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Though the underlying cause of fibromyalgia remains unknown, a very clear picture of its risk factors exists. What are they?

Fibromyalgia — under that name — didn't become a diagnosable condition until 1976, though it was described a few years before that, with a focus on the widespread pain and tender points so characteristic of the syndrome. We know a lot more about fibromyalgia now than we did then. Much also still remains to be discovered, however, not least its exact cause. 

What is modern science able to tell us about the contributing factors and risk factors of fibromyalgia?

Fibromyalgia: Does the brain cause your pain?

The idea that chemical changes in the central nervous system — which encompasses the brain, spinal cord, and nerves — alters the way the body reacts to sensory input, resulting in fibromyalgia, is well-accepted now. Considering the fact that your central nervous system sends and responds to messages throughout your body, it makes sense that alterations in the way it works, or damage to it, could lead to hypersensitivity to pain. 

Fibromyalgia patients might have a higher number of pain-transmitting cells than other people, while lacking cells that reduce pain signals. Your wiring may be responsible for your fibromyalgia, in other words, and that in turn means that you experience chronic pain as well as excessive pain reactions to touch that does not normally induce any discomfort. What isn't yet clear, however, is what causes these central nervous system changes in the first place. 

A chemical imbalance in the brain may also contribute to causing fibromyalgia, as patients have been discovered to be low on the neurotransmitters serotonin, noradrenaline and dopamine. These neurotransmitters are are important factors in determining how a person responds to stress, and also contribute to regulating your sleep, behavior, mood, and appetite. In addition — and especially relevant to fibromyalgia patients — they have a part in processing pain stimuli. This is why antidepressants (which target these same neurotransmitters) are often prescribed to people with fibromyalgia, and reduce their pain. 

Your levels of cortisol, a stress hormone, may likewise play a role in the development of fibromyalgia.

Your age

The majority of fibromyalgia patients are diagnosed somewhere between the ages of 20 and 50. This makes being in this age group one of the risk factors, although people can and do develop fibromyalgia at any age. 

Being female

Somewhere between 80 and 90 percent of people diagnosed with fibromyalgia are women. The fact that women have fibromyalgia at much higher rates may be because the female "hormonal cocktail" is very different to men's. Hormones may also explain why fibromyalgia is more common in women of reproductive age — estrogen levels fluctuate throughout the menstrual cycle. Women may also, additionally, be socially conditioned to respond to pain differently than men; there's generally less of an expectation for them to simply "tough it out" when they're hurting. 

Family history

Though not yet fully explored, it is clear that fibromyalgia has a genetic component — you are more likely to develop it if someone else in your immediate family also has it. Your genes may not just predispose you to hypersensitivity, but also to depression and anxiety. These two things can deepen the level at which you experience pain. 

Disordered sleep

Fibromyalgia is closely connected to disordered sleep — insomnia, frequent nightly waking, or non-restorative sleep in which you feel tired even after sleeping for eight hours — is a well-known feature of fibromyalgia. If you don't sleep well, you'll not just feel fatigued (another key fibromyalgia symptom), your pain will also grow worse. 

What isn't clear is whether trouble sleeping is merely a symptom, or also one of the root causes, of fibromyalgia. Disordered sleep can indeed induce a chemical imbalance, so it is possible that it contributes to the development of fibromyalgia. 

Fibromyalgia: Overlapping conditions

The amount of overlap between fibromyalgia and other conditions that also feature chronic pain — often rheumatic conditions — is alarming. Osteoarthritis, in which joint wear and tear leads to stiffness, reduced mobility, and pain, and rheumatoid arthritis, an autoimmune condition that causes inflammation of the joints and can also impact other organs, are two examples of conditions that are more common in people with fibromyalgia. 

In addition, fibromyalgia patients have higher rates of:

  • Ankylosing spondylitis — another member of the arthritis "family" that impacts the spine, sometimes causing vertebrae to fuse together, and in which patients are plagued by severe back pain. 
  • Lupus — an inflammatory autoimmune condition that causes skin rashes, fatigue, fever, and pain, among other symptoms. 
  • Temporomandibular Disorder (TMD) — a jaw condition the cause of which remains unknown. 

Stress and traumatic events

Many people develop fibromyalgia symptoms after a particularly stressful event, whether physical or mental, though the condition can also strike without any clear triggers.

Injury, surgery, a viral infection, and childbirth are examples of physical triggers. Emotional events that may trigger fibromyalgia, meanwhile, include the death of someone close to you, divorce or breakup, or being present for a natural disaster. Some traumatic events can be simultaneously emotionally and physically triggering — combat, rape, domestic violence, or a car crash, for instance. 

Severe childhood stress and post-traumatic stress syndrome alter the functioning of the brain, including how a person reacts to stress and pain, and depression and anxiety do the same. It is not very surprising, then, that they all make developing fibromyalgia more likely, though it isn't yet clear whether they directly cause the condition. 

A lack of physical activity

Sedentary people are more likely to develop fibromyalgia, and the symptoms of fibromyalgia are also generally worse in people who are not physically active. Those who have already been diagnosed benefit from gentle workout routines such as walking, yoga, and swimming, even for just 15 to 30 minutes twice a week, but they should consult their doctors before attempting more rigorous exercise programs. 

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