Temporal Onset Patterns in Fibromyalgia

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Definition[edit]

These are time patterns for the start of the illness. Generally, they can be divided into: a) relatively sudden onset (sub-acute) which is known to occur after some traumas and accidents such as railway accidents, falls motor vehicle accidents or war injuries); or b) insidious onset which means that the problem ramped up gradually over a period of months or years. (In the experience of the author this is the pattern seen in some patients with a history of multiple accidents and with some people who developed fibromyalgia after sexual abuse in childhood.

Sudden onset type[edit]

The sudden occurrence of fibromyalgia after a motor vehicle accident, particularly if there was an associated sudden onset of PTSD. is suggestive that the trauma was a precipitating factor or possibly even the causal factor for the fibromyalgia. (It also means that it is reasonable to seek psychological treatment for the trauma in the hope of assisting with the fibromyalgia symptoms.)

Here some questions which may help clarify the history:

“If you have any un¬explained widespread muscular pains: Did they come on gradually or suddenly? When? Do they include areas that were not directly injured?

For example, if you hurt your neck during the accident but not your back, did you notice that a few days after you started to get back pains or pains in many areas that were not to your knowledge stuck or strained during the accident?

(For information on the relationship between PTSD and fibromyalgia see: Posttraumatic stress disorder in fibromyalgia syndrome: Prevalence, temporal relationship between posttraumatic stress and fibromyalgia symptoms, and impact on clinical outcome. Häuser W1, Galek A, Erbslöh-Möller B, Köllner V, Kühn-Becker H, Langhorst J, Petermann F, Prothmann U, Winkelmann A, Schmutzer G, Brähler E, Glaesmer H. Pain. 2013 Aug;154(8):1216-23.)

Insidious onset type[edit]

This refers to patients whose pain and other symptoms came on gradually. Typically, it is hard for such patients to identify a discrete point at which they became fibromyalgics. (Disease perceptions of Brazilian fibromyalgia patients: do they resemble perceptions from other countries? Martinez JE1, Cruz CG, Aranda C, Boulos FC, Lagoa LA. Int J Rehabil Res. 2003 Sep;26(3):223-7.)

Sub-acute onset type[edit]

This refers to patients whose pain and other symptoms came on relatively suddenly but not as suddenly as right after a precipitating experience. An example of sub-acute is post-traumatic fibromyalgia after a falling accident in which there was definite injury to certain parts of the body, but the expected recovery did not materialize because poor sleep and widespread muscular pain set in over a period of a few months.