November 2025
Can Trauma Precipitate Fibromyalgia?
Pacific Northwest MD Legal Consulting — Medical Perspective
We recently discussed a case involving a 39-year-old woman who was properly seat-belted when her vehicle was struck on the driver’s side by a drunk driver. The airbags did not deploy. She initially thought her injuries were minor but later presented to the emergency department with chest, shoulder, and neck pain. X-rays were negative, and she was discharged with a diagnosis of soft tissue strain.
Over the following weeks, she continued to experience persistent pain in her neck, chest, and left shoulder despite conservative management and physical therapy, which worsened her symptoms. MRI imaging of the cervical spine and shoulder was unremarkable. A bone scan revealed mild increased uptake in the clavicle, anterior shoulder, and upper chest—findings suggestive of localized inflammation but without structural damage.
As her symptoms persisted and began to generalize, she was referred to a rheumatologist, who diagnosed fibromyalgia, potentially related to the traumatic event. She also experienced ongoing fatigue, cognitive slowing (“fibro fog”), and increased work absenteeism. One-year post-collision, her pain and fatigue had become chronic, interfering significantly with daily activities and quality of life.
Medical Discussion
Fibromyalgia is a chronic pain disorder of unclear etiology characterized by abnormal central pain processing rather than structural or inflammatory tissue damage. Current understanding suggests dysfunction in the central nervous system’s modulation of pain, involving:
Neurochemical imbalances:
Elevated excitatory neurotransmitters
Diminished serotonin and norepinephrine in descending anti-nociceptive pathways
Dysregulation of dopamine and endogenous opioids
Central sensitization: Heightened pain perception to normally non-painful stimuli (allodynia) and amplification of nociceptive signals
Associated features: Sleep disturbance, fatigue, cognitive impairment (“fibro fog”), headaches, paresthesias with normal neurologic exam, and irritable bowel syndrome
While fibromyalgia is not a structural injury, it may be precipitated or unmasked by physical or emotional trauma. Following trauma, inflammatory and neurochemical events at the cellular level can trigger sensitization of pain pathways. This process, once established, can persist even after tissue healing has occurred, resulting in the chronic pain and fatigue characteristic of fibromyalgia.
In this case, although conventional imaging (MRI, CT) was negative, findings such as localized increased blood flow on bone scan and persistent allodynia were consistent with early central sensitization mechanisms.
Medical-Legal Relevance
In personal injury or disability cases, understanding fibromyalgia’s pathophysiology is essential.
The absence of objective imaging findings does not exclude significant functional impairment.
Temporal association between trauma and onset of widespread pain supports causal linkage, particularly when other explanations are excluded.
Fibromyalgia remains a complex and often misunderstood condition. However, from a medical-legal perspective, recognizing the neurophysiologic underpinnings and trauma-related triggers is critical in accurately assessing causation, prognosis, and damages.
