Combat Deployment Linked to Onset of Fibromyalgia in PTSD Patients

Recent evidence indicates there may be a link between military combat and fibromyalgia in patients with PTSD. Combat deployment has been studied in relation to chronic illness in patients with PTSD and is an important area of investigation to better understand the health needs of veterans and trauma survivors.

Why It Matters

Fibromyalgia (FM) is a chronic pain and fatigue illness that is marked by widespread muscle and bone pain, fatigue, sleep difficulties, stiffness of joints, headaches, brain fog, and a variety of other symptoms that cannot be attributed to any known medical condition. In addition, many people with FM experience mood changes such as depression and anxiety, and emotional exhaustion. Several risk factors for fibromyalgia have been established, including age (over 30 years old), sex (female), and the presence of another disease (such as lupus or rheumatoid arthritis). There may be additional risk factors for FM but they have not yet been confirmed and require further research.

• Sex: women are twice as likely to develop fibromyalgia as men
• Stress/traumatic events: including adverse childhood experiences, car accidents, or PTSD
• Repetitive injuries: due to repetitive stress on a joint (e.g., frequent knee bending)
• Illness (e.g., viral infections)
• Family history of fibromyalgia
• Obesity

Two new studies have found an association between PTSD, including military-related PTSD, and the development of fibromyalgia. The odds ratios of the first study indicated that service members with predeployment PTSD were 2.96 times as likely to develop fibromyalgia post deployment than those without predeployment PTSD. The odds ratios of the second study found that service members with predeployment fibromyalgia were 3.12 times as likely to develop PTSD post deployment. These findings highlight the health issues of veterans and others with trauma-related disorders.

Understanding how PTSD can lead to the development of fibromyalgia offers new insights into the potential biological pathways by which psychological stress can result in physical symptoms and how healthcare providers can tailor treatment for traumatically injured patients. The majority of veterans with PTSD also have some form of physical health problem that can be a complex and not fully understood symptom cluster. A new study by researchers found that the bidirectional comorbidity between fibromyalgia and PTSD is likely to involve shared pathways in the brain and that treating both conditions will be a major goal for clinicians.

Treatment and Therapies

The number of veterans seeking healthcare is increasing and those receiving care often present with complex comorbidity. In addition to patients with veteran status and PTSD, healthcare providers must also have a thorough understanding of fibromyalgia and its treatment options. Medication, physical therapy, and cognitive behavioral treatments for fibromyalia are common, and a growing body of evidence suggests that the efficacy of these typical interventions may need to be reevaluated for individuals with comorbid PTSD. Pain management medications, antidepressants, and certain antiseizure medications have been found to be effective in alleviating symptoms of fibromyalgia. In addition, many individuals combine physical fitness, yoga, and/or physical rehabilitation with traditional treatments for fibromyalgia, and are often open to exploring complementary therapies such as acupuncture and massage. There are a number of herbal remedies which are said to help with irritable bowel syndrome symptoms. Some of these remedies have been studied, although they have not been fully proven and more research is needed. However, others have been used by some individuals with IBS with reported benefit.

With so many options, health care providers must team together to create a treatment plan for individual patients that incorporates both a psychological and physical perspective.

Future Needs

While treatments for co-occurring conditions are available, there is currently a lack of training for clinicians to identify and treat the combination of PTSD and fibromyalgia at a systems level. Long-term costs to the health care system from inappropriate treatment of these conditions will be substantial as the numbers of active military personnel and veterans requiring mental health services continues to rise. Policymakers must consider these system wide implications as they seek solutions for the growing number of service members and veterans struggling with PTSD.

Scientists at the National Institutes of Health’s (NIH) National Center for Complementary and Integrative Health (NCCIH) and National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) are conducting research on fibromyalia to aid in the development of effective treatments, diagnosis, and pain management for this condition. Current research includes exploring the possibility of a diagnostic test for fibromyalia based on genes. NCCIH and NIAMS research also includes the exploration of possible medications-free alternatives for treating this condition using tai chi and aerobic exercise.

Who it affects

As research highlights the connection between fibromyalgia and PTSD, implications are beginning to emerge for a number of different groups. The news is not particularly good for people with PTSD. Many veterans are struggling with both PTSD and fibromyalgia, two very difficult conditions that take a toll on a person’s quality of life and healthcare use. For the family members of people with chronic pain, including those with fibromyalgia, the experience of caring for a loved one can be both emotionally and physically draining, even if they have the best of intentions. This experience can dramatically alter the dynamics of the home and how family members interact with each other.

People with FM and depression co-morbidity require an integrated approach to treatment and care from a variety of health care professionals including the person’s primary care physician, a rheumatologist and/or other medical specialists and mental health professionals such as a clinical psychologist or psychiatrist. Education of health care professionals about FM and its associated symptoms is an essential first step in managing patients with co-morbid conditions. Complications of fibromyalgia

1. More hospitalizations
2. Lower quality of life
3. Higher rates of major depression
4. Higher death rates from suicide and injuries
5. Higher rates of other rheumatic conditions

Organizations and agencies focused on mental health and veterans and their families from all service eras, as well as their spouses, children and others affected by trauma, are important stakeholders in this work. Such organizations can highlight the connections between physical symptoms and trauma, and provide education and advocacy around issues related to trauma and illness from a medical and cultural context. They can also provide education to clinicians and the public about physical symptoms associated with trauma.

When developing health policy for veterans, it is crucial to recognize the many associated health conditions. In the last few years, Congress has passed legislation that fundamentally changed how veterans access healthcare. In the last several years, Congress has been working to improve the experience of veterans using the healthcare system, and this legislation is no exception. To develop effective health policy for veterans with physical health conditions such as TBI and amputations, there must be awareness of how comorbid mental health conditions affect this patient population and the quality of health care that they receive, and how health care policy can work to mitigate these effects over the long term.

What changes

• Improved clinician awareness and training on the interrelationship between PTSD and fibromyalgia can lead to more timely diagnoses and effective treatment plans.
• Utilization of multidisciplinary care models that involve both mental health and pain specialists can enhance treatment efficacy and patient satisfaction.
• Policy reforms may result in increased funding for integrated care programs aimed at veterans, leading to better health outcome tracking and resource allocation.

These changes can help the healthcare system better address the needs of our military service members and their families afflicted with post-traumatic stress disorder (PTSD) and related physical symptoms. As the science unfolds, we hope to see more effective treatments that address the mental and physical symptoms of symptoms of PTSD and related conditions experienced by our troops who have suffered the traumas of war. As an advocacy, education and research organization, we will continue to work with all stakeholders to improve the health care of patients with PTSD and fibromyalgia.

References

1. https://pubmed.ncbi.nlm.nih.gov/41568551/
2. https://magazine.medlineplus.gov/article/fibromyalgia-what-you-need-to-know
3. https://magazine.medlineplus.gov/article/whats-new-in-fibromyalgia-research/
4. https://archive.cdc.gov/www\_cdc\_gov/arthritis/types/fibromyalgia.htm
5. https://pmc.ncbi.nlm.nih.gov/articles/PMC10356693/