While the syndrome is often misunderstood and large portions of it are still a mystery, research is beginning to find observable physiological reasons for it.
Certainly there is still a very long way to go, however, the syndrome has a long history of misunderstanding and dismissal, so even a beginning on the project of finding further physical connections is a good step.
Fibromyalgia is often misunderstood, but there’s no real confusion about how it presents. The syndrome is characterized by widespread pain that commonly involves the muscles or the joints.
It can affect any area of the body, however, including tissues. It results in back pain and muscle pain, a feeling of general fatigue, and specific tender areas.
Despite having multiple spots that are tender to palpation, called “tender points,” the patient will have a normal neurological exam that gives no clue as to what is happening. Tender points are specific spots on the body and when pressure is put on these points, it causes pain.
The syndrome most commonly affects middle-aged women who are otherwise healthy. However, it can affect women of different ages as well as men and children.
In addition to pain, individuals with fibromyalgia often experience other symptoms as well, including sleep fatigue, other difficulties with sleep, and difficulties with memory and concentration. It can also cause bowel disturbances.
First, the syndrome can be responsible both for sleep disturbances and sleep fatigue. The later refers to the fact that sleep is often not restful or refreshing because of fibromyalgia. As a result, the syndrome is often confused with chronic fatigue syndrome.
The syndrome can also be responsible for something called “brain fog.†What this refers to is the inability to concentrate or think clearly that often accompanies the syndrome.
It isn’t clear that this is, in fact, directly related to fibromyalgia, or whether it is caused by the chronic pain and fatigue that the condition brings on.
Fibromyalgia can also be responsible for digestive upsets. It’s not uncommon for the syndrome to cause bowel irritations.
In addition to pain, the syndrome can also cause you to feel sensations of burning or itching. This is a rare side effect, but it does happen occasionally.
Finally, it is not uncommon for people suffering from fibromyalgia to also suffer from other psychological conditions at the same time.
This can be a problem since fibromyalgia has a long history of being dismissed as “all-in-your-head†by doctors and other health professionals previously.
However, this is not to categorize this syndrome as psychosomatic, only to recognize that there may be other things going on at the same time as fibromyalgia. Like sleep disturbances, it is not clear that this is directly related to the syndrome, however.
It is not at all surprising if patients who suffer from chronic pain and are experiencing the other kinds of frustration that fibromyalgia can create might also suffer from depression.
This isn’t a direct result of fibromyalgia, but rather the cause of symptoms that the syndrome brings with it. That doesn’t make it any less the result of fibromyalgia, it just means that it won’t be treated as a direct result.
Pathophysiology
Pathophysiology or physiopathology is 
the combination of pathology with physiology.
Pathology is the medical discipline that describes conditions typically observed during a disease state, whereas physiology is the biological discipline that describes processes or mechanisms operating inside a patient.
Pathology describes the abnormal or undesired condition, and pathophysiology seeks to explain the physiological processes or mechanisms whereby such condition develops and progresses.
Ultimately, pathophysiology can be described simply as the observable changes that occur physiologically because of a medical condition.
Pathophysiology is not the cause, but rather the effect that a condition has on the body.
This needs to be understood as distinct from etiology which is the term used for causes.
Pathophysiology does not describe the causes of anything, which in terms of fibromyalgia, is good since the causes of the syndrome is unknown.
Pathophysiology of Fibromyalgia
So what changes in the body of the patient are caused by fibromyalgia? This will naturally be difficult since almost everything about this syndrome is shrouded in uncertainty.
However, there are at least some aspects of the disease that are observable and so can be seen as part of the pathophysiology of the syndrome.
The most obvious, observable symptom is a pain. This is understood to be a problem with oversensitivity to stimuli in general, which then manifests as pain.
This oversensitivity is possibly a result of neurobiological changes or from “hypervigilance.â€
This latter is a psychological syndrome in which a patient is extremely sensitive to stimuli, as well as extremely stressed and anxious.
Neurotransmitters
There are also observable changes in the body’s chemistry. Most important of these are the changes to brain chemistry.
Sufferers of fibromyalgia have a significant shortage of certain neurotransmitters, including:
- Serotonin: pain regulation, sleep quality, fatigue level, appetite, temperature regulation, mood, emotion, libido.
- Norepinephrine: alertness, memory, level of interest, concentration, sleep.
- Dopamine: fine motor skills, muscle function, cognitive function, attention, balance.
These are many of the same neurotransmitters that are suffering imbalances in patients with depression. As a result, treatment for fibromyalgia will generally include anti-depressants.
These will include newer selective serotonin reuptake inhibitors or SSRIs and the older tricyclic antidepressants, including Amitriptyline.
Another observable condition is an elevation in levels of a chemical called Substance P. This chemical is the best-understood neuropeptide transmitter. The chemical is largely responsible for transmitting pain signals to the brain.
Increased levels of this substance will inhibit the activity of endorphins, which are the body’s natural painkillers.
There can also be disturbances in the levels of growth hormone in the body. A deficiency in growth hormone often accompanies the syndrome.
A lack of growth hormone can cause a variety of symptoms to occur that mimic or contribute to symptoms of fibromyalgia.
All of these changes to the biological chemistry of the body can indicate a disturbance in the operation of the autonomic or sympathetic nervous system.
The connection isn’t clear enough to create a blood test, but the connection has attracted attention.
Further Reading
“Fibromyalgia – The Misunderstood Syndrome.†The Wolfe Clinic. http://www.thewolfeclinic.com/index.php/information-and-tools/dr-wolfe-article-archive/235-fibromyalgia-the-misunderstood-syndrome.
“Fibromyalgia: Pathophysiology.†By Chad S. Boomershine. Medscape.com. http://emedicine.medscape.com/article/329838-overview#a0104.
Fibromyalgia Health Center: Overview and Facts. WebMD. http://www.webmd.com/fibromyalgia/guide/fibromyalgia-overview-facts.
I have had fibromyalgia for over 30 years before we gave the syndrome a name and diagnosis for me, along with RA and OA. The natural way has not been very successful for me so I do take Lyrica, Zoloft, Tramedol, Voltaren Gel, vitamin D3, magnesium, and Enbrel. This regime seems to help most of the time. Nothing is a cure all. I refuse to take opiates mainly because I do not believe they fully treat the pain issues associated with Fibro, instead they cause more and have a rebound affect. We are hopeful in the future research may resolve some,if not all, the issues with Fibro.
Hate to disappoint you but Tramadol is an opiate…a synthetic opiate.
I was struck by the list of symptoms looking a lot like those caused by pooling of toxins. A lot of the problems with the neurotransmitters mentioned may result from conflicting signals getting to the brain, such that the brain blocks dopamine and serotonin in response. The low norepinephrine levels could result from damaged adrenal glands in the body. The three low levels may or may not even be related to each other since the brain uses multiple signals from all over the body to determine what needs to be blocked or released.
The symptoms of fibromyalgia really look a lot like those when toxins travel in the interstitial (hypodermal/extracellular) fluids of the body to various places and pool, causing damage or interference with nerve signals. They do not have to enter the blood or lymph vessels to get there. They can also cause inflammation, thus pain. However, the brain can amplify pain because it wants you to do something about the chronic condition. This is true for both emotional and physical pain. But, since doctors do not know what to do, pain might amplify. No one knows if this is happening in cases of fibromyalgia. The patient needs to get a chart of acupuncture meridians/consult an acupuncturist, and see if there are symptoms of tenderness, itching, burning, pain, etc. in organs that would fall along those meridians (e.g. lower back pain and scalp tenderness). Some go deep into the body and often the symptoms are not that obvious because the sensory nerve fibers are often so specific and different from those innervating the skin. This is not to suggest the patient get acupuncture, but there are many acupressure methods that can help to alleviate pain.
Thanks Martha for your thoughts on the matter. All this combined makes me dizzy and maybe a little disoriented at times.
i too have fibro and RA and a new test that just came out i was lucky to get my insurance covered..and I got answers to just how bad my levels were and was astonished at the results..ive got very high inlamation and no wonder why ive been in soo much pain! ive tried Lyrica but my family couldnt stand to be around me o im on cymbalta now..it does not work as well and im also on mobic methotrexate folic acid and my symptoms like many incude sever pain especially joint and back pain my knees are really bad i cant cross my feet for long or it will feel like im breaking an ankle when I move them..often i need hep to get out of bed and dressed..my major concern is the fatique ..ive not heard many mention this..i dont know if its medicine or result from both diseases and meds..but i sleep till or pm until someone wakes me up..adont wok phone calls done work..its awful..its the most frustrating part..and im at my wits end im 45 feel like 65 have to be in a wheelchair i fi go into walmart or on long walks..im not the person i use to be for sure..so depressing..my husband does not understand at all and we fight over it..my kids are sick of mom being sick and do not understand..what do you do? what can I do? ive tried everything and am at a point im about to go off all my meds! Just to try to be more awake!
I have been living with Fibro pain since 2009 after a workplace injury to the right knee. I had to have two knee surgeries that caused a catastrophic event throughout my whole body that turned into Fibromyalgia. I had every test known to man, and tried all medications known to man. I was finally diagnosed in 2013 by my Primary Dic who refused to believe I was exaggerating my pain symptoms. I would give my life to him if he asked because he was the only Doc who didn’t give up on me. I experience all the symptoms that are written about this illness and have tests and tons of medical reports to prove it. I won my disability case by all the medical reports and tests given plus my Doc whose reports couldn’t be denied. Fast forward to this week, I just had an X-ray yesterday stating I’m going to need a total knee replacement. I’m sick of all of this pain. I’m not kidding I go through my normal Fibro pain every single day and night, but then there is breakthrough pain I experience also. Not kidding something causes my body to flare up in different areas in addition to my regular pain. For example, my knee flared up for a whole month then prior to that I had severe headaches and nose pain. Not kidding, my nose bled for an entire month. Prior to that it was chronic back pain then my shoulder. I never get a break. I could go on and on. I would be willing to be a specimen if asked because what I’m going through is unreal. I would love to hear from anyone on tips or just conversation.Thanks for listening to me vent and God Bless us Fibro Warriors!!!!
Oh sorry, forgot to mention that I go to Chronic Pain Management monthly for all meds pertaining to my Fibro/Chronic Pain regimen. I have a high dose of pain patch, plus pain meds, muscle relaxer, amtripilene for sleeping and depression which I never sleep, and have gone five days without frequently. I have cellulose for constipation, and something for headaches and nausea. Plus I have my other meds for diabetes and hypertension. So I’m getting slammed over here with this illness. I will be glad when a cure is found so I can have my life back. This all started from one knee injury at 39 years old in 2009. Thanks again for listening and letting me be a part of the discussion!!!
All of us are suffering and have nowhere to turn unless you are lucky and have an understanding Doctor in your corner. I was diagnosed in 1992 with fibro, chronic fatigue and Epstien Barr Sndrome. Once you aquire Epstien Barr, it can lay dormant in your systom forever. I have read that Fibro does NOT get progressively worse but I beg to differ! I worked full time from the time before my diagnosis to 2012 when I just could not work and was in fact falling asleep and taking pain pills that were doing nothing for the pain! I worked for a small company and was alone in the office for most of the time. I would sleep until the phone would ring and try to sound like I was not sleeping and did get caught 1 time by a caller who said he was sorry for interupting my nap! I was able to get SSD after fighting for a year and a half and am now in a wheelchair. Fast forward to 2016 I was in a horrible car accident and suffered injuries which included, broken pelvis both front and back and now have 2 very large screws holding it together, I no longer have a spleen since mine burst, 11 broken ribs, all on the left side, 2 brain bleeds, a punctured diaphram and they had to intubate me 3 times due to not being able to breathe on my own and still have the trache today and can not soeak and have not spoken for the past 8 and a half months. Now, my pain levels go thru the roof and because I now collect Medicare, I am unable to go to the Doctor who understood me so well and was reffered to a Pain Management Office. This Doctor is limited to the drugs he can prescribe and the ones he has me one just barely take the edge off so that I am not laying in bed in absolute agony. I am currently on: Oxycotin 30 mg every twelve hours, amitriptilyn one every night at bedtime, Gabapentin 600 mg three times a day, tylenol #4 and Paxil 40mg. I want desperately to get off of Oxy but then they can not give me anything else. The first and only time I took Lyrica I blew up like a goodyear blimp. I want something that will work on the pain without becoming an addict but I think that is a long way off. Now that it is finally considered a disease, we may get more research on it. I am not holding my breath because the pill factories are making too much money and the won’t be in a hurry to find anything that really works.
I almost died because of cymbalta I’ll never take another ssri in my life .
I am 32 years old got diagnosed with fibromyalgia after the birth of my first child (a c- cection)…often wondered if that was the start of it…I’m on savella I have found to be one of the best meds for my fibromyalgia.. also zanaflex and hydrocodone Ibuprofen and two antidepressants…I still deal with joint stiffness rls skin crawling and tingling..my hips are constantly out of place..I don’t sleep well..I have sensitivities to light and sound…my neck upper back legs feet and scalp are all sensitive to touch…I wish everyone in my life understood that this is real and that I’m not making any excuses…
Ginger rae what happen whem u drink cimbalta why u. Said u almost died ?i dont drink nothing except turmeric ginger curcuma in pills thats what has help me with inflamation
It made me suicidal , I had no appetite I was constantly nauseas and it was making me miserable , I cut my self up pretty badly and overdosed several times before I stopped taking the cymbalta then I had 35 days of withdrawal from it and then I was fine my mood improved and I went back on lyrica and morphine .
I’ve been diagnosed with fybro since 2015 after the birth of my first daughter. At the time I had a wonderful doctor who has since retired but he put me on savella 50mg twice a day..unlike the other fybro meds it doesn’t have the horrible sleepy side effect or the weight gain. My dr had to pull some strings to get my insurance to cover it but I’m so thankful he did..it’s the best treatment I’ve found. I don’t know why it isn’t a more known and prescribed medication because it’s one of the oldest ones for fybro..I hope this helps the people that aren’t getting relief from the medication they are currently taking!
To Mary Stronger.. .I too suffer from the exhaustion because of my fibromyalgia.. ..it is relentless…..i also have had a pain management doctor refuse me treatment because he said that epidural did not ease this type of pain…i had been getting treatment from the person he had replaced but the epidural had been a godsend to me pairwise.. …i had had spinal surgery which was not successful so the epidural had been a godsend to me……so i hope things get a little better for you Mary…..
Cymbalta made me suicidal as well. Worst med ever!! You should join the group Cymbalta Hurts Worse!! Never again. Lyrica did the same thing !