Can trauma trigger fibromyalgia?

Fibromyalgia is a chronic pain disorder affecting the central nervous system. It causes widespread pain and tenderness throughout the body, fatigue, trouble sleeping, cognitive problems, and a host of other symptoms. The exact cause of fibromyalgia is unknown but is likely a combination of genetic and environmental factors.

Diagnosing fibromyalgia

There is no single test for diagnosing the condition. Instead, doctors have traditionally diagnosed fibromyalgia based on a patient’s history and a physical examination. But as we discussed in an article last year, the Royal College of Physicians (RCP) has now published clinical guidelines – ‘The diagnosis of fibromyalgia syndrome‘ which, for the first time, provides some structure and cohesion to the diagnostic process.

Traumatic onset of fibromyalgia

One environmental factor that may trigger fibromyalgia is trauma, which is any event causing a person to feel intense fear, helplessness, or horror. It can be physical or emotional, and studies demonstrate that people who experience trauma are more likely to develop fibromyalgia than those who have not. Typical triggering events include:

• a serious injury, such as a road traffic accident.
• major surgery.
• an infection, such as Lyme disease.
• emotional trauma, such as that experienced in military combat.

Sometimes, however, there is no obvious trigger.

One possible explanation for trauma triggering fibromyalgia is that it can change how the brain processes pain. In people who have experienced trauma, the amygdala, the part of the brain that processes emotions, becomes more active, leading to a heightened sensitivity to pain.

Another possible explanation is that trauma can change how our nervous system responds to stress. Following the traumatic event, the body’s stress response becomes more exaggerated, leading to fibromyalgia symptoms.

Fibromyalgia following a road traffic accident

In many of our clients with fibromyalgia, the triggering traumatic event is a road traffic accident. But research suggests that although such an accident can trigger fibromyalgia, it does not result from direct ‘mechanical’ injury. Instead, the trauma of the accident acts as a stressor, which along with other factors such as genetic vulnerability and psychosocial and cultural factors, can result in the person developing chronic widespread pain and other symptoms.

It’s also possible that a road traffic accident or other trauma can make existing symptoms of fibromyalgia worse.

Proving trauma caused fibromyalgia

There are many possible triggering events for fibromyalgia. And, as mentioned above, it’s also possible that there is no obvious trigger. So, in the context of claiming compensation following an accident, how do you prove the accident was responsible?

The legal test applied is ‘on the balance of probabilities’. In other words, is it more likely than not that the accident was the triggering event?

In answering that question, the judge is guided by expert medical evidence, most likely from rheumatologists. We use the plural as it’s inevitable that the claimant and the defendant will each have instructed a rheumatology expert. And, of course, the two rheumatologists may disagree on the answer to the causation question. So, in that case, the judge must decide whose opinion they prefer.