Whiplash and brain injury educational materials

Whiplash Injury

Educate juries about the anatomy of auto injuries with our popular Auto Injuries PowerPoint

 

Posttraumatic Fibromyalgia: Physician Survey

Fibromyalgia (FM) is a controversial medical subject. Recent studies have found possible links between physical trauma and onset of FM symptoms with 25% to 50% of FM patients studied recalling some trauma event that occurred just before their FM symptoms began. This study by Canadian researchers sought to determine which issues general practitioners, orthopedic surgeons, physiatrists and rheumatologists consider most important in the patient with widespread chronic pain after a motor vehicle trauma. The authors' undertook this study in order to establish guidelines for future research on trauma and FM.

The researchers mailed a survey package to a random sample of 287 general practitioners, 160 orthopedists, 160 physiatrists, and 160 rheumatologists. The package included a case scenario of a 45-year-old female, with a whiplash injury who went on to develop chronic, generalized pain, fatigue, difficulties in sleeping, and diffuse muscle tenderness. Also included was a questionnaire asking if the respondents agreed with a diagnosis of FM, and asking them to detail what factors they found important in the development of chronic, generalized posttraumatic pain.

Those most likely to agree with the diagnosis of FM were rheumatologists (83%). Physiatrists and general practitioners fell in the middle (60.4% and 70.5% respectively). The least likely to agree were orthopedists (28.8%). Recent medical school graduates were also more likely to agree with the diagnosis.

There were five factors important in the respondent's agreement or disagreement with the FM diagnosis:

  1. The number of FM cases diagnosed weekly by the respondent.
  2. The patient's gender.
  3. The force of the initial impact.
  4. The patient's psychiatric history before the trauma.
  5. The initial injury severity.

The average number of FM diagnoses per week was the best predictor of agreement with a diagnosis of FM in the case scenario. Researchers found that specialty was only weakly linked to the likelihood of agreement; they speculate that this may be because of the strong association between number of FM cases diagnosed per week and specialty. The importance of the patient's sex as a strong predictor was not surprising as most studies of FM focus on women. All of the physician groups showed reluctance in ascribing responsibility for the chronic widespread pain to the trauma itself. They considered patient factors including attitudes, personality, and level of emotional stress, and in the case of orthopedists, ongoing litigation as more important than the trauma. Further patient factors that a majority of respondents considered important were pre-trauma physical health and fitness, and psychological health. It is interesting to note that once analysis of the respondent's data was completed, only the patient's pre-accident psychiatric history remained in the model predicting agreement or disagreement with the FM diagnosis.

The factors related to the accident, force of initial impact, and initial injury severity each predicted less than 1% of the variants. The force of impact was negatively correlated and the initial injury severity was positively correlated.

The authors emphasize that their study is not intended to assess the true association of trauma and FM. It is an opinion poll of different physician groups, intended to help future researchers in work on trauma and FM better design their studies, and to inform them as to which factors should be measured to gain appropriate interpretations of study results. They state:

"We argue that future studies of any association between trauma and FM should identify individuals suffering a traumatic event either prior to or as soon as possible after the trauma. They should be recruited outside of a specialty clinic (for example, in the emergency department or the GP's office). We also recommend that baseline assessment include some measurements of personality, emotional stress, and pre-accident physical and mental health. Subsequent research will determine whether these factors do predict the development of FM after trauma or merely reflect physicians' judgmental biases."

This study was limited in two respects. The case scenario did not state that the patient experienced chronic widespread pain for at least 3 months when diagnosed. The authors explain, "We wanted to eliminate the possibility that familiarity with the 3 month pain requirement of the ACR criteria would influence our results. However, we cannot rule out the possibility that we created bias by failing to include this detail." It is also possible that the study suffered from response bias. There is a chance that those that did not return the questionnaire had systematically different opinions than those that did return the questionnaire. However, the authors note that their response rate was consistent with that of other physician surveys.

White K, Ostbye T, Harth M, Nielson W, Speechley M,Teasell R, Bourne R. Perspectives on posttraumatic fibromyalgia: a random survey of Canadian general practitioners, orthopedists, psychiatrists, and rheumatologists. The Journal of Rheumatology 2000;27(3): 790-796

 

Please note that this article is copyrighted and may not be reproduced without permission. To include our articles and videos on your website, check out our chiropractic marketing.