Why would a whiplash injury cause fibromyalgia to develop?

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Q: I was in a car wreck six months ago and diagnosed with a whiplash injury. Despite medical treatment, the pain and stiffness still hasn't completely gone away. The nurse practitioner I saw thought I was developing fibromyalgia syndrome. Why would a whiplash injury cause fibromyalgia to develop?

A: There has been some considerable debate over this point. Do patients with chronic neck and/or shoulder pain from whiplash really have fibromyalgia? As you probably know, fibromyalgia, a common painful disorder among women in their middle years (40 to 60 years old) is no longer considered a "disease" but rather a syndrome.

The term syndrome is used to represent a group of symptoms that tend to occur together either at the same time or in close proximity to one another. Sometimes fibromyalgia is referred to as fibromyalgia syndrome (FMS).

The most common symptom is widespread pain throughout the body, with especially tender spots near certain joints. The pain stops people with fibromyalgia from functioning normally, partly because they feel exhausted most of the time.

Fibromyalgia is a chronic (meaning long-lasting) condition that usually requires many years of treatment. It can occur along with other forms of arthritis or all by itself. It can occur after an injury or out of the blue.

The history of an injury like a car accident is where the long-term effects of whiplash (called whiplash associated disorder or WAD) can get confused with fibromyalgia. With both conditions, there are tender points (TPs) in the neck and shoulder region.

According to a recent study, using tender points as the test in people who have chronic pain after a motor vehicle accident will often yield a diagnosis of fibromyalgia. Yet when retested six months later, the symptoms are gone for many people. The majority no longer have fibromyalgia.

Fibromyalgia is usually a long-lasting problem that doesn't just go away six months later -- not even after treatment. And it is characterized by tender points all over the body, not just in the neck and shoulder areas. As a general rule, people with whiplash associated disorder tend to have local tender points (i.e., just in the neck and shoulder and not anywhere else).

Reference: James P. Robinson, et al. Determination of Fibromyalgia Syndrome After Whiplash Injuries: Methodologic Issues. In Pain. June 2011. Vol. 152. No. 6. Pp. 1311-1316.

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