Determination of fibromyalgia syndrome after whiplash injuries: Methodologic issues

Abstract

Problems in diagnosing FM among motor vehicle collision (MVC) patients with whiplash (WL) include: the predominance of tender points (TPs) in the neck/shoulder girdle region; the 3-month duration of widespread pain criterion; and, the stability of diagnosis. The present study examined the prevalence of FM in a cohort (N = 326) with persistent neck pain 3 months following WL injury who were enrolled in a treatment program. Physical examinations were performed at baseline and at the end of treatment. Results indicated that WL patients had a greater proportion of neck/shoulder girdle TPs, relative to distal TPs. Compared to a matched cohort of treatment-seeking FM patients, WL patients indicated less distal TPs (M = 7.3 TPs vs. M = 5.6 TPs, p < 0.001), but were equivalent on neck/shoulder girdle TPs (M = 9.0 TPs vs. 9.2 TPs, ns). Baseline prevalence of FM for the WL cohort based on ACR criteria was 14% (95% CI: 10% – 18%), adjusted TP criterion discounting for neck/shoulder tenderness indicated a prevalence of FM of 8% (95% CI: 5% – 11%). Finally, 63% of patients meeting American College of Rheumatology FM criteria at baseline did not meet this criterion at post-treatment (approx. 6-months post-MVC). In conclusion, present criteria used in determining FM may result in spuriously inflated rates of diagnosis among WL patients due to persistent localized tenderness following MVC. Furthermore, the transient nature of FM “symptoms” among WL patients should be taken into account before making a final diagnosis.

The prevalence of fibromyalgia among patients with cervical radiculopathy due to cervical disc herniation: A pilot study

“…Our findings were consistent with a previous study done by Robinson et al. [23]. They investigated the prevalence of FM in a cohort of individuals with persistent neck pain 3 months after a whiplash injury and reported that the participants with FM preferentially reported tenderness in neck/shoulder girdle muscles compared with distal muscles.…”

“…They investigated the prevalence of FM in a cohort of individuals with persistent neck pain 3 months after a whiplash injury and reported that the participants with FM preferentially reported tenderness in neck/shoulder girdle muscles compared with distal muscles. They emphasized that 10 TPs are located around the neck and shoulder regions and this may bias the diagnosis of FM in patients with motor vehicle collision [23]. This also has to be taken into account when considering a diagnosis of FM in patients with CDH.…”

“…They found baseline prevalence of FM as 14%. They followed patients approximately 6 months and reported that 63% of patients meeting FM criteria at baseline did not meet this criterion at posttreatment [23]. Thirdly, there were only 6 male patients included to the study population.…”

The Central Sensitization Inventory (CSI): Establishing Clinically Significant Values for Identifying Central Sensitivity Syndromes in an Outpatient Chronic Pain Sample

“…The presence of CS has been demonstrated in CSS populations by comparing the pain thresholds of CSS patients to the thresholds of pain-free controls to various stimuli (such as electrical, pressure, cold, and heat). Objective measures of CS, which complement subjective self-report, include brain imaging and nociceptive spinal reflex tests 24,25,43 , CS is associated with allodynia, hyperalgesia (excessive sensitivity to a normally-painful stimulus), expansion of the receptive field (pain extending beyond the area of peripheral nerve supply), and unusually prolonged pain after a painful stimulus has been removed (usually throbbing, burning, tingling, or numbness). 44 CS has been proposed as the root etiology for “Central Sensitivity Syndromes” (CSSs) 15,30,41 , which refer to a group of medically-indistinct disorders for which no organic cause can be found.…”

Do Comorbid Fibromyalgia Diagnoses Change After a Functional Restoration Program in Patients With Chronic Disabling Occupational Musculoskeletal Disorders?

“…Most research assumes that fi bromyalgia is stable and chronic. 11 , 12 , 13 Treatments resulting in loss of the fi bromyalgia diagnosis involved relaxation training or exercise in a rheumatology clinic, 11 cognitive behavioral therapy, 12 and an interdisciplinary treatment at a community pain clinic. [7][8][9][10] The small number of studies that have examined fi bromyalgia diagnosis changes have all examined fi bromyalgia as the primary diagnosis and found that 30% to 70% of patients lost the diagnosis after discharge.…”