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Fibromyalgia-PTSD Link Shows Bidirectional Relationship With Exposure to Combat Environments
Spending time in a war zone can lead to chronic mental and physical pain. Now, research points to a link between two common disorders that can leave service members struggling.
Published in the journal Arthritis Care & Research, a longitudinal cohort study of 1761 US military service members found that those who had posttraumatic stress disorder (PTSD) before deployment were nearly 3times more likely to develop fibromyalgia after returning home (odds ratio, 2.96; 95% CI, 2.08-4.22). Those with fibromyalgia before deployment had more than threefold greater likelihood of developing PTSD after deployment (odds ratio, 3.12; 95% CI, 1.63-5.95).
This is the largest prospective study to date linking the stress of combat deployment to the onset of fibromyalgia.
“We had the advantage of observing a large population before and after exposure to an environment that often involves significant stress,” said lead study author Jay Higgs, MD, a retired rheumatologist with Brooke Army Medical Center and the University of Texas Health Science Center at San Antonio.
Here’s what the team found and why it matters.
Significant Increase in Fibromyalgia After Development
Service members were checked for fibromyalgia using the 2011 questionnaire modification of the 2010 American College of Rheumatology preliminary diagnostic criteria for fibromyalgia. They were assessed for PTSD using the PTSD Checklist Stressor-Specific Version.
Before deployment, service members had similar rates of fibromyalgia as the general population: 2.2% in men and 2.0% in women. After deployment, fibromyalgia rates increased significantly to 8.0% in men and 11.1% in women.
While fibromyalgia tends to be underreported in men, the findings suggest it should not be overlooked in this population. “Our results are consistent with the notion that there should be no gender bias when considering the possibility of fibromyalgia in an individual patient,” Higgs said.
Before deployment, 20.7% of men and 18.3% of women had PTSD symptoms. After deployment, the PTSD rate increased slightly to 22.7% in men and 25.5% in women.
The Link Between Fibromyalgia and PTSD
The researchers said the results suggest that PTSD and fibromyalgia might be linked through central nervous system mechanisms such as central sensitization, elevated hypothalamic-pituitary-adrenal axis activity, elevated cortisol, and proinflammatory cytokines. However, shared causation, associated risk factors, selection bias, or alternative mechanisms within the central and peripheral neuroendocrine and cytokine systems could also be part of the story.
“What we do not know is how much of what we see clinically represents central nervous system pathology, peripheral problems, or a combination of the 2,” Higgs said. “Neurotransmission in the central nervous system is highly complex, and may not only involve specific structures, but a web of communications between them.”
Loci in the midbrain appear especially important, he said.
Elizabeth Hoge, MD, professor and director of the Anxiety Disorders Research Program at Georgetown University School of Medicine, Washington, DC, said that patients with PTSD often have pain, headaches, sleep disturbances, and other symptoms that are part of the picture of fibromyalgia. It’s plausible that pain syndromes could be manifestations of PTSD or groupings of symptoms that suggest a subtype.
“Pain is one way that people experience distress, and we know that in PTSD, sometimes the trauma memories are encoded too strongly, more stressful and more alarming to the body system,” she said.
When patients have symptoms such as chronic pain, headaches, fatigue, or cognitive brain fog, clinicians should remember to ask about trauma exposure, Hoge said. You might be the first to broach the subject.
“I’ve certainly seen patients in clinic who never get asked about the exposure to trauma, including sexual trauma, so sometimes that can be the first pathway to helping people feel better is just to have their trauma recognized,” Hoge said.
If a patient has experienced or witnessed violence, consider a referral to a psychiatrist or psychologist to evaluate them for PTSD. Higgs said he collaborated closely with a psychologist to complement his treatment plans for active duty and retired military service members and families.
The US Department of Veterans Affairs and the Department of Defense (DoD) recommend trauma-focused psychotherapy as the first line of treatment for PTSD. This form of therapy deliberately focuses on bringing trauma memories into the open, Hoge said.
“When a person talks about their trauma, and it comes into direct consciousness, somehow it’s malleable, and so when it goes back down into the memory banks, it’s changed somewhat,” she said.
This study was supported by the DoD through awards from the US Army Medical Research and Materiel Command, Congressionally Directed Medical Research Programs, and Psychological Health and Traumatic Brain Injury Research Program. The funding organizations played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Higgs’s comments are his own and do not necessarily reflect the official policy or position of the Defense Health Agency, Brooke Army Medical Center, Carl R. Darnall Army Medical Center, the DoD, the Department of Veterans Affairs, or any agencies under the US government. Hoge had no relevant disclosures.
A version of this article first appeared on Medscape.com.
Spending time in a war zone can lead to chronic mental and physical pain. Now, research points to a link between two common disorders that can leave service members struggling.
Published in the journal Arthritis Care & Research, a longitudinal cohort study of 1761 US military service members found that those who had posttraumatic stress disorder (PTSD) before deployment were nearly 3times more likely to develop fibromyalgia after returning home (odds ratio, 2.96; 95% CI, 2.08-4.22). Those with fibromyalgia before deployment had more than threefold greater likelihood of developing PTSD after deployment (odds ratio, 3.12; 95% CI, 1.63-5.95).
This is the largest prospective study to date linking the stress of combat deployment to the onset of fibromyalgia.
“We had the advantage of observing a large population before and after exposure to an environment that often involves significant stress,” said lead study author Jay Higgs, MD, a retired rheumatologist with Brooke Army Medical Center and the University of Texas Health Science Center at San Antonio.
Here’s what the team found and why it matters.
Significant Increase in Fibromyalgia After Development
Service members were checked for fibromyalgia using the 2011 questionnaire modification of the 2010 American College of Rheumatology preliminary diagnostic criteria for fibromyalgia. They were assessed for PTSD using the PTSD Checklist Stressor-Specific Version.
Before deployment, service members had similar rates of fibromyalgia as the general population: 2.2% in men and 2.0% in women. After deployment, fibromyalgia rates increased significantly to 8.0% in men and 11.1% in women.
While fibromyalgia tends to be underreported in men, the findings suggest it should not be overlooked in this population. “Our results are consistent with the notion that there should be no gender bias when considering the possibility of fibromyalgia in an individual patient,” Higgs said.
Before deployment, 20.7% of men and 18.3% of women had PTSD symptoms. After deployment, the PTSD rate increased slightly to 22.7% in men and 25.5% in women.
The Link Between Fibromyalgia and PTSD
The researchers said the results suggest that PTSD and fibromyalgia might be linked through central nervous system mechanisms such as central sensitization, elevated hypothalamic-pituitary-adrenal axis activity, elevated cortisol, and proinflammatory cytokines. However, shared causation, associated risk factors, selection bias, or alternative mechanisms within the central and peripheral neuroendocrine and cytokine systems could also be part of the story.
“What we do not know is how much of what we see clinically represents central nervous system pathology, peripheral problems, or a combination of the 2,” Higgs said. “Neurotransmission in the central nervous system is highly complex, and may not only involve specific structures, but a web of communications between them.”
Loci in the midbrain appear especially important, he said.
Elizabeth Hoge, MD, professor and director of the Anxiety Disorders Research Program at Georgetown University School of Medicine, Washington, DC, said that patients with PTSD often have pain, headaches, sleep disturbances, and other symptoms that are part of the picture of fibromyalgia. It’s plausible that pain syndromes could be manifestations of PTSD or groupings of symptoms that suggest a subtype.
“Pain is one way that people experience distress, and we know that in PTSD, sometimes the trauma memories are encoded too strongly, more stressful and more alarming to the body system,” she said.
When patients have symptoms such as chronic pain, headaches, fatigue, or cognitive brain fog, clinicians should remember to ask about trauma exposure, Hoge said. You might be the first to broach the subject.
“I’ve certainly seen patients in clinic who never get asked about the exposure to trauma, including sexual trauma, so sometimes that can be the first pathway to helping people feel better is just to have their trauma recognized,” Hoge said.
If a patient has experienced or witnessed violence, consider a referral to a psychiatrist or psychologist to evaluate them for PTSD. Higgs said he collaborated closely with a psychologist to complement his treatment plans for active duty and retired military service members and families.
The US Department of Veterans Affairs and the Department of Defense (DoD) recommend trauma-focused psychotherapy as the first line of treatment for PTSD. This form of therapy deliberately focuses on bringing trauma memories into the open, Hoge said.
“When a person talks about their trauma, and it comes into direct consciousness, somehow it’s malleable, and so when it goes back down into the memory banks, it’s changed somewhat,” she said.
This study was supported by the DoD through awards from the US Army Medical Research and Materiel Command, Congressionally Directed Medical Research Programs, and Psychological Health and Traumatic Brain Injury Research Program. The funding organizations played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Higgs’s comments are his own and do not necessarily reflect the official policy or position of the Defense Health Agency, Brooke Army Medical Center, Carl R. Darnall Army Medical Center, the DoD, the Department of Veterans Affairs, or any agencies under the US government. Hoge had no relevant disclosures.
A version of this article first appeared on Medscape.com.
Spending time in a war zone can lead to chronic mental and physical pain. Now, research points to a link between two common disorders that can leave service members struggling.
Published in the journal Arthritis Care & Research, a longitudinal cohort study of 1761 US military service members found that those who had posttraumatic stress disorder (PTSD) before deployment were nearly 3times more likely to develop fibromyalgia after returning home (odds ratio, 2.96; 95% CI, 2.08-4.22). Those with fibromyalgia before deployment had more than threefold greater likelihood of developing PTSD after deployment (odds ratio, 3.12; 95% CI, 1.63-5.95).
This is the largest prospective study to date linking the stress of combat deployment to the onset of fibromyalgia.
“We had the advantage of observing a large population before and after exposure to an environment that often involves significant stress,” said lead study author Jay Higgs, MD, a retired rheumatologist with Brooke Army Medical Center and the University of Texas Health Science Center at San Antonio.
Here’s what the team found and why it matters.
Significant Increase in Fibromyalgia After Development
Service members were checked for fibromyalgia using the 2011 questionnaire modification of the 2010 American College of Rheumatology preliminary diagnostic criteria for fibromyalgia. They were assessed for PTSD using the PTSD Checklist Stressor-Specific Version.
Before deployment, service members had similar rates of fibromyalgia as the general population: 2.2% in men and 2.0% in women. After deployment, fibromyalgia rates increased significantly to 8.0% in men and 11.1% in women.
While fibromyalgia tends to be underreported in men, the findings suggest it should not be overlooked in this population. “Our results are consistent with the notion that there should be no gender bias when considering the possibility of fibromyalgia in an individual patient,” Higgs said.
Before deployment, 20.7% of men and 18.3% of women had PTSD symptoms. After deployment, the PTSD rate increased slightly to 22.7% in men and 25.5% in women.
The Link Between Fibromyalgia and PTSD
The researchers said the results suggest that PTSD and fibromyalgia might be linked through central nervous system mechanisms such as central sensitization, elevated hypothalamic-pituitary-adrenal axis activity, elevated cortisol, and proinflammatory cytokines. However, shared causation, associated risk factors, selection bias, or alternative mechanisms within the central and peripheral neuroendocrine and cytokine systems could also be part of the story.
“What we do not know is how much of what we see clinically represents central nervous system pathology, peripheral problems, or a combination of the 2,” Higgs said. “Neurotransmission in the central nervous system is highly complex, and may not only involve specific structures, but a web of communications between them.”
Loci in the midbrain appear especially important, he said.
Elizabeth Hoge, MD, professor and director of the Anxiety Disorders Research Program at Georgetown University School of Medicine, Washington, DC, said that patients with PTSD often have pain, headaches, sleep disturbances, and other symptoms that are part of the picture of fibromyalgia. It’s plausible that pain syndromes could be manifestations of PTSD or groupings of symptoms that suggest a subtype.
“Pain is one way that people experience distress, and we know that in PTSD, sometimes the trauma memories are encoded too strongly, more stressful and more alarming to the body system,” she said.
When patients have symptoms such as chronic pain, headaches, fatigue, or cognitive brain fog, clinicians should remember to ask about trauma exposure, Hoge said. You might be the first to broach the subject.
“I’ve certainly seen patients in clinic who never get asked about the exposure to trauma, including sexual trauma, so sometimes that can be the first pathway to helping people feel better is just to have their trauma recognized,” Hoge said.
If a patient has experienced or witnessed violence, consider a referral to a psychiatrist or psychologist to evaluate them for PTSD. Higgs said he collaborated closely with a psychologist to complement his treatment plans for active duty and retired military service members and families.
The US Department of Veterans Affairs and the Department of Defense (DoD) recommend trauma-focused psychotherapy as the first line of treatment for PTSD. This form of therapy deliberately focuses on bringing trauma memories into the open, Hoge said.
“When a person talks about their trauma, and it comes into direct consciousness, somehow it’s malleable, and so when it goes back down into the memory banks, it’s changed somewhat,” she said.
This study was supported by the DoD through awards from the US Army Medical Research and Materiel Command, Congressionally Directed Medical Research Programs, and Psychological Health and Traumatic Brain Injury Research Program. The funding organizations played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Higgs’s comments are his own and do not necessarily reflect the official policy or position of the Defense Health Agency, Brooke Army Medical Center, Carl R. Darnall Army Medical Center, the DoD, the Department of Veterans Affairs, or any agencies under the US government. Hoge had no relevant disclosures.
A version of this article first appeared on Medscape.com.
Fibromyalgia-PTSD Link Shows Bidirectional Relationship With Exposure to Combat Environments
Fibromyalgia-PTSD Link Shows Bidirectional Relationship With Exposure to Combat Environments