The role an acute traumatic injury such as whiplash has on the diagnosis of fibromyalgia (FM) is a controversial issue among scientists in the field of neuroscience and rheumatology. The conflicting results of studies conducted on the issue add to this continuing controversy.
The main point of debate is that the criteria used in determining fibromyalgia may result in inflated rates of diagnosis among whiplash patients because of persistent localized tenderness after motor vehicle collisions, which is also a hallmark symptom of FM.
Dr. Robert Ferrari MD., Professor Department of Medicine, University of Alberta, Canada, is focused on providing evidence to squelch the continuing debate. In his latest study entitled, “To measure the 1-year incidence of fibromyalgia in a cohort of acute whiplash-injured participants,” released this week in the new on-line open access journal Rheumatic and Musculoskeletal Diseases, measured the precise number of new cases of FM that can be contributed to an acute whiplash injury.
To determine this number, Dr. Ferrari followed 264 patients who met the following study criteria:
- WAD assessment was made within 14 days of their collision at 1 of 4 primary care centers taking part in the study over a 9-month period in 2012–2013
- WAD grade 1 or 2
- Seated within the interior of a car, truck, sports/utility vehicle or van in a collision, and had no loss of consciousness
- No history of previous WAD injury
- No previous diagnosis of fibromyalgia or other chronic pain condition such as rheumatoid arthritis, chronic mechanical spinal pain, or osteoarthritis
He assessed these patients for the presentation of FM at 3 months, 6 months and 1 year post-injury. At each visit, participants were also examined for recovery from whiplash injury.
The recovery rate from whiplash injury and Modified 2010 ACR criteria scores in this patient sample was as follows:
- At the 3-month follow-up, 62% (167/268) of participants reported recovery from their injuries.
- At 6 months, 76% (203/268) reported recovery.
- At 1 year 82% (216/264) reported recovery.
- At 3 months follow-up, none of the participants met the Modified 2010 ACR criteria for fibromyalgia.
- At 6 months follow-up, three participants had scores that met the Modified 2010 ACR criteria for fibromyalgia.
- Further assessment of these patients showed that their symptoms were results of other conditions.
- At the 1-year follow-up, ACR criteria for fibromyalgia were met, for 2 participants (0.8%), without any other explanation for their symptoms.
When discussing the findings, Dr. Ferrari stated, “The results are not surprising, as 80% of the acute whiplash-injured participants had recovered at 1 year. This leaves only 20% who could be at risk for fibromyalgia. When one examines the non-recovered participants, however, even though they have chronic pain and disability, they often report very localized pain disorders, such as chronic headache, chronic neck pain only, or even chronic low back pain only.”
For this study population, the evidence presented shows that with a 0.08% incidence rate post-injury, the likelihood of whiplash being the primary cause of the newly diagnosed cases is low. To determine if these results are generalizable to the entire population and to put this debate to a final end, a larger randomized trial should be conducted.