"I feel like I was hit by a Mack truck";

Discussion in 'Fibromyalgia Main Forum' started by allhart, Nov 12, 2002.

  1. allhart

    allhart New Member



    18 Tender Points and the "

    To the Editor.A common question asked by rheumatologists of their patients is, "How do you feel in the morning?" This question may refer to morning stiffness from inflammatory joint disease or restoration from the night's sleep in fibromyalgia. Fibromyalgia is common (2% to 5% of the population in a recent study1) and underdiagnosed as a cause of chronic fatigue, achiness, cognitive dysfunction, and irritability.2 Approximately 2 years ago, one of us (L.H.S.) noted that fibromyalgia patients often responded to this question with the answer, "I feel like I was hit by a Mack truck"; some did not specify the truck manufacturer, and others substituted bus or train. We determined the frequency and specificity of this finding, which could be referred to as the "18-wheeler" sign, as a clue in the diagnosis of fibromyalgia.

    All patients seen in initial consultation at The Lyme Disease Center and The Lupus Clinic at Robert Wood Johnson Medical School, New Brunswick, NJ, were asked, "How do you feel when you wake up in the morning?"no patients were provided any leading hints as to a desired response. Patients seen were then categorized as having fibromyalgia (meeting the American College of Rheumatology 1990 criteria for the diagnosis of fibromyalgia, which includes the presence of at least 11 of 18 defined tender points2) or a syndrome resembling fibromyalgia (not having a sufficient number of tender points to satisfy the criteria but having chronic fatigue, historical evidence of sleep disturbance, and cognitive dysfunction) or another rheumatologic syndrome (including systemic lupus, anticardiolipin antibody syndrome, rheumatoid arthritis, polymyalgia rheumatica, osteoarthritis, psoriatic arthritis, and Reiter syndrome).

    From September 22, 1995, through November 20, 1996, we saw 93 patients with fibromyalgia, 77 with a fibromyalgialike syndrome, and 202 patients with other rheumatologic diseases or no definable abnormalities (eg, asymptomatic patients referred for evaluation of an isolated positive antinuclear antibody test or positive anti–Borrelia burgdorferi antibody assay). In this group of 372 patients, 42 (45%) of the 93 in the fibromyalgia group, 29 (38%) of the 77 in the fibromyalgialike group, and 18 (9%) of the 202 in the other group were referred for evaluation of Lyme disease or "chronic Lyme disease."3 Although the primary focus of the evaluation of these patients was not chronic fatigue syndrome, for persons with a history of the syndrome, physical examination focused on the presence of fever or chills, sore throat, painful or nontender adenopathy, muscle pain or weakness, headache, arthralgia, and the rapidity with which the main symptom complex had developed. No patient was explicitly diagnosed as having chronic fatigue syndrome according to the Centers for Disease Control and Prevention definition then in use.4

    The "18-wheeler" sign was present in 30 (42%) of 93 patients in the fibromyalgia group, including a patient with underlying lupus in whom fibromyalgia had not been suspected; none of the patients in the other 2 groups had a positive "18-wheeler" sign. None of the 77 patients with fibromyalgialike disorder or the 202 patients with other rheumatologic disorders had a positive "18-wheeler" sign (P<.001; Fisher exact test).

    Further studies will be needed to determine if this historical feature is present in other conditions associated with chronic fatigue, eg, chronic fatigue syndrome, cancer, or hypothyroidism. Given that patients with chronic fatigue syndrome commonly satisfy criteria for the diagnosis of fibromyalgia (and vice versa), it is quite likely that the "18-wheeler" sign will be present in some patients with chronic fatigue syndrome. Nonetheless, as a clinical marker of fibromyalgia (whether or not in conjunction with chronic fatigue syndrome), the "18-wheeler" sign appears to be a specific, although not very sensitive, historical marker for the clinical entity fibromyalgia and may be useful in suggesting consideration of fibromyalgia.



    Leonard H. Sigal, MD
    David J. Chang, MD
    Victor Sloan, MD
    UMDNJ–Robert Wood Johnson Medical School
    New Brunswick, NJ
  2. allhart

    allhart New Member



    18 Tender Points and the "

    To the Editor.A common question asked by rheumatologists of their patients is, "How do you feel in the morning?" This question may refer to morning stiffness from inflammatory joint disease or restoration from the night's sleep in fibromyalgia. Fibromyalgia is common (2% to 5% of the population in a recent study1) and underdiagnosed as a cause of chronic fatigue, achiness, cognitive dysfunction, and irritability.2 Approximately 2 years ago, one of us (L.H.S.) noted that fibromyalgia patients often responded to this question with the answer, "I feel like I was hit by a Mack truck"; some did not specify the truck manufacturer, and others substituted bus or train. We determined the frequency and specificity of this finding, which could be referred to as the "18-wheeler" sign, as a clue in the diagnosis of fibromyalgia.

    All patients seen in initial consultation at The Lyme Disease Center and The Lupus Clinic at Robert Wood Johnson Medical School, New Brunswick, NJ, were asked, "How do you feel when you wake up in the morning?"no patients were provided any leading hints as to a desired response. Patients seen were then categorized as having fibromyalgia (meeting the American College of Rheumatology 1990 criteria for the diagnosis of fibromyalgia, which includes the presence of at least 11 of 18 defined tender points2) or a syndrome resembling fibromyalgia (not having a sufficient number of tender points to satisfy the criteria but having chronic fatigue, historical evidence of sleep disturbance, and cognitive dysfunction) or another rheumatologic syndrome (including systemic lupus, anticardiolipin antibody syndrome, rheumatoid arthritis, polymyalgia rheumatica, osteoarthritis, psoriatic arthritis, and Reiter syndrome).

    From September 22, 1995, through November 20, 1996, we saw 93 patients with fibromyalgia, 77 with a fibromyalgialike syndrome, and 202 patients with other rheumatologic diseases or no definable abnormalities (eg, asymptomatic patients referred for evaluation of an isolated positive antinuclear antibody test or positive anti–Borrelia burgdorferi antibody assay). In this group of 372 patients, 42 (45%) of the 93 in the fibromyalgia group, 29 (38%) of the 77 in the fibromyalgialike group, and 18 (9%) of the 202 in the other group were referred for evaluation of Lyme disease or "chronic Lyme disease."3 Although the primary focus of the evaluation of these patients was not chronic fatigue syndrome, for persons with a history of the syndrome, physical examination focused on the presence of fever or chills, sore throat, painful or nontender adenopathy, muscle pain or weakness, headache, arthralgia, and the rapidity with which the main symptom complex had developed. No patient was explicitly diagnosed as having chronic fatigue syndrome according to the Centers for Disease Control and Prevention definition then in use.4

    The "18-wheeler" sign was present in 30 (42%) of 93 patients in the fibromyalgia group, including a patient with underlying lupus in whom fibromyalgia had not been suspected; none of the patients in the other 2 groups had a positive "18-wheeler" sign. None of the 77 patients with fibromyalgialike disorder or the 202 patients with other rheumatologic disorders had a positive "18-wheeler" sign (P<.001; Fisher exact test).

    Further studies will be needed to determine if this historical feature is present in other conditions associated with chronic fatigue, eg, chronic fatigue syndrome, cancer, or hypothyroidism. Given that patients with chronic fatigue syndrome commonly satisfy criteria for the diagnosis of fibromyalgia (and vice versa), it is quite likely that the "18-wheeler" sign will be present in some patients with chronic fatigue syndrome. Nonetheless, as a clinical marker of fibromyalgia (whether or not in conjunction with chronic fatigue syndrome), the "18-wheeler" sign appears to be a specific, although not very sensitive, historical marker for the clinical entity fibromyalgia and may be useful in suggesting consideration of fibromyalgia.



    Leonard H. Sigal, MD
    David J. Chang, MD
    Victor Sloan, MD
    UMDNJ–Robert Wood Johnson Medical School
    New Brunswick, NJ
  3. allhart

    allhart New Member

    going to bump this back
  4. teach6

    teach6 New Member

    I've found old entries in my journal before I even had a clue about FM where I wrote I woke up feeling like I was hit by a Mack truck. Of course I feel most things coming out of Rutgers, like my oldest, are pretty darn good!

    Barbara
    [This Message was Edited on 12/12/2002]
  5. darlamk

    darlamk New Member

    Even in my mid 20's I used to get up in the morning and say "I feel like I've been run over by a mack truck!" I was not dx until 10 yrs later!! I thought maybe it was a midwestern slang thing but now after reading this........
  6. Annette2

    Annette2 New Member

    I also have used that term to describe how I often feel. I have heard that term used since I was a little child. It must have been around forever. But I've used it a lot since I was diagnosed with FMS. There really was no other way to describe that horrible feeling you get. I've also used the term "I feel like I have the flu without the fever". I guess it's not very scientific, but it sure does describe how we feel!

    Annette2
  7. nogilroy

    nogilroy New Member

    Was going to post somthing but this is how i felt all day the head ach never went away or the pain all i said to myself was i felt like i have been hit by a truck .but i pushed my self to get housework done thats maybe what did it hope friday is better may be just a van will hit me lol
    [This Message was Edited on 12/12/2002]
  8. tlc

    tlc New Member

    I have said that phrase mmany many many many times!!!!
    I thought it was a southern thing saying!!!
  9. fibolady

    fibolady New Member

    time for this truck to get on down the road!

    fibolady
  10. allhart

    allhart New Member

    someone realy needs to get this drivers lisence plate number hes running us all over and getting away with it!
    maybe its just some little old guy who cant see over the stearing wheel!
    lol
    kara