Background/Purpose: Traumatic experiences are postulated mediators of the development of Fibromyalgia Syndrome (FMS). The STRONG STAR Consortium study of PTSD provides a unique opportunity to study FMS in a large population of service members (SM) exposed to combat stress. We have previously reported a baseline 3% prevalence of fibromyalgia among active duty service members prior to deployment (Hildebrand et al, 2014). This cohort has now been re-assessed following deployment to a combat environment. 

Methods: Active duty US SM were recruited as part of a STRONG STAR Consortium study to evaluate genetic and environmental predictors of combat-related PTSD. Participants completed surveys immediately prior to overseas deployment to a combat environment and again upon return. The research classification of fibromyalgia was ascertained using the modified 2010 ACR survey criteria. Demographics, military service, and PTSD were assessed using standardized and psychometrically validated assessments.

Results: Questionnaires were completed both prior to and following deployment by 1761 SM from the original cohort of 4119. The pre-deployment (pre-D) prevalence of FMS was 2% vs post-deployment (post-D) 8% (p<.00001, odds ratio 8.2, 95% CL=4.8-14.0). The prevalence of PTSD was 20% pre-D and 23% post-D (p<.0415, OR=1.2, 95% CL=1.0-1.45). Stratification of groups by their fibromyalgia and PTSD classification revealed several trends: Among those without FMS pre-D, 13% of SM with pre-D PTSD developed FMS post-D (i.e., developed FMS during deployment) while only 6% without PTSD pre-D developed FMS post-D (p<.0001, OR=2.4, 95% CL=1.64-3.59). Among those without FMS pre-D, 23% with post-D PTSD developed FM, while only 3% of those without post-D PTSD met criteria for FMS (p<0001, OR=11.0, 95% CL=7.3-16.6). Conversely, 71% who met criteria for FMS pre-D also met criteria for pre-D PTSD while only 19% without FMS met criteria for PTSD (p<.00001, OR=10.2, 95% CL=5.0-20.9). Post-D, this ratio was similar in that 68% who met criteria for FMS also met criteria for PTSD while only 19% who did not meet criteria for FMS met criteria for PTSD (p<.00001, OR=9.4, 95% CL=6.5-13.6). For those SM gaining a new PTSD diagnosis post-D, the rate of new FMS was also significantly higher (22%) than for those who did not acquire new PTSD post-D (2.3%, p<.00001, OR=11.8, 95% CL=7.2-19.3).   

Conclusion: This is the first longitudinal study to assess the prevalence of FMS before and after a military deployment to a combat environment. Exposure to an environment in support of combat operations is strongly associated with an increased prevalence of FMS. Additionally, FMS and PTSD appear to be highly comorbid. Future research should consider the influence of other mental health diagnoses, repeated deployments, head injuries, genetic variations, and particular job exposures on the risk for FMS.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comorbid-development-of-fibromyalgia-and-posttraumatic-stress-disorder-after-exposure-to-a-combat-environment/