From the Guidelines
The exact cause of fibromyalgia remains unknown, though researchers believe it involves multiple factors working together, including abnormal pain processing in the central nervous system, genetic predisposition, physical or emotional trauma, and neurotransmitter imbalances 1. The condition appears to result from "central sensitization" where the brain and spinal cord amplify pain signals, making people with fibromyalgia experience pain more intensely than others. Several factors likely contribute to developing fibromyalgia, including:
- Genetic predisposition (it often runs in families)
- Physical or emotional trauma (such as accidents, surgery, or psychological stress)
- Certain infections (like Lyme disease or viral illnesses)
- Other coexisting conditions (such as rheumatoid arthritis or lupus) Neurotransmitter imbalances, particularly involving serotonin, norepinephrine, and dopamine, also play a role in pain regulation and sleep disturbances common in fibromyalgia, as noted in the 2008 EULAR evidence-based recommendations for the management of fibromyalgia syndrome 1. Additionally, hormonal disruptions and sleep disorders may contribute to symptom development and severity, as highlighted in the revised 2017 EULAR recommendations for the management of fibromyalgia, which emphasize the importance of addressing fatigue, non-refreshed sleep, mood disturbance, and cognitive impairment in managing the condition 2. While there's no single identifiable cause, understanding these contributing factors helps guide treatment approaches that typically include medication, exercise, stress management, and cognitive behavioral therapy to address the complex nature of this chronic pain condition.
From the Research
Causes of Fibromyalgia
The exact cause of fibromyalgia is still not fully understood, but several factors are believed to contribute to its development. These include:
- Genetic and environmental factors 3
- Central sensitization phenomenon characterized by the dysfunction of neuro-circuits, which involves the perception, transmission and processing of afferent nociceptive stimuli 4
- Inflammatory, immune, endocrine, genetic and psychosocial factors 4
- Aberrations in central pain processing, which may also be partly responsible for symptoms experienced in several chronic pain disorders that coaggregate with fibromyalgia 3
- Deficiencies in serotonergic and noradrenergic, but not opioidergic, transmission in the central nervous system 3
- Increases in pronociceptive neurotransmitters such as glutamate and substance P 3
- Psychological and behavioral factors 3
Triggering Factors
In some cases, symptoms of fibromyalgia may begin after physical or emotional trauma, but in many cases, there appears to be no obvious trigger 4. Women are more prone to developing the disease than men 5, 4.
Underlying Mechanisms
Fibromyalgia is now believed to be, at least in part, a disorder of central pain processing that produces heightened responses to painful stimuli (hyperalgesia) and painful responses to nonpainful stimuli (allodynia) 3. The pathogenesis of fibromyalgia has also been linked to other factors, such as inflammatory, immune, endocrine, genetic and psychosocial factors 4.