Fibromyalgia

What is fibromyalgia?

Fibromyalgia syndrome (FMS) typically occurs in women aged 20-50 years. It affects the muscles, tendons, ligaments and surrounding tissues, but not the joints themselves. A key sign is pain that results from gentle pressure at specific “tender/trigger points”. Even without pressure there is pain, tenderness and stiffness, which has not been caused by physical damage to the tissues. 

Other symptoms vary considerably between patients and can be both intermittent and persistent. They include: fatigue, sleep disturbances, anxiety, depression, irritable bowel syndrome, impaired memory and concentration, slow or confused speech, feeling cold, intolerance to exercise and a general inability to manage normal daily activity. 

What causes fibromyalgia?

It is not yet completely understood what causes it, and it manifests differently between individuals. But current scientific thought is that abnormal neurotransmitter (and hormone) activity results in distorted pain processing and excessive sensitivity to pain. MRI scans show hyperconnectivity between pain processing regions in the brain. The main neurotransmitters involved are serotonin, dopamine, noradrenaline, GABA and substance P. Abnormal levels of these neurotransmitters are found in patients, which may account for not only the pain but also other symptoms, such as fatigue, disturbed sleep and mood. 

So, what causes the distorted neurotransmission in the first place? It is likely that genetic and environmental factors play a role. It tends to run in families and sufferers often have gene variations (known as polymorphisms) affecting the function of these neurotransmitters. 

Stress plays an important role as both a cause and symptom. Stress triggers complex interactions between the hormone, cortisol, and these neurotransmitters. These varied interactions reflect the observed symptom diversity between patients. As discussed in my Stress: part 1 blog post, there are many types of stress. Research highlights trauma (early-life, physical ie injury or surgery, and psychological trauma), lack of social support, toxin exposure, viral infections or other illness as additional triggers.

An underactive thyroid is also common. This slows the body’s metabolism and thereby results in pain, tenderness and sensitivity via its effect on neurotransmission.

What keeps it going?

Why is it that long after the initial ‘trigger’ has passed, the disease process continues? Again, we can point the finger at ‘stress’, with its complex interactions on the hormone cortisol and on neurotransmission. The circadian rhythm is also affected, with sufferers often feeling more energised in the evenings. Inflammation and oxidative stress are important factors to consider, particularly with their damaging effects on the mitochondria (which is the part of your cell that makes energy). There’s a vicious cycle with depression: FMS may result in depression but depression also perpetuates FMS. Similarly, the tiredness and lack of sleep make things worse. Patients tend to avoid physical exercise due to pain, but this causes physical deconditioning. Many dietary factors have also been found, including gluten sensitivity and additives like glutamate. 

What may help?

Although there is no established treatment or cure for FMS, there are many nutritional and lifestyle therapies with evidence-based support, which may improve symptoms, function and quality of life. It’s always best to work with a professional who can tailor the recommendations to each individual’s particular case. Diet is incredibly important. Lattanzio & Imbesi (2018) discuss a case study where dietary changes resulted in symptom remission. The protocol should address inflammation, oxidative stress and mitochondrial dysfunction. Particular attention should be paid to vitamins D, B6 and B12, and the minerals magnesium, zinc and selenium. Protein intake must be adequate. Toxin exposure and/or accumulation must be considered, especially of food additives, and heavy metals such as mercury and lead which are associated with pain and fatigue. Isasi et al. (2014) find that a gluten-free diet resulted in pain remission. Lifestyle therapies, such as gentle physical exercise, mindfulness and stress management, have also been found to help.