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Pain isn’t fun. So why do we feel it then? Because it is a learning mechanism. When I burn myself tasting boiling soup I quickly pull the spoon away, blow on it, and learn not to do that again until tomorrow. Pain is useful, but what about when it’s not? Fibromyalgia is a condition where the body’s sensitivity to pain has increased beyond the useful range. Instead of keeping you from stopping damaging activities, it can stop people from performing healthy ones. It is a complex, poorly understood disease.

Fibromyalgia affects between 2-8% of the world population, somewhere around 500 million people worldwide. It mostly affects women and onset is usually between 30 and 35 years of age. Risk factors include being female, experiencing trauma, infections, diabetes, inflammatory diseases, neurological and psychiatric disorders, genetics, and oxidative stress. Major symptoms include:

• Sleep difficulty, including insomnia and sleep that doesn’t make you feel rested
• Cognitive dysfunction
• Mood changes, such as anxiety and depression
• Fatigue
• Gut changes
• Muscle stiffness
• Joint stiffness

Fibromyalgia is hard to diagnose because it doesn’t have physical symptoms that we know how to detect. Doctors look for pain that has been spreading for three or more months. A rheumatologist (a doctor who specializes in inflammatory diseases), may provide the diagnosis. 

How does fibromyalgia work? It is multifactorial, meaning there are several possible causes that all lead to the same result. Because of this, looking at individual causes may not be helpful. Instead, according to Dr. Siracusa, fibromyalgia “…is thought to represent the degradation of the autonomic nervous system in a failed attempt to adapt to a hostile environment” (Siracusa, 2021). The autonomic nervous system is the part which controls involuntary activity, like heart rate and digestion. This theory holds that as this system breaks down from repeated or constant stresses to it; it eventually fails to interpret pain signals in a useful way. Some of these stresses may include:

• Increased inflammation
• Immune system changes, including in the brain
• Genetic differences
• Psychosocial changes, including depression, anxiety, and sleep disorders
• Hormonal changes, including to stress hormones
• Stress

We will digress here to talk about some of the controversy and problems with fibromyalgia. It is hard to diagnose, doesn’t leave good molecular clues, and is hard or impossible to see. This has led to widely proliferated discounting of the symptoms, even by medical professionals. This is unacceptable. I have heard that fibromyalgia is “in their head.” Even if true, this doesn’t mean it’s any less real! Chronic and sensitized pain is debilitating. Having acquaintances and medical professionals dismiss debilitating symptoms can be devastating.

With any change in how we sense the world, there are changes in the body and brain. With fibromyalgia, the most likely culprit of change is the pain system. This system, called the nociceptive system, becomes high strung, firing willy-nilly. There are changes to neurotransmitter levels, molecules that lessen pain, and nerve fibers associated with pain. Many of these changes occur in the peripheral nervous system; the nerves outside of the brain and spinal cord. There are also changes to overall brain structure, which may lead to pain when at rest. Central sensitization is a term for a state of increased pain sensitivity. Repeated injury or pain can cause sensitization, where the nerves that send pain signals fire more easily and at inappropriate times. We are just beginning to see the differences in how the brain fires using MRI and fMRI (functional magnetic resonance imaging) technology.

What can be done about fibromyalgia? There are no cures, but there may be some methods to find a modicum of relief. Education is the first piece of the puzzle. Understanding what fibromyalgia is and that it tracks changes in your body can help you understand what is going on. One of the stressors to the pain system is stress and anxiety. Along with education, psychotherapy may provide some relief. Fitness can also help, and is particularly helpful when a patient has received dismissive medical advice in the past. Some patients experience a reduction in symptoms with a low glutamate diet. This is NOT a low gluten diet. Glutamate is a neurotransmitter that is a possible culprit for some nociceptive changes. Low glutamate diets are specific, quite restrictive diets that should be discussed with a dietitian. MSG, aspartame, protein concentrates, smoke flavoring, and more are all restricted on this diet. Finally, some fibromyalgia patients find relief with medication. Some specific anti-nociceptive neurotransmitter medications seem to help, as do other specific brain-altering medications. Some patients find relief with medical marijuana or prescription opioids, though side effects may not be worth it. Across the board, NSAIDs, such as ibuprofen (motrin, advil), aspirin, and naproxen (aleve) do NOT seem to provide relief. Talking to a medical professional is a good idea before making changes to your medical routine or diet. Hopefully this article helps with the education aspect of relief, and hopefully sufferers can find more as well!

Staff Writer / Editor Benton Lowey-Ball, BS, BFA

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References:

Holton, K. F., Taren, D. L., Thomson, C. A., Bennett, R. M., & Jones, K. D. (2012). The effect of dietary glutamate on fibromyalgia and irritable bowel symptoms. Clin Exp Rheumatol, 30(6 Suppl 74), 10-7.

Kandel, E. R., Schwartz, J. H., Jessell, T. M., Siegelbaum, S., Hudspeth, A. J., & Mack, S. (Eds.). (2000). Principles of neural science (Vol. 4, pp. 472-479). New York: McGraw-hill.

Sagy, I., Bar-Lev Schleider, L., Abu-Shakra, M., & Novack, V. (2019). Safety and efficacy of medical cannabis in fibromyalgia. Journal of clinical medicine, 8(6), 807. https://doi.org/10.3390/jcm8060807

Siracusa, R.; Paola, R.D.; Cuzzocrea, S.; Impellizzeri, D. Fibromyalgia: Pathogenesis, Mechanisms, Diagnosis and Treatment Options Update. Int. J. Mol. Sci. 2021, 22, 3891. https://doi.org/10.3390/ijms22083891