title: A painful train of events: increased prevalence of fibromyalgia in survivors of a major train crash.
abstract: OBJECTIVE
  To evaluate the prevalence of fibromyalgia in survivors of a major train crash in southern Israel, three years after the event.
  
  
  METHODS
  Survivors were contacted by mail and telephone. Individuals consenting to participate in the study underwent physical examination, including a tender point count and dolorimetry, as well as extensive evaluation of parameters relating to quality of life, presence of widespread pain, fatigue, physical and social function, posttraumatic symptoms and symptoms related to anxiety, dissociation, depression, somatisation, etc.
  
  
  RESULTS
  Fifteen percent of survivors participating in the study met ACR criteria for the classification of fibromyalgia. Significantly lower rates of physical and emotional functioning were found among survivors with fibromyalgia compared with those not meeting the classification criteria. Survivors with fibromyalgia rated significantly higher on scales of somatisation, obsessive-compulsive ideation, interpersonal sensitivity, depression, anger and hostility, phobic and general anxiety, paranoid ideation and psychoticism. Survivors with fibromyalgia also rated significantly higher on scales of posttraumatic symptoms including intrusion, avoidance and arousal. These individuals also rated significantly higher on the Peritraumatic Dissociative Experiences Questionnaire (PDE-Q) and the Dissociative Experiences Scale (Hebrew version) (DES-H).
  
  
  CONCLUSIONS
  Fibromyalgia was found to be highly prevalent, three years after a major train crash, among individuals exposed to the combination of physical injury and extreme stress. This finding is in accordance with previous data regarding the association of fibromyalgia with both physical and emotional trauma and calls attention to studying the underlying susceptibility factors which may partake in this association.
authors.affiliation: Division of Internal Medicine, Department of Medicine H, Soroka Medical Center, Ben Gurion University, Beer Sheva, Israel.
authors.forename: D
authors.initials: D
authors.lastname: Buskila
authors.forename: J N
authors.initials: JN
authors.lastname: Ablin
authors.forename: I
authors.initials: I
authors.lastname: Ben-Zion
authors.forename: D
authors.initials: D
authors.lastname: Muntanu
authors.forename: A
authors.initials: A
authors.lastname: Shalev
authors.forename: P
authors.initials: P
authors.lastname: Sarzi-Puttini
authors.forename: H
authors.initials: H
authors.lastname: Cohen
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D004190:Disasters; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D018579:Patient Selection; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology; D011795:Surveys and Questionnaires; D017741:Survivors