Background/Purpose: Triggering events – those that are followed by the onset or rapid increase in FMS symptoms – have a significant impact in some cases.  In order to learn more about the nature and impact of triggering events, we asked FMS patients about traumatic experiences in their lives, and whether these events affected the onset of their FMS symptoms.

Methods:  As a part of an Internet survey administered by the volunteer community fibromyalgia organization, AFFTER, 763 female self-identified FMS patients and 115 female controls without FMS responded to questions about emotionally stressful or life-changing events and whether any of these events suddenly triggered FMS, as well as follow-up questions on the pace of onset of FMS symptoms before and after triggering events. Only women’s responses were analyzed to eliminate confounding by gender.

To validate the Internet Survey, an identical rheumatology office questionnaire was administered to 115 FMS patients and 63 control patients with other rheumatic diseases.  The chi-square test of association and Fisher’s exact test were used to compare percentages, and the Mann-Whitney test was done to compare FMS and control patients with respect to age. A 0.05 significance level was used and all tests were two-sided.

Results:  In the Internet survey the mean respondent age was 49.8 ± 11.4 years. 78.0% of FMS respondents reported that they had experienced a significant life-changing event or emotional stressor, vs. 35.7% of controls (p < 0.001). Specific traumatic events experienced by FMS patients vs. controls included major surgery (70.4% vs. 43.5%, p < 0.001), major or long lasting illness (44.7% vs. 18.3%, p < 0.001), and accidents 26.9% vs. 12.2, p = 0.001).

Post-traumatic symptoms included startling easily (32.2%), intrusive memories of the trauma (18.1%), nightmares (17.7%), reluctance to speak or think about the trauma (14.5%), and symptoms of hypervigilance and post-traumatic stress disorder.  30.2% indicated that their FMS began suddenly after one of these events. These post-traumatic episodes generally began as either back pain (50.4%), neck pain (50.0%) or both.

In the rheumatology office practice questionnaire 81.7% of FMS patients and 61.9% of control patients were women (p = 0.004). The mean age was 48.1 ± 12.3 years for FMS patients and 50.7 ± 13.6 for control patients (p = 0.092). 88.7% of FMS patients and 76.2% of control patients reported that they had experienced at least one very stressful or life-changing event (p = 0.028). Some of the FMS patients who reported a traumatic FMS trigger also reported other post-trauma symptoms: startling easily (15.4%), intrusive memories of the trauma (10.3%), reluctance to speak or think about the trauma (10.3%), and nightmares (7.7%).

Conclusion:  Surgery, severe illness, and accidents precipitated the onset of fibromyalgia in some patients. In the Internet survey, 30.2% of fibromyalgia patients experienced FMS onset after a traumatic event.  Fibromyalgia symptoms usually began with neck or back pain. Some of the FMS patients experienced symptoms consistent with hypervigilance and post-traumatic stress disorder.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/events-that-trigger-the-onset-of-the-fibromyalgia-syndrome-fms/