Trauma and Fibromyalgia

Research actually shows that chronic pain is experienced by a significant portion of individuals with a trauma history, ranging from 20% to 80%, and approximately 10% to 50% of people with PTSD also report living with chronic pain. Furthermore, patients with chronic pain who have a background of trauma tend to experience more significant impairments in their functional status, express higher levels of distress, and exhibit poorer responses to medical treatments.

Fibromyalgia is a complex and often misunderstood chronic disorder characterised by widespread musculoskeletal pain, tenderness, and a range of other symptoms. While the exact causes of fibromyalgia remain elusive, researchers have been exploring various factors, including the role of trauma, both physical and psychological, in the development of this condition. This mutual relationship between the two conditions raises an intriguing question: could they share a common underlying cause?

What is Fibromyalgia?

Before we explore the relationship between trauma and fibromyalgia, it’s essential to understand what fibromyalgia is and what sets it apart from other chronic disorders. Fibromyalgia isn’t classified as an autoimmune disease, joint or muscle disorder, or an inflammatory condition. Despite the often severe pain experienced in fibromyalgia, there is no discernible evidence of physical tissue damage within the body. Instead, fibromyalgia is categorised as a nervous system disorder, where pain signals are transmitted and processed in an abnormal manner.

People living with fibromyalgia experience this chronic pain throughout their bodies, often accompanied by symptoms such as:

1. Heightened Sensitivity to Pain: Those with fibromyalgia often experience an increased sensitivity to pain, where even minor sensations can become intensely discomforting.
2. Muscle Stiffness: Persistent muscle stiffness is a common symptom, making everyday movements and activities more challenging.
3. Sleep Struggles: Many people with fibromyalgia encounter difficulties falling asleep or staying asleep, resulting in profound fatigue and exhaustion.
4. Cognitive Hurdles (Fibro-Fog): Dubbed “fibro-fog,” this phenomenon involves cognitive challenges such as trouble concentrating or remembering things clearly.
5. Headaches: Headaches are a frequent companion of fibromyalgia, adding to the overall burden of discomfort.
6. Irritable Bowel Syndrome (IBS): Some individuals with fibromyalgia also contend with irritable bowel syndrome (IBS), a digestive condition characterised by abdominal pain and bloating.
7. Emotional Impact: Feelings of frustration, worry, or low mood are often intertwined with the experience of fibromyalgia, affecting one’s overall emotional well-being.

It’s important to note that the symptoms of fibromyalgia can be quite variable. They may ebb and flow, with periods of improvement followed by exacerbation. This unpredictability adds to the complexity of managing this condition.

The exact mechanisms behind these symptoms are still a subject of ongoing research, however someone with PTSD or C-PTSD might find the above list of fibromyalgia symptoms eerily familiar. This is because many of these other symptoms also closely mirror the physical and emotional responses observed in cases of trauma, PTSD, and C-PTSD.

The Trauma Connection

While the exact cause of fibromyalgia is still unknown, it is believed to be associated with irregular levels of specific brain chemicals and alterations in how the central nervous system (comprising the brain, spinal cord, and nerves) manages pain signals throughout the body.

A growing body of evidence suggests that trauma, both physical and emotional, may be linked to the onset and exacerbation of fibromyalgia symptoms. Several studies have explored this connection, highlighting the role of trauma in the development of this complex condition.

One significant study from 2018, which reviewed 51 different studies, found that many individuals living with fibromyalgia reported a significant association between the onset of their symptoms and experiences of emotional or physical trauma. While the data quality did not allow for definitive conclusions, it was noted that emotional trauma appeared to be more common than physical trauma in these cases.

People with both PTSD and fibromyalgia have noted that their pain often appears distinct from their trauma, suggesting the involvement of an underlying mechanism, possibly related to central nervous system sensitisation.

PTSD is recognised for its capacity to sensitise the nervous system, so the strong correlation between PTSD and fibromyalgia pain comes as no surprise.

When triggered, both PTSD and fibromyalgia activate the body’s fight-or-flight response and prompt the release of stress hormones like cortisol, which sensitise nerves.

This heightened sensitivity of nerves can lead to the transmission of pain signals even in the absence of any physical source of pain.

The Impact of Trauma

Understanding how trauma contributes to fibromyalgia involves examining how the body responds to extreme distress. Trauma can trigger a series of neurobiological responses that affect brain structures, alter neurological synapses, and potentially modify gene expression. This cascade of changes may disrupt central nervous system communication, leading to skewed pain perception and contributing to other common fibromyalgia symptoms like cognitive impairment, sleep disturbances, and fatigue.

Childhood Trauma and Fibromyalgia

While fibromyalgia isn’t exclusively linked to childhood trauma, there is evidence suggesting a connection between childhood traumatic events (CTEs) and fibromyalgia. A small 2018 study found that CTEs were significantly more common among individuals living with fibromyalgia. In 2020, a large-scale population-based study reported that mistreatment in childhood was associated with a significantly higher risk of developing fibromyalgia later in life. Another study in 2022 found that 88.2% of people with fibromyalgia had experienced childhood trauma.

Researchers believe that exposure to significant stress during childhood can negatively affect the development of one’s stress response, increasing vulnerability to stress-related disorders later in life.

Fibromyalgia and Mental Health

It remains unclear whether fibromyalgia is a manifestation of chronic pain in PTSD, if PTSD exacerbates pre-existing fibromyalgia, or if both scenarios can occur, but there appears to be a clear link between the two.

It’s also worth mentioning that around 25% of people diagnosed with fibromyalgia also have accompanying depression at the time of diagnosis. Furthermore, a significant portion, ranging from 50% to 75%, of fibromyalgia patients have a history of depression over their lifetime. Additionally, the lifetime occurrence of an anxiety disorder among fibromyalgia patients is approximately 60%.

Living with chronic pain can undoubtedly take a toll on one’s mental health, and the experience of fibromyalgia itself can lead to rapid mood changes. Research suggests that intense feelings of sadness, fear, anger, and guilt may be more common in fibromyalgia due to changes in the brain that increase sensitivity to pain. This heightened sensitivity can extend to emotional responses, making individuals more susceptible to intense emotions when faced with challenging situations.

Managing Fibromyalgia

Given the multifaceted nature of fibromyalgia and its potential connections to trauma, there is no one-size-fits-all treatment approach. Successful management typically involves a multidisciplinary approach, which may include

• Lifestyle Adjustments: This entails the adoption of exercise routines and relaxation methods.
• Therapeutic Interventions: Talking therapies like cognitive-behavioural therapy (CBT) and acceptance and commitment therapy (ACT) can be beneficial.
• Medication: In some cases, antidepressants may be prescribed.
• Exercise, in particular, offers numerous advantages for individuals living with fibromyalgia, as it can help mitigate pain and improve overall well-being.

Conclusion

In the complex puzzle of fibromyalgia, trauma emerges as a piece that warrants attention. While not everyone with fibromyalgia has a history of trauma, research suggests that trauma, both physical and emotional, may play a role in the development and exacerbation of this challenging condition. Understanding this connection can help healthcare providers better support individuals living with fibromyalgia and guide future research into more effective treatments, but it also emphasises the importance of gaining a deeper understanding of and addressing stressful life events in individuals coping with chronic pain and the pain-related issues that people who have experienced trauma may face.

In the journey to manage fibromyalgia, a holistic approach that addresses both physical and emotional well-being is crucial. By recognising and addressing the potential impact of trauma, people living with fibromyalgia can work toward improved pain management and a better quality of life.