Falling, Fear of Falling and Psycho-vestibular Syndrome in Fibromyalgia

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Causes of falling[edit]

The causes of fear of falling and actual falling by fibromyalgia patients are only partially known. The author’s current (2021) impression is that the main causes are severe fatigue, deconditioning, and in some people psychological issues such as his case of a woman who was psychologically traumatized by a severe fall and who became fearful of falling.

In the clinical experience of the author, many very severe fibromyalgia patients end up using walking aids such as walkers. The author’s impression is that many of the severe cases do not exercise enough because of pain and other concerns. Those that fail to exercise are prone to becoming deconditioned and weak. Various efforts have been made to try to deal with this including aqua fitness.

Associated fear of falling[edit]

A study by Collado-Mateo indicated that along with falling there is an associated fear. (Fear of Falling in Women with Fibromyalgia and Its Relation with Number of Falls and Balance Performance. Collado-Mateo D1, Gallego-Diaz JM1, Adsuar JC1, Domínguez-Muñoz FJ1, Olivares PR2, Gusi N1. Biomed Res Int. 2015;2015:589014. doi: 10.1155/2015/589014. Epub 2015 Nov 5.)

The high frequency of falling in fibromyalgia patients[edit]

A study by Meireles et al. looked at the frequency of falls in 60 patients in each of the following groups: fibromyalgia, rheumatoid arthritis, and controls. Results were: “Fibromyalgia patients had a higher frequency of falls than RA patients and control individuals in one month (p<0.0001), in six months (p<0.0001) and in one year (p<0.0001). No relationship was found between falls and body mass index, pain or depression scores. Falls in 12 months were associated with higher Fibromyalgia Impact Questionnaire values.” Prevalence of falls in fibromyalgia patients. Meireles SA1, Antero DC2, Kulczycki MM1, Skare TL2. Acta Ortop Bras. 2014;22(3):163-6, available in full online at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4108701/.)

Psychological themes related to falling that have been found in fibromyalgics[edit]

Rutledege et al. have conducted what they call a “descriptive longitudinal study” of falls using “fall diaries and interviews” of 18 US women ages 21-69 years with fibromyalgia. Results over 6 months showed that “17 of 18 participants fell or had a near-fall. For the 15 women with 6-month fall-prevalence data, median number of falls was 2, with 3 near-falls.” The authors stated: “A substantial minority (32-48%) experienced severe symptoms (pain, fatigue, stiffness) at the time. Most falls/near-falls occurred in homes during the day; one resulted in injury.”

The authors identified the following psychological themes: “always being careful or generally cautious; fear of losing control of one's body, especially related to balance; desire to continue activities counterbalanced with frustration at not being able to because of fear of falling; perception of having become clumsy.” Fall experiences of persons with fibromyalgia over 6 months. Rutledge DN1, Martinez A, Traska TK, Rose DJ. J Adv Nurs. 2013 Feb;69(2):435-48.

Fall prevention[edit]

The problem of falling in fibromyalgia has reached a sufficient level that Carlos-Vivas et al saw fit to develop a prevention protocol.

Huston et al. recommended tai chi. (Health benefits of tai chi: What is the evidence? Huston P, McFarlane B. Can Fam Physician. 2016 Nov;62(11):881-890, available in full online at: https://www.cfp.ca/content/62/11/881.long.)

Extreme cases[edit]

The occasional very severe fibromyalgia patient has a walker because of it. The reasons are not always clear but there are cases in which there is no other known explanation for using it and they may arrive at the doctor’s office leaning heavily on it and leaving the impression that if the did not have it they would topple over.

Falling dreams[edit]

Falling nightmares are amongst the most common of all nightmares of mankind. Given the association between PTSD (which is characterized by nightmares), and the numbers of falls in fibromyalgia patients, it seems likely that fibromyalgia patients might have more of them than the general population. This requires further study.

The author has seen fibromyalgia patients with recurrent hypnogogic falling dreams.

Falling nightmares can be associated, in the author’s experience with patients, with hypnic jerks, such as having a dream of falling down a hole into a void when falling asleep, then waking up hyperventilating with no strength in the legs. The feeling is described as one of rapid descent and weightless ness. This sound like a psycho-vestibular hallucination. One person woke with sore hands and had the impression it was from trying to prevent falling during the nightmare.

Concept of psycho-vestibular syndrome[edit]

This is the author’s term for a pattern seen in a small number of patients. It is not a proven entity in the medical literature at this time. It is a symptom complex seen in fibromyalgia and non-fibromyalgia patients typically involving a traumatic fall experience or a great desire to fly through the air (as is found in some daredevils and motorcycle jumpers. The author suspects it may involve connections in the brain between the vestibular cortex and evaluative processing centers. The patient may have post-traumatic dizziness of a psychological nature. For example, if they see something such as an escalator that reminded them of their traumatic fall, they may get dizzy and feel like they are falling. Associated symptoms based on a very small sample from the experience of the author are:

  • Hallucinations of an evil perpetrator pushing the person off their bed
  • Feelings of bouncing
  • Excessive and vivid post-traumatic falling nightmares
  • Actual falling of one’s bed during a falling dream
  • Hallucinatory feelings of falling during the daytime
  • Unusual sensations of falling forwards during the day

Further information on the issue of falling and falls in fibromyalgia[edit]

Functional capacity, muscle strength and falls in women with fibromyalgia. Góes SM1, Leite N, Shay BL, Homann D, Stefanello JM, Rodacki AL. Clin Biomech (Bristol, Avon). 2012 Jul;27(6):578-83.)

Fibromyalgia is Associated with Impaired Balance and Falls. Kim D. Jones, Ph.D., Fay B. Horak, Ph.D., Kerri Stone Winters, Ph.D., Jessica M. Morea, M.S., and Robert M. Bennett, M.D. J Clin Rheumatol. 2009 Feb; 15(1): 16–21.”