Stress and Fibromyalgia: What’s the Connection?

Fibromyalgia is a chronic condition that is associated with widespread pain, fatigue, and cognitive difficulties. While researchers continue to explore its complex causes, mounting research shows that long-term stress, trauma, and nervous system disregulation can be key contributors because of how deeply the nervous system is affected by prolonged stress. 

Unfortunately, many patients with fibromyalgia have experienced dismissal or minimization from healthcare providers, told that their symptoms are “just stress” or “all in their head,” and leaving them seeking answers. Understanding how stress changes the brain and body in very concrete ways, and how this can set the stage for chronic pain conditions, can help both patients and their providers treat fibromyalgia more effectively. 

In this article, we’ll explore why stress is linked to the development of fibromyalgia, the underlying mechanisms involved, and strategies for managing stress to alleviate symptoms and flares.

How Stress Affects the Body and Brain

When the body is under constant or recurring stress—whether from physical injury, emotional trauma, ongoing life pressure, or unresolved conflict—it enters a state of persistent high alert. This prolonged stress response disrupts the normal function of an area of the brain called the hypothalamic-pituitary-adrenal (HPA) axis, which governs the release of cortisol and other stress hormones.¹

Over time, these disruptions can lead to immune system dysregulation, inflammation, and changes in how the nervous system processes pain. These aren’t psychological changes; they are physiological ones, visible on brain imaging studies. In someone who develops fibromyalgia, the brain and body learn to react differently to signals than they did before, often becoming more sensitive and less able to “filter out” pain.

Stress and the Development of Central Sensitization

At the heart of fibromyalgia is a phenomenon known as central sensitization. This means the central nervous system—the brain and spinal cord—has become overly responsive to stimuli. Sensations that wouldn’t normally hurt (like gentle pressure or cool air) can become painful. This isn’t imagined pain—it’s the nervous system in a state of high reactivity.

Chronic stress can contribute directly to this heightened sensitivity. Stress alters neurotransmitter levels (like serotonin and norepinephrine) and disrupts the brain’s pain-inhibition systems. Areas of the brain that help regulate pain, such as the amygdala and anterior cingulate cortex, become more active or dysregulated under stress, making it harder for your system to turn down the pain signals.

This type of pain processing is now known to underlie many chronic pain conditions; it was formally added to the taxonomy of the International Association for the Study of Pain in 2017, as a category called “nociplastic pain.” ² This comes from the Latin words “nocere,” meaning “to hurt,” and the Greek “πλαστός” meaning “formed.” 

Fibromyalgia is now widely classified as a nociplastic pain condition—meaning the pain arises from altered nociception (pain signaling) without clear evidence of tissue damage or inflammation. This contrasts with nociceptive pain (e.g., from injury) and neuropathic pain (e.g., from nerve damage). The term “nociplastic” emphasizes that the pain is real and biologically based, but stems from dysfunction in the central processing of pain, not from structural injury.

Other Factors Contributing to Fibromyalgia

While stress and trauma can be major contributors, they are part of a larger picture. Fibromyalgia may also be linked to:

• Genetic factors: Some studies indicate a hereditary component, where fibromyalgia may run in families; research has found common genetic chromosome variants in people with fibromyalgia, although more data is needed.³
• Infections or viral illnesses: Certain infections have been linked to the onset of fibromyalgia in some patients; the effects of COVID-19 and Long COVID are one example. Central sensitization may also play a role in how these symptoms become chronic. Systemic inflammation during and after a COVID-19 infection can alter the way the brain and spinal cord process pain.⁴
• Immune system dysregulation: Abnormal immune responses may play a role in fibromyalgia symptoms, with central sensitization also playing a role in responding to inflammation.⁵

Stress and Fibromyalgia Flares

If you live with fibromyalgia, you’ve probably noticed that stress—emotional, physical, or environmental—can make symptoms worse. These episodes, often called fibro flares, are thought to be the result of the nervous system responding to overload.

Triggers like poor sleep, loud environments, emotional distress, or even weather changes can lead to intense pain, fatigue, and brain fog. These triggers can vary from person to person, and understanding them can help people with fibromyalgia understand how to best manage them when they do arise. 

Managing Stress and Fibromyalgia

Managing stress doesn’t mean pretending it’s not there; in fibromyalgia, it can be the means of giving yourself tools to support your nervous system and body—especially during a symptom flare, but also when considering how to improve well-being long-term. 

Some gentle, research-supported ways to reduce stress include:

• Mindfulness and meditation activities: Practicing mindfulness involves focusing on the present moment without judgment. Regular mindfulness meditation can reduce stress, improve mood, and decrease the perception of pain.⁶
• Cognitive Behavioral Therapy (CBT): CBT is a form of therapy that helps people identify and reframe negative thought patterns and behaviors. It has been shown to be effective in managing chronic pain and reducing stress in fibromyalgia patients, particularly if past trauma or anxiety are part of your story.⁷
• Meaningful movement: Engaging in low-impact activities, such as walking, swimming, or yoga, can help reduce stress and improve overall well-being. Physical activity releases endorphins, which are natural painkillers and mood elevators.
• Prioritizing sleep: Establishing a regular sleep schedule and creating a restful sleep environment can improve sleep quality, which is often disrupted in fibromyalgia. Adequate sleep helps the body recover and manage stress more effectively.
• Community and support groups: Joining fibromyalgia support groups allows individuals to share experiences and coping strategies, reducing feelings of isolation and stress.

Summary

When someone has fibromyalgia, pain is not simply due to worry. Stress is a biological force that, when prolonged or overwhelming, can shape the way your nervous system functions. You may have a nervous system that has been through too much—and that deserves care. 

Understanding the connection between stress and fibromyalgia is crucial in managing the condition effectively. Ongoing research continues to shed light on the complex interplay between stress, trauma, and chronic pain, offering hope for better management and potential treatments in the future. By exploring various treatment options, people with fibromyalgia can improve their quality of life. 

Medically reviewed by Dr. Andrea Chadwick, MD, MSc, FASA

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