Fibromyalgia often goes undiagnosed due to lack of understanding of the symptoms which often present themselves following an injury.
What is fibromyalgia?
Fibromyalgia is a chronic muscular/tendon pain disorder. The exact causes of which are unknown, but several factors are thought to be triggers of the condition.
What is clear is that many of the symptoms can be mistaken with other conditions which is why it often takes a long time to obtain a diagnosis.
What are the causes?
Fibromyalgia is often triggered by a stressful event, including physical stress or emotional (psychological) stress, such as an accident and/ or injury.
Further triggers for the condition include:
Having an operation
Being in an abusive relationship
The death of a loved one
Poor sleep patterns
A viral infection
The breakdown of a relationship
It is fair to say, however, that some Fibromyalgia patients may be predisposed to develop the condition without one specific trigger. There is also a body of evidence to suggest that people who have experienced childhood trauma such as abuse are more prone to develop the condition in adulthood, although this is controversial and tends to play towards the argument that fibromyalgia has a somatic origin rather than being physiological. Victims of fibromyalgia find it very frustrating to be told that their condition may be psychological in origin.
In forming an opinion as to the cause and onset of the condition, particularly in medico-legal cases, experts will take a detailed view of the patients pre-existing physical and psychosocial history in order to establish, or not, whether medical causation of Fibromyalgia is as a result of a single trigger or whether they were already symptomatic or were likely to be in the future, in the absence of one specific event.
The official criteria for classification of Fibromyalgia broadly states that patients with Fibromyalgia or fibromyalgia pain syndrome (FPS), will have severe pain in three to six different areas of their body, or milder pain in seven or more different areas.
The patient should also experience pain (not just “tenderness”) in at least 11 of 18 tender point sites when palpated (pushed) as shown below.
When might it reasonably be classified as fibromyalgia?
The symptoms will have remained at a similar level for at least three months and there will be no other obvious cause for the symptoms, such as a fracture or tumour. X-Rays may be undertaken to establish a bony or soft tissue injury/ cause.
Pain will be exhibited in both sides of the body, above and below the waist. In addition, pain in the cervical spine, anterior chest, thoracic spine or low back must be present.
Pain neural pathways
One of the main theories is that Fibromyalgia patients have developed changes in the way the central nervous system processes pain messages, often described as the neuropathic pathways. This could be due to changes to chemicals within the central nervous system.
The central nervous system (brain, spinal cord and nerves) send messages all over the body, including messages triggering a pain response.
Changes in the way this system works may explain why Fibromyalgia results in constant feelings of, and extreme sensitivity to, pain. The gateway to pain is disrupted and may be less capable to shut down, causing pain signals to reach the brain, sometimes when the trigger for pain is no longer present.
Could the condition be hereditary / genetic?
Genetics may play a part in a patient’s predisposition to development Fibromyalgia, with some people perhaps being more likely than others to develop the condition because of their genes.
If this is the case, genetics could explain why many people develop Fibromyalgia after some sort of trigger. Also, the age of a patient can be relevant, and research has shown that people, particularly females between the ages of 40 and 50 are more likely to develop the condition. Misdiagnosis or late diagnosis
There are several other conditions often misdiagnosed as Fibromyalgia, in the same way that late diagnosis of fibromyalgia is commonplace due to a range of previous opinions offered to explain the symptoms.
Before being formally diagnosed, it is likely a patient would be considered for conditions such as osteoarthritis, rheumatoid arthritis and lupus.
Patients will likely be asked about how their symptoms are affecting their daily life. A patient should be examined to check for visible signs of other conditions – for example, swollen joints may suggest arthritis, rather than Fibromyalgia.
Tests to check for some of these conditions include urine and blood tests and you may also be sent for X-rays and other scans.
Can it be treated or better cured?
Sadly there’s no cure for the condition at this stage, although some physicians say that activity or exercise, coupled with good posture, stopping smoking and weight loss are all factors that help and coupled with physical and psychotherapy can meet with a good quality of life. However, there is certainly not a pill or a definitive cure currently. Understanding is increasing and specialist treatments can help manage the condition to some extent and improve overall quality of life.
A GP will play an important role in the treatment and care. If patients have developed the condition as a result of an accident for which a third party is to blame, it may be that insurance-funding can be secured in order to access specialist treatment.
In some cases, a multidisciplinary approach to a patient’s care might be advised and often includes:
Pain Consultants – a specialist in anaesthetics and management of pain
Rheumatologists – a specialist in conditions that affect muscles and joints
Neurologists - a specialist in conditions of the central nervous system
Psychologist – a specialist in mental health and psychological treatments
Physiotherapists – a specialist in physical rehabilitation
Often patients are best referred onto a pain management programme, where they can benefit from expertise from each field of medical expertise.
Fibromyalgia has numerous symptoms, meaning that no single treatment will work for all of them nor will the medication be as effective on every patient. Treatments that work for some people will not necessarily work for others.
A variety of treatments may need to be explored in order to find a combination that suits a particular patient. This will normally be a combination of medication and lifestyle changes. Breaking the pain cycle can often lead to the best outcomes.
Gentle re-engagement with activities often avoided by Fibromyalgia patients, can improve mental health and assist them engaging in physical and psychological rehab to maximum effect.
As part of the successful treatment of the symptoms of Fibromyalgia, a review of medication will be required, and it is likely a patient will be prescribed painkillers and antidepressants.
Often over the counter painkillers such as paracetamol are not effective in controlling symptoms of pain. A GP may prescribe stronger medication such as opioids if regular non opioid based medications prove ineffective.
Painkillers of this kind can be addictive, and their effect tends to weaken over time. This means that the dose may require increasing over time and addiction and withdrawal are risks.
Antidepressants can also be effective in helping boost certain chemicals in the brain which helps to ease widespread pain, but these can sometimes cause side effects and need to be closely monitored by a patient’s GP. Some antidepressants, such as diazepam, are also used as muscle relaxants.
Concerned that you might have fibromyalgia?
If you consider the symptoms explained within this article are similar to those experienced, it would be worth having a conversation with your GP so that they can give you the necessary medical opinion or referral to a specialist.
At FT Chronic Pain Solicitors, we are not doctors, however, have seen and represented many clients who have developed fibromyalgia as a result of an accident. If you had an accident within the past 3 years and you feel your health has gone downhill and your recovery just has not happened, talk to us. Any lasting pain that persists beyond three months of an injury could be described as chronic in nature.
For all of the reasons stated above in terms of diagnosis of the condition and the broad range of alternative causes of pain, can make it very difficult to establish as fact that one event, such as a car accident has caused the condition to arise.
Listen to our video on causation in fibromyalgia cases and call us today if you would like a free initial consultation. Even if you already have a solicitor you can talk to us informally on 0800 999 1078.
In some cases, you can even transfer your claim to us if you are unsatisfied that your solicitor has the knowledge or expertise to best investigate your condition.