The development of widespread pain after injuries

Objective: To evaluate the evidence suggesting the development of widespread pain and fibromyalgia [FMS] after musculoskeletal injuries. Findings: Few studies have determined the frequency of a precipitating event occurring prior to the onset of widespread pain and FMS. Evidence comes mostly from case series or case reports. The strongest evidence supporting the development of widespread pain and FMS comes from an Israeli study in which adults with neck injuries had a 10-fold increased risk of developing FMS within one year of their injury, compared with adults with lower extremity fractures. Although widespread pain and FMS may be associated with trauma, the present data from the literature are insufficient to indicate whether causal relationships exist between injuries and widespread pain. It was suggested that precipitating triggers such as injuries might interact with genetic factors, and together cause the development of FMS, which is the result of central nervous system dysfunction. The outcome of post-injury widespread pain/FMS was found in most of the reports to be worse than that of idiopathic FMS. Social systems and social acceptability of work disability play a strong role in determining the outcome of post-injury FMS. Conclusions: Widespread pain and FMS are obviously associated with injury. However, overall data are insufficient to indicate whether causal relationships exist between injury and FMS. Future studies should prospectively document the chronology of symptoms from the onset of the injury and repeatedly evaluate the patients for disability, quality of life, change in occupation, and litigation status.