although there is some evidence supporting an association between trauma and FM, the evidence is not definitive. Further prospective studies are needed to confirm this association and to identify whether trauma has a causal role.
2. Stress in Fibromyalgia
This paper focuses on recent evidence of etiopathogenetic links between fibromyalgia and life stress.
From an etiologic point of view, studies concerning the role of adverse life events, personality and lifestyle factors, post-traumatic stress, and negative childhood experiences are reviewed.
From a pathogenetic point of view, neurobiologic links between stress and fibromyalgia symptoms, notably chronic pain and fatigue are highlighted.
Finally, several methodologic issues with regard to stress research on fibromyalgia, as well as the clinical relevance of the stress concept for fibromyalgia are discussed.
3/Psychological stress and fibromyalgia/neuroendocrine link
The present review attempts to reconcile the dichotomy that exists in the literature in relation to fibromyalgia, in that it is considered either a somatic response to psychological stress or a distinct organically based syndrome.
Specifically, the hypothesis explored is that the link between chronic stress and the subsequent development of fibromyalgia can be explained by one or more abnormalities in neuroendocrine function.
There are several such abnormalities recognised that both occur as a result of chronic stress and are observed in fibromyalgia.
Whether such abnormalities have an aetiologic role remains uncertain but should be testable by well-designed prospective studies.
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