Primary Care Physician
Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…
10 Things We Know About What Causes Fibromyalgia
Posted in Fibromyalgia by Dr. Sharon Orrange on Dec 19, 2013
There may not be one simple answer, but the last few years have moved us closer to an answer to this question. Fibromyalgia (FM) is a chronic pain disorder with unknown etiology and unclear pathophysiology. Here are 10 things we do know.
1. There is no evidence that a single event “causes” fibromyalgia. Rather, many physical and/or emotional stressors may trigger or aggravate symptoms. This may include anything from an infection, such as a viral illness or Lyme disease, to emotional, or physical trauma.

2. Fibromyalgia (FM) is considered to be a disorder of pain regulation. Fibromyalgia shares several features with other pain disorders that are considered to be more central rather than peripheral pain conditions, such as: migraine, tension headaches, temporomandibular joint disorder, and irritable bowel syndrome.

3. It is not a muscle disease. During much of the 20th century, fibromyalgia was thought to be a muscle disease however, years of studies have found no evidence for pathologic or biochemical muscle abnormalities.

4. The muscle soreness associated with FM is now believed to be secondary—a result of pain and inactivity rather than being a primary muscle disorder.

5. It’s in the genes. First-degree relatives of patients with FM are 8.5 times more likely to have FM than relatives of patients with rheumatoid arthritis. This suggests a shared hereditary factor that may account for the overlap of chronic pain and mood disorders (depression, anxiety) in families.

6. Pain processing is off in FM. Alterations in pain and sensory processing in the central nervous system are present in FM. What this means is patients with FM perceive noxious stimuli, such as heat, electrical current, or pressure, as being painful at lower levels of physical stimulation than do healthy controls.

7. Disrupted sleep and FM is a big deal. Underlying central nervous system dysfunction is suggested by the sleep and mood disturbances noted in the majority of FM patients. What is really interesting is that disordered sleep patterns precedes the development of fibromyalgia pain and that abnormal sleep and pain predict depressive symptoms.

8. Autonomic nervous system dysfunction. Yes, that’s a mouthful but know this: abnormal function of the autonomic nervous system in those with FM is suggested by the fact that some patients with FM have been found to have orthostatic hypotension (their blood pressure drops when they stand.)

9. It is not an immune system change. There is little evidence to support the concept that FM is an immune mediated disorder.

10. Hot spots. Fibromyalgia patients often have areas of focal tissue abnormalities including myofascial trigger points or osteoarthritis of the joints and spine. In FM patients there are abnormal peripheral pain generators which means those above listed tender areas may initiate or perpetuate chronic pain.
- Dr. O


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CONDITIONS AND COMMUNITIES: Chronic Pain  •  Fibromyalgia
TAGS: Symptoms  •  Therapies

TOTAL COMMENTS: 4 - View All Comments »

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I developed Fibro a couple of years after I had breast cancer and a very traumatic life event. I was send by my pain management doctor to a pain support group, it was a very negative group, and I knew I did not need that.
Also I saw that many with fibro have mental issues, that I do not have.
I do not take pain medications, I meditate and use self hypnosis.
I thought the pain was bad till I got Polymyalgia rheumatica and that is the worse pain one can have.
I still do my activities, I work, rest when I need, my pain management team agrees that keeping busy helps manage my pain.
I have days that are bad and others worse. To a cancer survivor it is a sign that I am alive and it is not cancer ,thank God.
I know people on disability because of fibro, I believe in the power of the mind, if I act as a victim of my pain, I will be.
By deraming  Dec 25, 2013
I just read an article last week about some new developments:

" 2013 there's been this absolute explosion of papers....The whole view on this has shifted."

"...half or more of the cases of fibromyalgia are really a little-known condition affecting the nerves."

"...also discovered that there are excessive nerve fibers lining the blood vessels of the skin of fibromyalgia patients...."

"These fibers [blood vessel nerve fibers] in the skin can sense blood flow and control the dilation and constriction of vessels to regulate body temperature, Rice says, as well as direct nutrients to muscles during exercise. Women have more of these fibers than men, he says, perhaps explaining why they are much more likely to get fibromyalgia."

"...Chou says there is some preliminary evidence that the nerve damage is caused by the immune system."
By aprilraven  Dec 23, 2013
Wow, I am so excited to find your post . I always pay more attention to health, and what you show mus is very useful and timely!
By mercuryqiqi  Dec 22, 2013
How many patients with Fibromyalgia or IBS or Chronic Fatigue, or any other so-called disease without any known cause, are even tested for Thyroid related conditions? If the TSH is normal would they ever be tested for auto immune antibodies?

I have had antibodies consistent with both Graves' Disease and Hashimoto's Thyroiditis simultaneously with a TSH "in range", and to me, at least, it seems important to be adequately tested for some known cause of fatigue, etc. before sticking someone with a diagnosis of something with no more evidence than found in an astrology book.
By Fern RL  Dec 22, 2013
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