How a disorder starts can be very informative. A rapid onset illness associated with swollen lymph glands, muscle aches, fatigue and fever so often marks the onset of a short-term infection that rarely do doctors attempt to identify the precipitating pathogen. Other beginnings are more obscure. The onset of complex regional pain syndrome (CRPS) usually starts with a wound,  but research suggests an infection occurring before the wound appears to be necessary to prime the system to respond bizarrely to the wound.

ball rolling fibromyalgia

What got the ball rolling in fibromyalgia? For many people – maybe nothing…

Fibromyalgia seemed a lot simpler. Most cases were probably triggered by a physical trauma (eg car accident or surgery) or infection.  A recent study, however, suggested that the most common road to fibromyalgia involves neither a physical trauma or an infection.

The most common pathway to FM, in fact, doesn’t involve anything discernible at all.  For most people with FM, their FM appears to have descended like the dusk falling – slowly and surely and for no obvious reason. It just happened.

Am J Phys Med Rehabil. 2015 Apr 16. [Epub ahead of print]. Physical Trauma and Infection as Precipitating Factors in Patients with FibromyalgiaJiao J1, Vincent A, Cha SS, Luedtke CA, Kim CH, Oh TH.

The study looked at almost 1,000 patients, 94% of whom were women. Despite the consensus that a traumatic event – either physical trauma or infection –  usually kicks off  FM, only 27% of patients reported an obvious precipitating factor.  Of those 22% reported experiencing some sort of physical trauma (e.g. motor vehicle accident), while 5% reported an infection was present. Seventy-two percent reported no obvious trigger at all.

The most common physical trauma reported was a car accident (6%), followed by surgery (5%) and childbirth (3%). When an infection did appear to trigger FM it was usually a respiratory infection.  Only 1% of FM patients reported having an infection associated with Epstein-Barr virus.

Emotional traumas such as the death of a family member or the loss of a job – the types of things that often tip some people over into depression –  rarely triggered FM (@3%). That’s an intriguing finding given how susceptible some people with FM are to the effects of emotional stress.

The type of trigger may have some impact on later health.  People with infection triggered fibromyalgia had worse quality of life scores but better emotional health scores.

The study deepens the mystery that is fibromyalgia. Physical trauma or infection have been supposed to precipitate FM by triggering a cascade of responses that ultimately jumble the system up.  While it’s not clear how it happens it’s fairly easy to envision  a rapid and traumatic event such as surgery or a car accident triggering an alteration in the pain response system.  Similarly, it’s fairly easy to envision an infection throwing the immune system or a stressful event throwing the immune or endocrine systems out of whack.

For most of the FM patients in this study, however, FM appears to have just happened.

Take the Poll

How did your fibromyalgia happen? We dig deeper in a poll on the Health Rising Forums. Take it and let us know here.

Thus far the numbers are flipped in our poll; just 25% of poll respondents report nothing unusual occurred at the time of onset. We’re also asking about gut infections and feelings of being overworked or stressed at the time. Check it out here.


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