If you’re exploring a fibromyalgia diagnosis or experiencing chronic pain, you’re likely considering where it all started. Maybe you’ve had a lingering pain that started recently but that won’t go away, or maybe have been experiencing pain for a long time.
Taking time to unpack some of the potential causes of fibromyalgia can give you more context about the condition and where to go next. In this article, we’ll look at the research behind five commonly-cited root causes of fibromyalgia, to help you better understand the condition and history.
Why Pain Becomes Chronic
Before diving into what causes fibromyalgia specifically, let’s explore how pain can become chronic.
The definition of “chronic” pain is when pain persists for more than twelve weeks, despite treatment or medication. Sometimes it starts with acute pain from an injury; for example, you may obtain an injury in your ankle from football, receive treatment but continue to feel pain for years.
Central sensitization is thought to play a key role in developing chronic pain conditions such as fibromyalgia. Central sensitization involves the entire central nervous system (CNS) becoming hypersensitive to pain. This is supported by brain studies which have found increased connectivity in systems that amplify pain signals and decreased connectivity in systems that are meant to reduce the processing of pain, which ultimately results in pain (or even non-painful sensations) feeling more intense and lasting longer.
But what affects the development of central sensitization? We’ll explore a few theories here, and look at the evidence behind them.
Genetics has been found to play a role in the likelihood that one will develop fibromyalgia. A study on siblings found if one sibling had fibromyalgia, there was a 27% increased likelihood the other sibling also had fibromyalgia, compared to the rest of the general population.
A review of different studies exploring a genetic link for fibromyalgia found evidence to support the theory that genetics can play a role. For example, in this review, one study found that 28% of the offspring of mothers who had fibromyalgia also had fibromyalgia themselves. Another study found 52% of parents and siblings showed clinical signs of fibromyalgia.
Specific genes and variations of these genes have also been found to play a role in developing fibromyalgia, adding further support to the genetic theory. Research has found common genetic chromosome variants in people with fibromyalgia. These variants are linked to CNS dysfunction, which may help to explain central sensitization’s role in fibromyalgia.
However, genetic factors alone cannot explain the cause of fibromyalgia. Just because a blood relative has fibromyalgia does not automatically mean you will experience it too. Likewise, these genetic variations are not causation, as they are not present in everyone with fibromyalgia. There are a variety of other factors that can play into developing fibromyalgia too.
Infections and Illnesses
Infections and illnesses are linked to fibromyalgia, as it has been shown in studies that the prevalence of fibromyalgia is higher in individuals who have had particular infections and illnesses. A survey study also found 26.7% of people with fibromyalgia reported acute illness to be the triggering event for their fibromyalgia.
For example, a study which followed people for 10 years found fibromyalgia to be more prevalent in individuals who developed giardiasis (a stomach bug that results in diarrhea and bloating) than those who did not become infected with giardiasis. A host of other infections and illnesses have also been linked with developing fibromyalgia, such as hepatitis C, Covid-19, liver disease and Lyme disease.
Infections and illnesses are thought to be one of the causes of fibromyalgia because of central sensitization. For example, if someone is diagnosed with liver disease, abdominal pain is a common symptom. This constant abdominal pain may lead to central sensitization, as the continued pain may result in the CNS over-responding to the pain, lowering a patient’s pain threshold.
Another reason for the link between infections and illnesses and fibromyalgia is due to changes in immune response. Fibromyalgia has been linked with an overactive immune response; when someone has an infection, the bacteria/virus from the infection may linger in the body, resulting in the immune response being constantly active. This overactivity may lead to fibromyalgia symptoms.
Again, it’s important to highlight that the evidence for the link between infections, the immune response and fibromyalgia is still unclear, and there are a variety of causes for fibromyalgia which should be considered when evaluating potential causes.
Road accidents, whiplash, surgeries and other physical traumas have all been associated with the development of fibromyalgia. A review of 20 different studies that examined a link between physical traumas and fibromyalgia found a significant, meaningful link between physical traumas and fibromyalgia. These physical events included car accidents, surgeries, whiplash, physical injuries such as soft tissue neck injury and more.
Why is there a link? Again, it’s central sensitization that plays an important role. A physical, traumatic event may result in the CNS having a prolonged and heightened response to the physical injury. This can lead to hyper-sensitization to pain, which can result in fibromyalgia symptoms.
The link between physical events and fibromyalgia should be taken with a pinch of salt. In the review of these studies, the authors found that many of the studies exploring this link had issues with their methodology. Most studies supporting this link also rely on people retrospectively reporting (which could be false memories or an attempt to try to explain their symptoms). Therefore, it’s hard to find a definitive, causal link between the role of physical events and fibromyalgia.
Adverse, traumatic experiences during childhood have been found to be another link to developing fibromyalgia. Research has identified there to be higher reported levels of childhood traumatic experiences in individuals with fibromyalgia, which includes physical, sexual and emotional abuse, as well as emotional and physical neglect.
The most common type of childhood trauma reported in fibromyalgia patients in this study was physical neglect or when a child’s basic needs are not met. Also, almost half of the participants experienced physical abuse (being physically harmed on purpose). Although this study was conducted only on women, other research has found a link between childhood maltreatment and fibromyalgia in men too.
A reason for this link is because childhood traumas can result in acute and chronic stress responses. Brain scan studies have found that individuals who have experienced childhood trauma have changes in the brain regions associated with the pain response. This can affect someone’s ability to perceive and respond to pain. When the regions controlling the pain response are disrupted, it can ultimately result in fibromyalgia symptoms because they may have a greater sensitivity to pain.
A fifth commonly-cited cause of fibromyalgia is prolonged stress. When someone is experiencing prolonged exposure to stressors, the constant overburdening of different stressors can change the body’s stress response, which ultimately leads to disturbances in how the brain processes pain. If pain processing mechanisms are disturbed, it can result in widespread pain.
A variety of studies support this link between prolonged stress and fibromyalgia. For example, a study which followed participants over time found those who experienced prolonged occupational stress such as high workload and being bullied at work had two to four times the likelihood of developing fibromyalgia.
However, just because a link between stress and fibromyalgia has been found, it doesn’t indicate a causal link. Some studies haven’t found similar evidence for a link between prolonged stress and fibromyalgia, and there are still other external, environmental or behavioral factors involved in the development of fibromyalgia.
Fibro Flare Triggers
Fibromyalgia symptoms occur on a spectrum and can vary in intensity from day-to-day or even month-to-month. Because of this, it can often leave you scratching your head as to what causes these fibromyalgia flares.
A useful research study, asking people with fibromyalgia to identify triggers to flares found multiple, including:
- Poor sleep
- Weather changes
- “Overdoing it” or overexertion
People with fibromyalgia have also reported there are foods that are linked with their fibromyalgia flare-ups, like sugar, fried food, and refined carbs like breads, pastries and cookies. Although the research behind these links isn’t strong, it can be helpful to make a note of the foods you eat and see if any coincide with a fibromyalgia flare-up. That way you can track any link between certain foods you eat and when you experience flares.
Unpacking some of these most commonly cited causes and the research behind them may help give you more context about fibromyalgia and where to go next. Treating fibromyalgia starts with understanding central sensitization, and exploring different ways to retrain the brain in order to address fibromyalgia pain.