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Neck News

Caution: Chronic Pain After Whiplash Injuries Doesn't Equal Fibromyalgia

Anyone with chronic neck and shoulder pain following a car accident may be diagnosed as having fibromyalgia when in fact, they are simply experiencing long-term symptoms of whiplash. How can we tell the difference?

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.

What's wrong with this picture? As we mentioned, 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).

The research was conducted at the University of Washington in Seattle. The authors examined over 300 patients with continued neck and shoulder pain more than three months after a motor vehicle accident.

They tested everyone using two sets of tests: one was the standard, full test for fibromyalgia developed by the American College of Rheumatology (ACR). The second was a modified test leaving out the tender points in the neck and shoulder areas.

As it turns out, there was an inflated number of patients diagnosed with fibromyalgia when the neck and shoulder points were included. The results of this study support findings from some other studies but there is still some disagreement in results from study-to-study.

For example, one study compared the number of patients with what looked like fibromyalgia after injuries of the neck versus injuries (fractures) of the leg. The patients with neck injuries were 13 times more likely to have fibromyalgia than the group with leg fractures.

In another study, it was discovered that the patients with whiplash who also developed fibromyalgia didn't really have widespread pain (a hallmark finding with fibromyalgia) on a consistent basis. When tested every month for a year, it became clear that the symptoms were transient (came and went) after a car accident.

What is the general trend here? Just because patients with whiplash associated disorder continue to have neck and shoulder pain doesn't mean: a) now they have fibromyalgia or b) the symptoms of fibromyalgia are permanent.

In this particular study, patients were treated after their neck injuries with a combination of behavioral therapy and physical therapy. The behavioral therapy was to help keep them moving and not allow fear of reinjury to get in the way of recovery.

The results were compared to patients with fibromyalgia treated in a similar fashion. This comparison was to make sure the difference in results wasn't because of the fact that the whiplash group had this type of treatment. But again, the whiplash group did not end up with permanent symptoms of fibromyalgia so it wasn't the treatment that made the difference.

It should not be assumed that patients suffering from chronic whiplash associated disorder (WAD) have fibromyalgia syndrome (FMS) -- even when they test positive for it.

Most patients with chronic neck and/or shoulder pain following a whiplash injury don't have widespread tender points. If they do, these points are not consistently tender when tested over time. The fluctuating symptoms are an indicator that fibromyalgia is not the underlying problem.


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.

07/13/2011

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