Traumatic experiences, major life stressors, and self-reporting a physician-given fibromyalgia diagnosis
Introduction
Fibromyalgia is a complex and difficult-to-treat medical condition characterized by widespread musculoskeletal pain, decreased pain threshold, and multiple “tender-points” in all four body quadrants (Clauw and Taylor-Moon, 2006, Chakrabarty and Zoorob, 2007, National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2007, Abeles et al., 2008, Wolfe and Rasker, 2008). Prominent associated symptoms/comorbidities include chronic fatigue, sleep disturbances, mood (depression and anxiety) disorders, and irritable bowel syndrome (Bradley, 2008, Schweinhardt et al., 2008, Wolfe and Rasker, 2008).
Fibromyalgia symptoms have been described for centuries and given various labels (e.g., muscular rheumatism and fibrositis) (Inanici and Yunus, 2004). The modern term fibromyalgia was coined in the mid-1970s, but it was not until the 1980s that its present formulation was established and, to some extent, legitimized (Yunus et al., 1981, Goldenberg, 1987, Inanici and Yunus, 2004). In 1990, the American College of Rheumatology established research diagnostic criteria (pain and tender point evaluations), which now are used to diagnose the disorder (Wolfe et al., 1990). Although recognized as a legitimate clinical entity by, for example, the American College of Rheumatology, the American Medical Association, the National Institute of Arthritis, Musculoskeletal, and Skin Diseases, and the World Health Organization (Starlanyl and Copeland, 2001), fibromyalgia is a disputed medical condition (Bohr, 1996, Wolfe and Rasker, 2008, Wolfe, 2009). Many believe, for example, that fibromyalgia is not a disease but rather a collection of symptoms (overlapping most other “medically unexplained” syndromes) that place people at the upper end of a “pain-distress” continuum (Wolfe and Rasker, 2008). Moreover, Wolfe and Rasker (2008) also note that establishing a fibromyalgia “cut-point” is quite arbitrary and that such a cut-point has been made only for political and financial, but not scientific reasons.
Fibromyalgia prevalence figures in the United States are based on a single study conducted in the early 1990s in Wichita, Kansas (sample approximately 88% White; Wolfe et al., 1995). They estimated that fibromyalgia was affecting 2% (3.7 million people) of the United States population (18 years and older), 3.4% of women and 0.5% of men. In women, prevalence estimates increased dramatically with age (as high as 7.0% in women in the 60 to 79 year age range). Based on 2005 Census Bureau adjustments, Lawrence et al. (2008), estimated the number of Americans with fibromyalgia to be approximately 5 million. What causes fibromyalgia is not known, and other than pain testing for making a diagnosis and following clinical course, there are no other biomarkers for susceptibility, diagnosis, or clinical outcome (Dadabhoy et al., 2008). Several factors appear to contribute to fibromyalgia's pathophysiology: genetics (familial predisposition), abnormal neuroendocrine and autonomic nervous system function (disordered central pain processing), and environmental triggers (mechanical/physical trauma and psychosocial stressors) (Bradley, 2008). The relationship between reporting a fibromyalgia diagnosis and environmental triggers–specifically trauma and major life stressors–is the subject of the present study.
Trauma and major life stress likely do not cause fibromyalgia per se; some propose that in genetically susceptible people, early life and prolonged trauma/stress in adulthood affects brain modulatory circuitry of both pain and emotions (Crofford, 2007, Bradley, 2008, Schweinhardt et al., 2008), which could account for fibromyalgia patients' enhanced pain responses and co-occurring symptoms. A critical review of studies on the relationship between traumatic stress (childhood abuse) and various chronic pain conditions in adulthood, however, supports an association in some cross-sectional, but not prospective, studies (Raphael et al., 2004). Moreover, although individual studies on the relationship between emotional, physical, and sexual abuse and specifically a fibromyalgia diagnosis are intriguing (e.g., Boisset-Pioro et al., 1995, Walker et al., 1997, Van Houdenhove et al., 2001, Ciccone et al., 2005), reviews across all studies are inconclusive (Romans and Cohen, 2008, Russell and Raphael, 2008). That some traumatic experiences are related to fibromyalgia in one study and not in another, however, is unsurprising, given that sampling and methods vary considerably from study to study. Clearly needed are large, community-based (versus small, clinical) studies, with (a) sufficient numbers of individuals with fibromyalgia (given its relatively low base rate in the population) and (b) assessment of many and varied trauma/stress experiences.
The primary purpose of the present study is to address this need and evaluate the relationship between traumatic and major life stressors and self-reporting a physician-given fibromyalgia diagnosis in a relatively large group of older women and men.
Section snippets
Data source
Data were from the Biopsychosocial Religion and Health Study (BRHS; Lee et al., 2009), which randomly sampled participants from the Adventist Health Study (AHS-2) — a cohort study of approximately 96,000 Seventh-day Adventists investigating cancer, diet, and lifestyle (Butler et al., 2008). Seventh-day Adventists are evangelical Protestants who include healthy lifestyle beliefs in their religious doctrine; as such, 1% smoke, 7% consume alcohol, and only 47% eat meat. In Butler et al. (2008),
Fibromyalgia diagnosis
A physician-given fibromyalgia diagnosis (in one's lifetime) was reported by 3.7% of the sample, 4.8% of the women and 1.3% of the men. The percentages for White subjects only (more comparable to the established figures) are 4.5% overall, 6.2% women, and 1.5% men; and for non-Whites, respectively, 2.3%, 2.7%, and 0.8%.
Bivariate comparisons
Biographic/demographic factors by fibromyalgia diagnosis for women, men, and all respondents are shown in Table 1 (In Table 1, Table 2, Table 3, due to rounding, not all
Discussion
Among all respondents and women only, two types of traumatic experiences–sexual assault/abuse and physical assault/abuse–were associated with a fibromyalgia diagnosis, whereas life-threatening trauma, emotional abuse/neglect, and major life stress were not. The highest odds ratios in both models were those for sexual and physical assault/abuse. Traumatic stress bore the stronger relationship to fibromyalgia compared to major life stress (as operationalized in the present study), and among the
Acknowledgments
Funding for this study was from the National Institute on Aging (Biopsychosocial Religion and Health Study, 5R01AG026348-05) and from the National Cancer Institute for the parent study (Adventist Health Study 2, 5R01 CA094594). The authors thank Drs. Peter Przekop, Jerry Lee, and Denise Bellinger for their helpful comments throughout the course of this study.
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