Fibromyalgia: Complex But Not Invisible

By Dr. Peter Abaci

As some of you may know, I recently hosted a live Facebook chat on behalf of Pain Pathways Magazine. Lots of great questions were submitted, and there were certain topics that got raised repeatedly that seemed to call out for a more detailed discussion than what I could offer during the one hour event and still cover many of the other questions that were submitted. One question that seemed to crop up more than once has to do with fibromyalgia and how it occurs. In other words, what causes fibromyalgia?

As I mentioned during the Facebook chat, fibromyalgia as a syndrome is still somewhat of a mystery when it comes to understanding the mechanisms in the body that lead to its genesis. For many, these unknown qualities serve as an area of great frustration. Fibromyalgia is typically associated with widespread pain along with other symptoms including fatigue, insomnia, depression, and lapses in mental clarity. Putting this all together, fibromyalgia can impact a person’s quality of life in a big way, but when something that impactful is hard to explain scientifically and there isn’t a specific test that can be done to prove its severity, then that puts fibromyalgia sufferers in an unfortunately awkward position when it comes to perceptions from others including friends, family, and even their doctors. (Some refer to fibromyalgia as “an invisible disease”.)

Despite the lapses in our medical understanding of fibromyalgia, there are still some important contributing factors that have been studied that I would like to review. Hopefully, this synopsis can also serve as an educational tool for friends and family, too. Let’s take a look at some of the different systems in the body that can be altered in the wake of this syndrome:

  • Central Nervous System: An important concept to understand here is the one of central sensitization where the brain becomes super-sensitized to stimulation that can cause pain. With central sensitization, everything just hurts more and the pain not only gets magnified but it spreads throughout the body. This is when driving over a pothole is annoyance to one person but very uncomfortable for another. There are a number of different changes that take place within the central nervous system that lead to this “wind-up” in pain activity. Interestingly, we also see central sensitization occur in other types of chronic pain problems including neuropathic pain. (To learn more about how the brain changes with chronic pain, see the chapter titled “The Pain Brain” in my new book Conquer Your Chronic Pain.)
  • Autonomic Nervous System: Our autonomic nervous system, comprised of the sympathetic and parasympathetic nervous systems, governs involuntary functions of the body like blood flow, sweating, and blood pressure. Disruptions in the autonomic nervous system (ANS) can also lead to enhanced pain. Studies done on fibromyalgia patients have shown deficiencies in certain ANS functions, resulting in problems like unwanted drops in blood pressure and a lack of heart rate variability. Some researchers feel the disruptions in normal ANS activity may also be connected to certain fibromyalgia symptoms like fatigue and sleeplessness.
  • Endocrine System: Disruptions in hormone regulation has been seen in fibromyalgia patients. For example, studies have shown that levels of cortisol are elevated with fibromyalgia, particularly at night, which might factor in to insomnia problems. Growth hormone levels dip lower at night in fibromyalgia patients. The problems with hormone regulation in fibromyalgia seem to stem from alterations with the hypothalamus and pituitary glands in the brain and how they regulate glands in the body.
  • Immune System: Fibromyalgia commonly shows up in patients with inflammatory autoimmune diseases like rheumatoid arthritis, but researchers have not yet been able to find an autoimmune mechanism that causes fibromyalgia. There does appear to be a genetic predisposition to fibromyalgia which may explain its connection to other autoimmune disorders. Several genetic markers linked to fibromyalgia have been identified.
  • Peptides: The activity of a number of important chemical mediators appears to be altered in fibromyalgia patients. One of the better known examples has to do with serotonin, an important neurotransmitter in the regulation of pain, mood, and sleep. Genetic studies have implicated alterations in the way serotonin gets transported leading to reduced activity in fibromyalgia.
  • Environment: Both physical and emotional environmental factors appear to be quite relevant to the better understanding of fibromyalgia. For example, certain repetitive physical tasks, such squatting and heavy lifting can be linked to symptoms of widespread pain. Psychosocial stressors, both past and present, are often linked to fibromyalgia, as well. Fibromyalgia can also be associated with increased rates of other psychological disorders including depression, panic disorders, and PTSD.

While there is still so much to learn to better understand fibromyalgia, research has started to reveal what a complex and multi-system disease it seems to be.





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