Does Trauma Cause Chronic Widespread Pain?, Volume 5, Issue 5, March 2000

CHRONIC WIDESPREAD PAIN

Does Trauma Cause Chronic Widespread Pain?

SUMMARY Chronic widespread pain is a frequently reported symptom. Like most common bodily symptoms, chronic widespread pain usually does not have a serious cause. Chronic widespread pain sufferers who blame localised soft-tissue injury have more severe symptoms and greater disability. There is little scientific basis for such causal attribution.

Chronic widespread pain is a frequently reported symptom. Widespread pain, like Low Back Pain¹, is common in the otherwise healthy, uninjured population². A US population survey found that 0.5% of men, 3.4% of women and more than 7% of older women fulfilled the generalised pain and tender point criteria for FibroMyalgia Syndrome (FMS). These sufferers not seeking medical attention are less distressed than patients, but more distressed than people without chronic widespread pain³.

PRACTICE POINT

Chronic widespread pain is relatively common in the uninjured female population

Like most common bodily symptoms, chronic widespread pain usually does not have a serious cause. A wide diversity of symptoms that accompany generalised chronic pain are similarly prevalent in those without disease or injury⁴.

Some people have an increased liability to somatise⁵. Among general practice patients, between two and three out of every five patients complain of symptoms that have no serious basis. Even among general medical outpatients, less than 1 in 5 of those with the most common bodily symptoms proves to have a physical cause.

Chronic widespread pain sufferers who blame localised soft-tissue injury have more severe symptoms and greater disability. The belief in a precipitating event, rather than acceptance of a medical condition of uncertain cause, appears to both amplify symptoms and increase disability⁶.

There is little scientific basis for such causal attribution. Evidence Based Medicine⁷ does not support the contention that localised trauma causes Chronic Widespread Pain^{8,
9}. The finding that cervical spine injury was thirteen times more likely to be followed by FMS than leg fracture¹⁰ remains the only quality study supporting a traumatic cause.

PRACTICE POINT

There is currently neither empirical evidence nor a pathological basis for causation of chronic generalised pain by localised injury

Injury may provide a focus for attribution of those symptoms. As with Low Back Pain and neck pain¹¹, the occurrence of compensable injury may cause patients to misattribute chronic or recurrent widespread pain that they do not recall as pre-existing.

PRACTICE POINT

Have at least 5 years of pre-injury clinical records reviewed before proposing or conceding de novo onset of widespread pain

However, if examination of the pre- and post- injury clinical records confirms de novo onset shortly after compensable injury, medical expert opinion favouring post-traumatic cause may prevail, even though there is presently little or no understanding of a pathophysiological mechanism.

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