Developments in the Scientific and Clinical Understanding of Fibromyalgia

Dan Buskila

Disclosures

Arthritis Res Ther. 2009;11(5):242 

In This Article

Triggers

In addition to the genetic associations, various external stimuli such as infection, trauma and stress may contribute to development of the syndrome (see Table 3). Bennett and colleagues provided an Internet survey of 2,596 people with FM.[32] Approximately 21% of responders indicated that they could not identify any triggering events of their illness. Over 73% of those who indicated some triggering event made attributions to emotional trauma or chronic stress. The next most common attribution was acute illness (26.7%), followed by physical stressors (surgery, motor vehicle collisions, and other injuries). Various infectious agents have been linked to the development of FM as well as to that of the closely related chronic fatigue syndrome.

Viral agents, including hepatitis C and HIV, have been associated with FM on epidemiological and clinical grounds.[33,34] In particular cases, such as Lyme disease and HIV, obvious overlap of clinical manifestations can be described; nonetheless, evidence of the utility of antibiotic or antiviral treatment in FM or chronic fatigue syndrome is lacking.[35]

Various forms of physical trauma have been implicated as triggering events in the pathogenesis of FM. Increased rates of FM have been demonstrated among patients undergoing cervical trauma during motor vehicle accidents.[36] Most recently, Wynne-Jones and colleagues found a 7.8% frequency of widespread pain within 12 months among a cohort of patients who underwent a motor vehicle collision.[37] Emotional trauma and stress have also been implicated as triggers of FM. Post-traumatic stress disorder may precipitate the development of FM, and both conditions share similar pathogenic mechanisms.[38]

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