Fibromyalgia Precipitating Factors

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(These are factors that serve as triggers for a flare.)


The author recommends posing the following question:

Looking back at previous flare ups, widespread, unexplained muscle pains, which of the following apply to you?

Precipitating factor Reference
Post-injury/after a physical trauma
After a physical injury Waylonis 1994, Al-Allaf 2002, Bennett 2007, Aaron 1997
After a neck injury Buskila 1997
After a motor vehicle accident Waylonis and Perkins 1994, McLean 2005, Bennett 2007
After a sports injury Waylonis and Perkins 1994
After a work injury or repetitive strain Waylonis and Perkins 1994
After a falling injury Rutledge DN 2013, Anecdotal by author's experience
Physical injury non-motor vehicle Bennett 2007
Perceived assaults on the body
By post-operative complications Furness 2018
By industrial chemicals Furness 2018
By chemotherapy Furness 2018
By allergen Furness 2018
By vaccinations Furness 2018
By viruses Furness 2018
Acute illness
Acute illness in general Bennett 2007
Flare of acute attack of IBS in chronic IBS Anecdotal by author's experience
Post-surgical
After a hysterectomy Pamuk 2009
After breast implant Cuellar 1995
After another type of surgery Al-Allaf 2002
Thyroid problems
Thyroid problem in general Bennett 2007
After thyroid surgery Anecdotal by author’s experience
Post-infectious
After a flu or virus Fibromyalgia Network 1997
After being diagnosed with HIV Fibromyalgia Network 1997
After Lyme disease Ranque-Garnier S. 2019, Cited in Clauw 2001, Dinerman 1992
After an Epstein-Barr virus/ mononucleosis infection Cited in Clauw 2001
After a parvovirus infection Leventhal 1991
Headaches
Migraine attacks Giamberardino 2016
Sexual abuse
Rape Ciccone 2005
Sexual abuse in childhood Hausser 2011, Bennett 2007
Post-vaccine
Post hepatitis B vaccine Agmon-Levin 2014
Post HPV vaccine Martinez-Levin
Post rubella vaccine
Post toxin or after a possible toxin
Acute illness in general Bennett 2007
Flare of acute attack of IBS in chronic IBS Anecdotal by author's experience
Post-surgical
After a breast implant breaks Brown 2001
After exposure to certain oils Alonso-Ruiz 1985
After gonadotropin-releasing hormone Toussirot 2001
After other chemicals
Emotional trauma/life event
Stress Vincent 2016, Bennett 2007
Over-doing it Vincent 2016
Death of a loved one NHS accessed 2020
Breakdown of a relationship NHS accessed 2020
Emotional trauma Bennett 2007, Yavne 2016
Bereavement Furness 2018
Sleep
Poor Sleep Vincent 2016
Weather
Weather change Vincent 2016
Catastrophic events
War Eisen 2005
Chernobyl Pastel 2002
Other pregnancy and childbirth related situations
Pregnant women in with imperiled fetus Anecdotal based on author’s experience
Childbirth Bennett 2007
Difficult pregnancy Furness 2018
Giving birth/traumatic labour, or difficult birth NHS accessed 2020, Furness 2018
Young mother with imperiled or with an ill newborn Anecdotal based on author’s experience


For a useful list entitled “Perceived triggering events of FM onset (in descending order of frequency), see table 5 in “An internet survey of 2,596 people with fibromyalgia. Robert M Bennett, 1 Jessie Jones,2 Dennis C Turk,3 I Jon Russell,4 and Lynne Matallana5 BMC Musculoskelet Disord. 2007; 8: 27, doi: 10.1186/1471-2474-8-27 available in full online at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1829161/.”

Alphabetical listing of sources for precipitating factors:

A case-control study examining the role of physical trauma in the onset of fibromyalgia syndrome. A W Al-Allaf 1, K L Dunbar, N S Hallum, B Nosratzadeh, K D Templeton, T Pullar 2002 (Rheumatology (Oxford). Apr;41(4):450-3, available in full online at: case–control study examining the role of physical trauma in the onset of fibromyalgia syndrome | Rheumatology | Oxford Academic (oup.com)

Perceived physical and emotional trauma as precipitating events in fibromyalgia. Associations with health care seeking and disability status but not pain severity. L A Aaron 1, L A Bradley, G S Alarcón, M Triana-Alexander, R W Alexander, M Y Martin, K R Alberts, Arthritis Rheum. 1997 Mar;40(3):453-60. doi: 10.1002/art.1780400311, https://pubmed.ncbi.nlm.nih.gov/9082933/

Chronic fatigue syndrome and fibromyalgia following immunization with the hepatitis B vaccine: another angle of the 'autoimmune (auto-inflammatory) syndrome induced by adjuvants' (ASIA). Agmon-Levin N, Zafrir Y, Kivity S, Balofsky A, Amital H, Shoenfeld Y. Immunol Res. 2014 Dec;60(2-3):376-83. doi: 10.1007/s12026-014-8604-2.

An internet survey of 2,596 people with fibromyalgia. Robert M Bennett, 1 Jessie Jones,2 Dennis C Turk,3 I Jon Russell,4 and Lynne Matallana5 BMC Musculoskelet Disord. 2007; 8: 27, doi: 10.1186/1471-2474-8-27 available in full online at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1829161/.

Silicone gel breast implant rupture, extracapsular silicone, and health status in a population of women. Brown SL, Pennello G, Berg WA, Soo MS, Middleton MS. J Rheumatol 2001 May;28(5):996-1003, https://www.ncbi.nlm.nih.gov/pubmed/11361228.

Increased rates of fibromyalgia following cervical spine injury. A controlled study of 161 cases of traumatic injury. Buskila D1, Neumann L, Vaisberg G, Alkalay D, Wolfe F. Arthritis Rheum. 1997 Mar;40(3):446-52.

Increased rates of fibromyalgia following cervical spine injury. A controlled study of 161 cases of traumatic injury. Buskila D1, Neumann L, Vaisberg G, Alkalay D, Wolfe F. Arthritis Rheum. 1997 Mar;40(3):446-52.

Sexual and physical abuse in women with fibromyalgia syndrome: a test of the trauma hypothesis. Ciccone DS1, Elliott DK, Chandler HK, Nayak S, Raphael KG. Clin J Pain. 2005 Sep-Oct;21(5):378-86.

Silicone breast implant--associated musculoskeletal manifestations. Cuellar ML1, Gluck O, Molina JF, Gutierrez S, Garcia C, Espinoza R. Clin Rheumatol. 1995 Nov;14(6):667-72.

Lyme disease associated with fibromyalgia. Ann Intern Med. 1992;117(4):281–5. Dinerman H, Steere AC. [PubMed] [Google Scholar]

Gulf War veterans' health: medical evaluation of a U.S. cohort. Eisen SA1, Kang HK, Murphy FM, Blanchard MS, Reda DJ, Henderson WG, Toomey R, Jackson LW, Alpern R, Parks BJ, Klimas N, Hall C, Pak HS, Hunter J, Karlinsky J, Battistone MJ, Lyons MJ; Ann Intern Med. 2005 Jun 7;142(11):881-90.

What causes fibromyalgia? An online survey of patient perspectives. Penny J Furness,1 Katharina Vogt,2 Simon Ashe,1 Sophie Taylor,1 Sarah Haywood-Small,1 and Kim Lawson1. Health Psychol Open. 2018 Jul-Dec; 5(2): 2055102918802683, doi: 10.1177/2055102918802683, available in full online at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6158621/. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use.

Impact of migraine on fibromyalgia symptoms. Maria Adele Giamberardino, Giannapia Affaitati, Paolo Martelletti, Claudio Tana, Andrea Negro, Domenico Lapenna, Martina Curto, Cosima Schiavone, Luisa Stellin, Francesco Cipollone, and Raffaele Costantini J Headache Pain. 2016; 17: 28. Published online 2016 Mar 22. doi: 10.1186/s10194-016-0619-8, available in full online at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803717/

Emotional, physical, and sexual abuse in fibromyalgia syndrome: a systematic review with meta-analysis. Winfried Häuser 1, Maria Kosseva, Nurcan Üceyler, Petra Klose, Claudia Sommer, DOI: 10.1002/acr.20328, available in full online at: https://onlinelibrary.wiley.com/doi/10.1002/acr.20328.

Fibromyalgia and parvovirus infection, L J Leventhal 1, S J Naides, B Freundlich Arthritis Rheum. 1991 Oct;34(10):1319-24, DOI: 10.1002/art.1780341018

HPV vaccination syndrome: A clinical mirage, or a new tragic fibromyalgia model. [Article in English, Spanish] Martínez-Lavín M1. Reumatol Clin. 2018 Jul - Aug;14(4):211-214. doi: 10.1016/j.reuma.2018.01.014. Epub 2018 Mar 13.

Fibromyalgia after motor vehicle collision: evidence and implications. McLean SA1, Williams DA, Clauw DJ. Traffic Inj Prev. 2005 Jun;6(2):97-104.

National Health Service Website, https://www.nhs.uk/conditions/fibromyalgia/causes/

Radiophobia: long-term psychological consequences of Chernobyl. Pastel RH. Mil Med 2002 Feb;167(2 Suppl):134-6, https://www.ncbi.nlm.nih.gov/pubmed/11873498.

Increased frequencies of hysterectomy and early menopause in fibromyalgia patients: a comparative study. Omer Nuri Pamuk 1, Salim Dönmez, Necati Cakir DOI: 10.1007/s10067-009-1087-1 Clin Rheumatol. 2009 May;28(5):561-4. Epub 2009 Jan 24.

Fibromyalgia syndrome as a late complication of toxic-oil syndrome. Alonso-Ruiz A, de la Hoz-Martinez A, Zea-Mendoza AC. J Rheumatol. 1985 Dec;12(6):1207-8.

Management of patients presenting with generalized musculoskeletal pain and a suspicion of Lyme disease. Ranque-Garnier S1, Eldin C2, Sault C1, Raoult D3, Donnet A1. Med Mal Infect. 2019 Mar;49(2):157-166. doi: 10.1016/j.medmal.2019.01.008. Epub 2019 Feb 11.

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. doi: 10.1111/j.1365-2648.2012.06026.x. Epub 2012 May 2.

Fibromyalgia developed after administration of gonadotrophin-releasing hormone analogue. Toussirot E1, Wendling D. Clin Rheumatol. 2001;20(2):150-2.

Fibromyalgia Flares: A Qualitative Analysis, Ann Vincent, MD, Mary O. Whipple, BA, BSN, RN, CCRP, Lori M. Rhudy, PhD, RN, ACNS, CNRN , Pain Medicine, Volume 17, Issue 3, March 2016, Pages 463–468, https://doi.org/10.1111/pme.12676

Post-traumatic fibromyalgia. A long-term follow-up. Waylonis GW1, Perkins RH. Am J Phys Med Rehabil. 1994 Nov-Dec;73(6):403-12.

A systematic review of precipitating physical and psychological traumatic events in the development of fibromyalgia, Yarden Yavne 1, Daniela Amital 2, Abdulla Watad 1, Shmuel Tiosano 1, Howard Amital 3 Semin Arthritis Rheum . 2018 Aug;48(1):121-133, doi: 10.1016/j.semarthrit.2017.12.011. Epub 2018 Jan 10, DOI: 10.1016/j.semarthrit.2017.12.011