7
Trauma and work-related pain syndromes: Risk factors, clinical picture, insurance and law interventions

https://doi.org/10.1016/j.berh.2011.01.003Get rights and content

In the past decade, major progress has been made in our understanding of fibromyalgia syndrome (FMS). Various triggers have been implicated as contributing to symptom development in FMS when genetically susceptible individuals are challenged.

A substantial amount of data points towards the association between trauma and chronic widespread pain/fibromyalgia syndrome (CWP/FMS). There is abundant data suggesting that the pathogenesis of CWP/FMS might be related to cervical spine injury. Furthermore, several persistent local pain conditions may progress to CWP/FMS. These conditions may share a common pathogenic mechanism namely, central sensitisation. Physical trauma and emotional trauma co-exist in many traumatic events and may interact in the pathogenesis of CWP/FMS.

Section snippets

Trauma, chronic pain and FMS

Twenty-nine of 127 patents (23%) with FMS reported having trauma, surgery or a medical illness before the onset of FMS, and were classified as having reactive fibromyalgia [17].

Waylonis and Perkins [18] provided a follow-up study of patients with post-traumatic fibromyalgia. A total of 60.7% noted the onset of symptoms after a motor vehicle accident (MVA) and 12.5% after a work injury.

Buskila et al. [12] assessed 102 patients with neck injury and 59 patients with leg fractures (control group)

Whiplash injury, chronic pain and fibromyalgia

A substantial amount of data points towards the association between whiplash injury and chronic pain. These conditions may share as well a common pathogenetic mechanism, namely central sensitisation.

Radanov et al. [29] have shown that 2 years after ‘whiplash’ injury of the neck, 18% of patients still had injury-related symptoms including fatigue, headaches, anxiety, sleep disturbances and muscle tenderness. Interestingly, these manifestations, although not specific, are characteristic of

Development of CWP/FMS from persistent local pain

Scientific and clinical data gathered over the past decade provide evidence for the development from an acute localised musculoskeletal disorder towards CWP/FMS.

The case of acute whiplash injury triggering the development of FMS is one example that has been already discussed [12].

Vierck Jr. [43] stated that “the progression from chronic local pain to fibromyalgia (FM) appears to be associated with injuries to deep tissues which do not heal within several months.”

Nielsen and Henrikson [44]

Work-related mechanical factors and CWP/FMS

McBeth et al. [58], determined the role of workplace low-level mechanical trauma, posture and environment in the onset of CWP. The study provided only limited support for the hypothesis that low-level mechanical injury may be a risk factor for developing CWP. The onset of CWP appeared to be multifactorial and was strongly predicted by individual psychosocial factors [58]. These authors [21] carried out another study, the aim of which was to determine whether repeated exposure to mechanical

Outcome of post-traumatic fibromyalgia

The outcome of post-traumatic FMS was found to be worse than that of non-traumatic FMS, by some authors [17], [61]. Greenfield et al. [17] found that patients with reactive FMS were more disabled than those with primary FMS resulting in loss of employment in 70%, disability compensation in 34% and reduced physical activity in 45%.

Walonis and Perkins [18] reported that 65% of the patients with post-traumatic FMS continued to have significant symptoms and clinical evidence of FMS after a

Medico-legal aspects of post-traumatic FMS/CWP

Chronic pain/FMS developing after an MVC or work injury is often a focus in determining medico-legal disability [65]. Some believe that litigation plays a major role in reporting post-traumatic CWP/FMS symptoms. However, Withe and Thompson [66] argued that, the results of their study, demonstrating that FMS is relatively common among the Amish, a community, which does not use municipal, provincial/state or federal disability compensations systems, suggest that litigation does not have a

Conclusions

Ample evidence suggests that trauma, especially to the cervical spine, may trigger the development of CWP/FMS. WADs and CWP/FMS share similar symptomatology and pathogenic mechanism (central sensitisation). Physical and emotional effects of the trauma may interact in the pathogenesis of FMS.

Practice points

  • •

    Recent evidence suggests that trauma, especially to the cervical spine, may trigger FMS/CWP.

  • •

    Emotional and physical effects of the trauma may interact in the pathogenesis of FMS.

  • •

    Central

References (74)

  • C. Linnman et al.

    Chronic whiplash symptoms are related to altered regional cerebral blood flow in the resting state

    European Journal of Pain

    (2009)
  • A.J. Holman

    Positional cervical spinal cord compression and fibromyalgia: a novel comorbiditiy with important diagnostic and treatment implications

    Journal of Pain

    (2008)
  • C.J. Vierck

    Mechanisns underlying development of spatially distributed chronic pain (fibromyalgia)

    Pain

    (2006)
  • L.A. Nielsen et al.

    Patho-physiological mechanisms in chronic musculoskeletal pain (fibromyalgia): the role of central and peripheral sensitization and pain disinhibition

    Best Practice Research Clinical Rheumatology

    (2007)
  • R. Bennett

    Myofascial pain syndromes and their evaluation

    Best Practice Research Clinical Rheumatology

    (2007)
  • H.Y. Ge et al.

    The predetermined sites of examination for tender points in fibromyalgia syndrome are frequently associated with myofascial trigger points

    Journal of Pain

    (2010)
  • A.S. Leffler et al.

    Somatosensory perception and function of diffuse noxious inhibitory controls (DNIC) in patients suffering from rheumatoid arthritis

    European Journal of Pain

    (2002)
  • E. Kosek et al.

    Abnormalities of somatosensory perception in patients with painful osteoartritis normalize following successful treatment

    European Journal of Pain

    (2000)
  • R.J. Wurtman

    Fibromyalgia and complex regional pain syndrome: similarities in pathophysiology and treatment

    Metabolism

    (2010)
  • Jo Nijs et al.

    From acute musculoskeletal pain to chronic widespread pain and fibromyalgia: application of pain neurophysiology in manual therapy practice

    Manual Therapy

    (2009)
  • A.L. Gallinaro et al.

    An evaluation of the association between fibromyalgia and repetitive strain injuriesin metalworkers of an industry in Guarulhos, Brazil

    Joint Bone Spine

    (2001)
  • D.C. Turk et al.

    Effects of type of symptom onset on psychological distress and disability in fibromyalgia syndrome patients

    Pain

    (1996)
  • L. Neumann et al.

    Outcome of posttraumatic fibromyalgia; a 3 year follow up of 78 cases of cervical spine injuries

    Seminars in Arthritis and Rheumatism

    (2003)
  • K.P. White et al.

    Trauma and fibromyalgia: is there an association and what does it mean?

    Seminars in Arthritis and Rheumatism

    (2000)
  • B. Pennie et al.

    Patterns of injury and recovery in whiplash

    Injury

    (1991)
  • F. Leavitt et al.

    Characteristics and frequency of malingering among patients with low back pain

    Pain

    (1986)
  • L. Arendt-Nielsen et al.

    Central sensitization in fibromyalgia and other musculoskeletal disorders

    Current Pain Headache Reports

    (2003)
  • M.A. Grant et al.

    fMRI evaluation of pain intensity coding in fibromyalgia patients and controls

    Arthritis and Rheumatism

    (2001)
  • R.H. Gracely et al.

    Functional magnetic. Resonance imaging evidence of augmented pain processing in fibromyalgia

    Arthritis and Rheumatism

    (2002)
  • D. Buskila et al.

    The genetics of fibromyalgia syndrome

    Pharmacogenomic

    (2007)
  • J.N. Ablin et al.

    Mechanisms of disease: genetics of fibromyalgia

    Nature Clinical Practice Rheumatology

    (2006)
  • D. Buskila

    Developments in the scientific and clinical understanding of fibromyalgia

    Arthritis Research and Therapy

    (2009)
  • F. Wolfe

    Post traumatic fibromyalgia: a case report narrated by the patient

    Arthritis Care and Research

    (1994)
  • D. Buskila et al.

    Increased rates of fibromyalgia following cervical spine injury. A controlled study of 161 cases of traumatic injury

    Arthritis and Rheumatism

    (1997)
  • A.W. AlAlaf et al.

    A case control study examining the role of physical trauma in the onset of fibromyalgia syndrome

    Rheumatology (Oxford)

    (2002)
  • R.M. Bennett et al.

    An internet survey of 2596 people with fibromyalgia

    BMC Musculoskeletal Disorders

    (2007)
  • G. Wynne-Jones et al.

    Predicting new onset widespread pain following a motor vehicle collision

    Journal of Rheumatology

    (2006)

    • Cited by (0)

    View full text
    Copyright © 2011 Published by Elsevier Ltd.