title: Perceived physical and emotional trauma as precipitating events in fibromyalgia. Associations with health care seeking and disability status but not pain severity.
abstract: OBJECTIVE
  We examined relationships between perceived physical and emotional trauma that occur prior to, or that initiate, pain onset and health care seeking for fibromyalgia syndrome (FMS). We also assessed associations between perceived trauma and levels of health care usage, symptom severity, functional disability, and receipt of disability compensation among patients with FMS.
  
  
  METHODS
  We evaluated these variables using interviews and standardized instruments in a consecutive series of FMS patients and community residents who met the American College of Rheumatology criteria for FMS but had not sought medical care ("nonpatients").
  
  
  RESULTS
  Emotional trauma was associated with status as an FMS patient independently of demographics, physical trauma, and sexual/physical abuse (P = 0.007). Among patients, emotional trauma was related to a high number of physician visits (P = 0.013), functional disability ratings (P = 0.012), and fatigue (P = 0.029), but physical trauma was associated with receipt of disability compensation (P = 0.019). Trauma history was not related to pain severity or pain thresholds.
  
  
  CONCLUSIONS
  Perception of physical trauma is a greater determinant of disability compensation for FMS than is perceived emotional trauma, symptom severity, or functional disability. Effort should be devoted to understanding the social and legal factors underlying this observation, as well as to reducing high health care usage among FMS patients with emotional trauma.
authors.affiliation: Division of Clinical Immunology and Rheumatology, University of Alabama, Birmingham 35294-0012, USA.
authors.forename: L A
authors.initials: LA
authors.lastname: Aaron
authors.forename: L A
authors.initials: LA
authors.lastname: Bradley
authors.forename: G S
authors.initials: GS
authors.lastname: Alarcón
authors.forename: M
authors.initials: M
authors.lastname: Triana-Alexander
authors.forename: R W
authors.initials: RW
authors.lastname: Alexander
authors.forename: M Y
authors.initials: MY
authors.lastname: Martin
authors.forename: K R
authors.initials: KR
authors.lastname: Alberts
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D005260:Female; D005356:Fibromyalgia / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010342:Patient Acceptance of Health Care; D013315:Stress, Psychological / Q000150:complications*; D014947:Wounds and Injuries / Q000150:complications*