10 Reasons You Are Suffering From Fibromyalgia
Updated: Aug 10
𝐓𝐡𝐞𝐫𝐞'𝐬 𝐚 𝐫𝐞𝐚𝐬𝐨𝐧 𝐲𝐨𝐮 𝐟𝐞𝐞𝐥 𝐭𝐡𝐞 𝐰𝐚𝐲 𝐲𝐨𝐮 𝐝𝐨.
Despite what you've been told over and over, fibromyalgia is 𝘕𝘖𝘛 "all in your head".
Research shows that there are a number of physiologic problems leading to the symptoms of fibromyalgia when compared to a control population (a population without fibromyalgia).
Reason #1: The appearance of muscles in people with fibromyalgia are different than those without fibromyalgia.
Muscles in people with fibromyalgia show a moth-eaten appearance, abnormalities in the way individual muscle fibers look, and abnormalities in the cell membranes of individual muscle cells. Biopsies have also shown some degeneration of certain types of muscle fibers in people with fibromyalgia.
Structure determines function in biology. The way a tissue is arranged plays a huge role in how well it performs it's role within the body. In turn, it makes sense that the muscles in people with fibromyalgia aren't functioning optimally if their structure appears abnormal.
Reason #2: Blood flow to muscles in people with fibromyalgia is compromised.
To add insult to injury, blood flow to muscles appears to be compromised in people with fibromyalgia. Biopsies show decreased numbers of capillaries (small blood vessels) and thicker capillary walls within muscle tissue, which may contribute to abnormal oxygen distribution in the muscles of people with fibromyalgia.
This means that your muscles cells aren't getting the oxygen they need to function properly. Your muscle cells also can't get rid of waste products as easily as they would normally, which can result in build-up of metabolites that shouldn't be hanging around.
This abnormality in blood flow and oxygen concentration is particularly apparent during exercise, which likely contributes to symptoms of pain, fatigue, difficulty exercising, and slow recovery from exercise.
Research has shown that people with fibromyalgia use the same amounts of energy to perform less work compared to healthy participants. This research supports the observation that people with fibromyalgia have difficulty with tasks requiring muscular endurance (sustained physical activity or movement).
So no, you're not lazy. Your body has to work much harder than those without fibromyalgia to move and be active.
Reason #3: Your energy-producing powerhouses aren't functioning as well as they should.
If you’ve been reading up on fibromyalgia, it’s very likely that you’ve come across the term mitochondrial dysfunction. Mitochondria are the part of our cells responsible for producing energy that our cells need to carry out the necessary functions to survive. They are the cell's powerhouses.
Within mitochondria, there are many of chemical reactions that occur to produce this energy in the form of Adenosine Triphosphate, abbreviated as ATP. These chemical reactions require a number of nutrients and enzymes to proceed quickly and meet the body’s needs.
In people with fibromyalgia, the mitochondria don’t function properly to produce the energy required by cells to function. Studies have shown that levels of ATP in muscle and blood cells of people with fibromyalgia are lower both at rest and during exercise, compared to levels in those without fibromyalgia.
Research has shown that this mitochondrial dysfunction occurs because of decreased numbers of mitochondria, as well as defects in the functioning of key mitochondrial enzymes. Deficiencies in nutrients required for the energy production process to occur have also been identified.
When mitochondria aren’t functioning properly, the body destroys them. This destruction of malfunctioning parts is a normal process for the body; however, these mitochondria are eventually replaced with new mitochondria that also don’t function well and the cycle is repeated. A lack in proper energy production contributes to fatigue, pain, and cognitive symptoms.
Reason #4: Your body is inflamed.
Some measures of inflammation in patients with fibromyalgia show higher than normal levels of inflammatory molecules within the blood. Inflammation within the brain is thought to contribute to the fibrofog and widespread pain that people with fibromyalgia experience.
So yes, there is a reason you feel like you can't follow a conversation, retain what you read, follow directions, and remember things as well as others.
Reason #5: Parts of your immune system are suppressed.
Studies show that some parts of the immune system are suppressed compared to people without fibromyalgia. We don't know exactly how this plays into the symptoms of fibromyalgia, but it is suspected that mitochondrial dysfunction, nutrient deficiencies, and an abnormal stress response all contribute to unhealthy levels of inflammation and an immune system that is not functioning as expected.
Reason #6: Your sleep cycle is out of sync.
Poor sleep is a very common concern in people with fibromyalgia. Sleep studies performed on people with fibromyalgia have shown deviations in what we would expect from a normal sleep cycle.
On studies measuring brain waves during sleep, there is evidence of alpha brain waves intruding upon delta brain waves. Alpha brain waves are the type present when you are awake or during periods of relaxation, such as meditation. Delta brain waves are present in deeper sleep, also called slow wave sleep.
This means the brain of someone with fibromyalgia spends more time in the more alert (less restorative) type of brain waves than we expect when comparing to people without fibromyalgia. It's no wonder you can sleep for hours and still feel exhausted.
The sleep pattern in fibromyalgia is different from that experienced by people suffering from insomnia; however, they share some similarities.
In research comparing these two groups, both the fibromyalgia group and the insomnia group showed decreased total sleep time, decreased slow wave (deeper) sleep, increased time to consistent sleep, and increased time spent awake through the night compared to people with no difficulty sleeping.
When comparing sleep between the fibromyalgia group and the insomnia group, researches noticed that people with fibromyalgia had more slow wave (deeper) sleep, shorter time to consistent sleep, but were awake for a similar amount of time during night time awakenings. Specifically, people with fibromyalgia tend to wake more often through the night, but are awake for shorter periods of time.
The abnormalities in brain wave activity during sleep and frequent night time awakenings make for poor sleep quality, which has been shown to increase pain levels and impair cognitive function in people with fibromyalgia. Although pain levels can most definitely affect sleep, research has shown that improving sleep quality decreases pain severity and improves cognitive function in people with fibromyalgia.
Reason #7: Your brain interprets pain and touch differently.
Fibromyalgia is often referred to as a disorder of centralized pain processing (also called central sensitization). Initially, researchers thought that the brain was more sensitive to pain signals travelling from the limbs of the body to the brain. It was suspected these signals were amplified within the brain, resulting in higher pain intensity.
Research investigating this theory compared brain imaging studies of people with fibromyalgia to people who did not have a painful condition. In this research, there was evidence that the brain of people with fibromyalgia reacts to lower stimulus levels in the form of a pressure sensation. The brain interprets this pressure signal as more painful, compared to people without a painful condition.
More recent research showed that there may also be dysfunctions in communication between areas of the brain that shut off pain signals. This combination of amplified pain signals within the brain and inability to turn off such pain signals may be at least partially due to the presence of inflammation within the brain and central nervous system.
Reason #8: Your gut bacteria are imbalanced.
More and more attention is being dedicated to the role of digestion and gut bacteria in fibromyalgia. Research performed on the gut bacteria composition in people with fibromyalgia has uncovered a strong correlation between Small Intestinal Bacterial Overgrowth (SIBO) and fibromyalgia.
It is possible that imbalances in the populations of different bacteria within the gut could be a causative factor to the symptoms and metabolic abnormalities noted in fibromyalgia. Various metabolites produced by common gut bacteria species have been linked to low levels of cortisol, vitamin D, tryptophan, serotonin, thyroid hormone, and melatonin levels. Imbalances in all of which have been correlated with fibromyalgia. Further to the connection between gut bacteria imbalances and fibromyalgia, patients who achieved eradication of SIBO showed significant improvements in symptoms.
In other research performed on this topic, researchers have uncovered distinct patterns in gut bacterial growth that seem to correlate with symptoms and severity of fibromyalgia. Stress has been identified as a potent disruptor of gut bacteria balance and this may be the underlying factor that leads to imbalances.
Reason #9: You're likely deficient in nutrients.
There are a number of nutrient deficiencies that commonly occur in people with fibromyalgia. It is suspected that several of these deficiencies link to dysfunctions in the production of neurotransmitters within the brain or affect other physiologic processes that may contribute to the pain, fatigue, and cognitive symptoms experienced with fibromyalgia.
At this time, it is not clear whether there is an error in the absorption or the metabolism of these nutrients, or both. Nutrient deficiencies that have been correlated with fibromyalgia include vitamin D, a number of amino acids, and coenzyme Q10. In my practice, I commonly see deficiencies in iron and B vitamins in people with fibromyalgia as well.
Reason #10: Your body is in a high stress state ALL THE TIME.
Research specifically performed in people with fibromyalgia has shown that at rest, the body is in a high stress state. To the surprise of many researchers, when exposed to a stressor the stress response in someone with fibromyalgia is less responsive when compared to people without fibromyalgia.
This may be due to an overload of the stress response, meaning the body of someone with fibromyalgia cannot physically respond to any additional stress appropriately. The body doesn't have the resources or the energy to mount the stress response. We see this in burnout as well.
Researchers suspect that this high stress state at rest and low response to stressors may be due to genetic differences in enzymes involved in the stress response, a history high stress events (trauma, abuse, etc.), and decreased sensitivity to messages stimulating an appropriate stress response.
Clinically, this dysfunction in the stress response can result in many of the symptoms associated with fibromyalgia, including fatigue, morning stiffness, sleep abnormalities, anxiety, depression, Raynaud’s phenomenon, digestive symptoms, muscle tension, pain, brain fog, and gut bacterial imbalances.
In working with people with fibromyalgia, I find addressing the dysfunctional stress response makes the biggest difference in symptoms. Providing the body with the nutrients and energy it needs to mount the stress response, as well as re-training the body how to relax and shut off the stress response is absolutely essential to making progress toward living symptom-free.
I know that hearing all that is going wrong with your body can be very discouraging. It can make you wonder how you will ever get better. From a medical standpoint, this information has been missing for years and it is just what we need. When we understand what is going wrong in the body and begin to explore how it occurred, we can better tailor our treatments to address these dysfunctions to get the body functioning properly and heal the damage that has been done as a result.
1. Park JH, Niermann KJ, Olsen N. Evidence for metabolic abnormalities in the muscles of patients with fibromyalgia. Curr Rheumatol Rep. 2000;2(2):131–140. doi:10.1007/s11926-000-0053-3
2. Yunus MB, Kalyan-Raman UP, Kalyan-Raman K, Masi AT. Pathologic changes in muscle in primary fibromyalgia syndrome. Am J Med. 1986;81(3A):38–42. doi:10.1016/0002-9343(86)90872-7
3. Bengtsson A, Henriksson KG, Larsson J. Reduced high-energy phosphate levels in the painful muscles of patients with primary fibromyalgia. Arthritis Rheum. 1986;29(7):817–821. doi:10.1002/art.1780290701
4. Cordero MD, De Miguel M, Moreno Fernández AM, et al. Mitochondrial dysfunction and mitophagy activation in blood mononuclear cells of fibromyalgia patients: implications in the pathogenesis of the disease. Arthritis Res Ther. 2010;12(1):R17. doi:10.1186/ar2918
5. Cordero MD, Díaz-Parrado E, Carrión AM, et al. Is inflammation a mitochondrial dysfunction-dependent event in fibromyalgia?. Antioxid Redox Signal. 2013;18(7):800–807. doi:10.1089/ars.2012.4892
6. Castro-Marrero J, Cordero MD, Sáez-Francas N, et al. Could mitochondrial dysfunction be a differentiating marker between chronic fatigue syndrome and fibromyalgia?. Antioxid Redox Signal. 2013;19(15):1855–1860. doi:10.1089/ars.2013.5346
7. Gerdle B, Forsgren MF, Bengtsson A, et al. Decreased muscle concentrations of ATP and PCR in the quadriceps muscle of fibromyalgia patients--a 31P-MRS study. Eur J Pain. 2013;17(8):1205–1215. doi:10.1002/j.1532-2149.2013.00284.x
8. Andrés-Rodríguez L, Borràs X, Feliu-Soler A, et al. Machine Learning to Understand the Immune-Inflammatory Pathways in Fibromyalgia. Int J Mol Sci. 2019;20(17):4231. Published 2019 Aug 29. doi:10.3390/ijms20174231
9. Bote ME, García JJ, Hinchado MD, Ortega E. Inflammatory/stress feedback dysregulation in women with fibromyalgia. Neuroimmunomodulation. 2012;19(6):343–351. doi:10.1159/000341664
10. Sturgill J, McGee E, Menzies V. Unique cytokine signature in the plasma of patients with fibromyalgia. J Immunol Res. 2014;2014:938576. doi:10.1155/2014/938576
11. Behm FG, Gavin IM, Karpenko O, et al. Unique immunologic patterns in fibromyalgia. BMC Clin Pathol. 2012;12:25. Published 2012 Dec 17. doi:10.1186/1472-6890-12-25
12. Martinez-Lavin M. Biology and therapy of fibromyalgia. Stress, the stress response system, and fibromyalgia. Arthritis Res Ther. 2007;9(4):216. doi:10.1186/ar2146
13. Pardo JV, Larson RC, Spencer RJ, et al. Exposure to Cold Unmasks Potential Biomarkers of Fibromyalgia Syndrome Reflecting Insufficient Sympathetic Responses to Stress. Clin J Pain. 2019;35(5):407–419. doi:10.1097/AJP.0000000000000695
14. Heim C, Ehlert U, Hellhammer DH. The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology. 2000;25(1):1–35. doi:10.1016/s0306-4530(99)00035-9
15. Rosenfeld VW, Rutledge DN, Stern JM. Polysomnography with quantitative EEG in patients with and without fibromyalgia. J Clin Neurophysiol. 2015;32(2):164–170. doi:10.1097/WNP.0000000000000134
16. Roth T, Bhadra-Brown P, Pitman VW, Roehrs TA, Resnick EM. Characteristics of Disturbed Sleep in Patients With Fibromyalgia Compared With Insomnia or With Pain-Free Volunteers. Clin J Pain. 2016;32(4):302–307. doi:10.1097/AJP.0000000000000261
17. Fang SC, Wu YL, Chen SC, Teng HW, Tsai PS. Subjective sleep quality as a mediator in the relationship between pain severity and sustained attention performance in patients with fibromyalgia. J Sleep Res. 2019;28(6):e12843. doi:10.1111/jsr.12843
18. Çetin B, Güleç H, Toktaş HE, Ulutaş Ö, Yılmaz SG, İsbir T. Objective measures of sleep in fibromyalgia syndrome: Relationship to clinical, psychiatric, and immunological variables. Psychiatry Res. 2018;263:125–129. doi:10.1016/j.psychres.2018.02.057
19. Gracely RH, Petzke F, Wolf JM, Clauw DJ. Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis Rheum. 2002;46(5):1333–1343. doi:10.1002/art.10225
20. Jensen KB, Loitoile R, Kosek E, et al. Patients with fibromyalgia display less functional connectivity in the brain's pain inhibitory network. Mol Pain. 2012;8:32. Published 2012 Apr 26. doi:10.1186/1744-8069-8-32
21. Littlejohn G, Guymer E. Neurogenic inflammation in fibromyalgia. Semin Immunopathol. 2018;40(3):291–300. doi:10.1007/s00281-018-0672-2
22. Tomasello G, Mazzola M, Bosco V, et al. Intestinal dysbiosis and hormonal neuroendocrine secretion in the fibromyalgic patient: Relationship and correlations [published online ahead of print, 2018 Sep 11]. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2018;10.5507/bp.2018.051. doi:10.5507/bp.2018.051
23. Minerbi A, Gonzalez E, Brereton NJB, et al. Altered microbiome composition in individuals with fibromyalgia. Pain. 2019;160(11):2589–2602. doi:10.1097/j.pain.0000000000001640
24. Bazzichi L, Palego L, Giannaccini G, et al. Altered amino acid homeostasis in subjects affected by fibromyalgia. Clin Biochem. 2009;42(10-11):1064–1070. doi:10.1016/j.clinbiochem.2009.02.025
25. Wu Z, Malihi Z, Stewart AW, Lawes CM, Scragg R. The association between vitamin D concentration and pain: a systematic review and meta-analysis. Public Health Nutr. 2018;21(11):2022–2037. doi:10.1017/S1368980018000551
26. Cordero MD, Moreno-Fernández AM, deMiguel M, et al. Coenzyme Q10 distribution in blood is altered in patients with fibromyalgia. Clin Biochem. 2009;42(7-8):732–735. doi:10.1016/j.clinbiochem.2008.12.010