Open Access Open Badges Research article

Vulnerability to traumatic stress in fibromyalgia patients: 19 month follow-up after the great East Japan disaster

Chie Usui1*, Kotaro Hatta1, Satoko Aratani2, Naoko Yagishita3, Kenya Nishioka4, Satoko Okamura5, Kenji Itoh6, Yoshihisa Yamano3, Hiroyuki Nakamura7, Nozomu Asukai8, Toshihiro Nakajima2 and Kusuki Nishioka2

Author Affiliations

1 Department of Psychiatry, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-Ku, Tokyo 177-8521, Japan

2 Institute of Innovative Medical Science and Education, Tokyo Medical University, 6-1-1 Shinjyuku, Shinjyuku-ku, Tokyo 160-8402, Japan

3 Institute of Medical Science, St. Marianna University School of Medicine, 2-16-1 Sugo, Kawasaki, Miyame-ku, Kanagawa 216-8511, Japan

4 Department of Neurology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo 113-8421, Japan

5 Kochi-Daiichi Hospital, 2-14 Kutanda, Kochi 780-0832, Japan

6 Department of Rheumatology, National Center for Global Health and Medicine, 1-21-1Toyama, Shinjuku-ku, Tokyo 162-8655, Japan

7 Department of Environmental and Preventive Medicine, Graduate School of Medical Science, Kanazawa University, Kakuma-cho, Kanazawa-city, Kanazawa 920-1192, Japan

8 Department of Psychiatry and Behavioral Sciences, Tokyo Metropolitan Institute of Medical Science, 2-1-8 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan

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Arthritis Research & Therapy 2013, 15:R130  doi:10.1186/ar4310

Published: 23 September 2013



The aim of this study was to investigate vulnerability and long-term influence of traumatic stress caused by the Great East Japan Disaster which occurred on March 11, 2011, in patients with fibromyalgia, which is a chronic pain syndrome probably involving central sensitization.


A total of 60 female patients with fibromyalgia were compared with female patients with rheumatoid arthritis (RA, n = 23) as another chronic pain disease, and with female healthy controls (HC, n = 26) in the observational study. To evaluate responses to traumatic stress, the scores of Impact of Event Scale-Revised (IES-R) were assessed one month after the disaster and every six months until 19 months after the disaster. We also evaluated levels of depression during the study period. To know the score of IES-R of patients with fibromyalgia during usual living, we assessed IES-R in another population of fibromyalgia patients without exposure to a great disaster.


The mean score of IES-R one month after the disaster in the fibromyalgia group (24.6 [SD 18.9]) was significantly higher than that of RA group (13.4 [SD 14.5]) or HC group (9.1 [9.2]) (F = 9.96, p < 0.0001). However, the mean score of IES-R in fibromyalgia patients without exposure to a great disaster was (20.3 [SD 18.7]), which was almost the same value as the fibromyalgia group seven months after the disaster (20.2 [SD 19.5]). Repeated measures analysis of variance showed significant effect of time course in the depression-related symptoms (F = 6.68, P = 0.001), and a post-hoc test revealed that the number of depression-related symptoms one month before the disaster was significantly different from other time points until 19 months after the disaster, respectively.


Although response to acute stress induced by the great earthquake was likely to be settled within seven months after the disaster, depression-related symptoms have been increasing for more than one year after the disaster, despite exclusion of patients with major depression at baseline. This long-lasting worsening of depression-related symptoms may have been in response to chronic stress induced by the fear of radiation due to the nuclear power disaster. These findings suggest that patients with fibromyalgia are vulnerable to chronic stress rather than acute stress.