Can fibromyalgia be associated with whiplash injury? A 3-year follow-up study

Abstract

The objective of this study is to assess the long-term outcome and natural history of a cohort of patients with whiplash injury regarding the development of fibromyalgia. Of the 153 patients who were admitted to the emergency room after whiplash injury in 2004, 126 were reassessed 3 years later. Also, 33 of 53 patients from the original control group of hospitalized patients with fractures were reevaluated. Patients were interviewed by phone and by written forms using a detailed questionnaire. Patients who complained of musculoskeletal symptoms were invited and examined. The study group included 68 men and 58 women, with a mean age of 50.1 ± 9.7. The control group included 19 men and 14 women with a mean age of 44.2 ± 10.3. Follow-up period did not differ significantly between the groups 38.3 ± 2.3 vs. 36.4 ± 4.2 months. At the end of the follow-up period, three patients in the study group compared with one patient in the control group were diagnosed as having fibromyalgia; all of them were women. The rate of new onset widespread pain increased with time in both groups. Symptoms of dizziness, headaches, fatigue and sleep disturbances improved, as well as the quality of life (QOL) and the Fibromyalgia Impact Questionnaire (FIQ) scores. Insurance claims continued to be more prevalent in the control group. The results of this extended follow-up study confirm previous short-term results showing that whiplash injury and road accident trauma are not associated with an increased risk of fibromyalgia.

Determination of fibromyalgia syndrome after whiplash injuries: Methodologic issues

“…Recently Tishler et al, [19] published a 3-year prospective cohort study following the original individuals in the Tishler et al study who had WL following an MVC. These investigators reported a 2.5% prevalence of FM [19], no higher than the established prevalence of FM noted in the general population.…”

“…These investigators reported a 2.5% prevalence of FM [19], no higher than the established prevalence of FM noted in the general population. On the surface, it might seem that our results fall somewhere between the estimates cited previously by Buskila et al [4] and Tishler et al [19, 20]. However, these studies contain limitations that raise concerns about the validity of the results.…”

“…Buskila himself raised concerns about the interpretation and conclusion that could be drawn based of the results of his study [3]. Tishler et al [19, 20] relied on participants’ reports of symptoms and functioning following MVCs, and follow-up physical examinations were only conducted if patients reported elevated symptoms during telephone interviews.…”

A Medicolegal Analysis of Worker Appeals for Fibromyalgia as a Compensable Condition Following Workplace Soft-tissue Injury

“…Two studies from the United Kingdom have linked motor vehicle accidents, but not workplace injuries, with onset of diffuse pain, with poorer general health and psychological status in the pre-accident phase recorded as important predisposing factors 13,14 . Therefore, reports relating injury to causation in FM, mostly following whiplash injury, both support and refute the association of localized injury and diffuse pain 16,17,18 . Therefore, reports relating injury to causation in FM, mostly following whiplash injury, both support and refute the association of localized injury and diffuse pain 16,17,18 .…”

Comment on “Fibromyalgia and Physical Trauma: The Concepts We Invent”

“…In their review of Tishler, et al 7,8 , the authors forgot to mention that the majority of the patients were male, in contrast to the expected sex distribution in FM. Only 0.6% of the study group developed FM, far below the expected prevalence of FM in the general population, suggesting a protective role for neck injury in FM.…”