We are hearing more and more about fibromyalgia because it is now a disease recognized by the World Health Organization. Unfortunately, many people have been followed by a psychiatrist because it was believed to be merely a mental disorder.

It is now known that this is a disease that can result from several causes and potentiate a variety of symptoms and problems. It is advisable to consult your doctor. Don’t just rely on information you find on the internet or an equivalence of symptoms; it is important to consult. In this article we will not repeat the advice of the first article, but we will focus on the explanation on known causes.

There are now 3 well described causes, which we will take time in explaining what characterizes them:

  • Central hypersensitivity: a chronic source of pain (different types possible) which eventually cause dysregulation of pain management by the brain which then begins to interpret different stimuli (often perceived) as being pain.
  • Too much pressure in the cerebrospinal fluid.
  • Destruction of small peripheral fibers (peripheral neuropathy).

There are also what would be called aggravating factors, which are not necessarily causes, such as the imbalance of the intestinal microbiota. We will revisit this.

Central hypersensitivity

The principle is relatively simple: too much continual pain perceived by the brain ends up causing an imbalance in the management of sensations. The brain is, in a way, no longer able to differentiate what pain really is, from what is not. It then interprets different types of stimuli, such as proprioceptors (receptors that tell us about the position of the limbs) or receptors for touching the skin. The brain is therefore no longer able to distinguish between what is a trivial sensation (e.g. the weight of your sweater on your shoulders) and the sensation of pain.

It is possible that some people may have a deficit or an overproduction of certain neurotransmitters which would facilitate the development of central hypersensitivity. Certain factors may play an important role, such as inflammation, diet and sleep. Quality sleep is essential to restoring healthy levels of the different neurotransmitters in the brain every day. Sleep problems caused by pain can therefore participate in the development or maintenance of central hypersensitivity (a vicious circle). A recent study (Kosek et al, 2018. Brain, Behavior, and Immunity, September 2018) demonstrated an important role of inflammation of the brain which is directly correlated to the level of fatigue of people suffering from fibromyalgia.

The pressure of the cerebrospinal fluid

Another recent study suggests this new hypothesis for some people with fibromyalgia or unexplained generalized pain (Hulens et al, 2018. Annals of Physical and Rehabilitation Medicine, July 2018). Cerebrospinal fluid is a clear fluid that bathes the brain and the cerebellum. It has a structural role in maintaining the shape of the brain and protection against shock by creating a form of shock absorber between it and the skull. The study by Hulens et al. demonstrated that many fibromyalgia symptoms were relieved within hours and up to 8 weeks by taking cerebrospinal fluid to reduce the pressure. Too much fluid pressure would cause drainage from the envelope of the nerves at the base of the brain, which would irritate the envelope and cause generalized pain.

The destruction of small peripheral fibers

A recent meta-analysis (study combining several studies already carried out) has determined that a pathology of the small peripheral fibers is present in approximately 50% of fibromyalgia cases (Grayston et al, 2018. Seminars in Arthritis and Rheumatism, August 2018). The small peripheral fibers are the ends of the nerve fibers which allow the detection of sensations (heat, touch, sight, etc.). The causes of their destruction or malfunction are not known. It may very well be for some people a consequence of the development of central hypersensitivity or, for others, a cause.

Indeed, animal studies have shown that the development of hypersensitivity by poor proportions of neurotransmitters can cause the decline of small peripheral nerve fibers. On the other hand, researchers have hypothesized that some cases of fibromyalgia could be caused by dysfunctions of the small peripheral fibers. Among other things, small fibers could be attacked by the immune system. If a person’s immune system inadvertently attacks their small peripheral fibers (an autoimmune disease), this would result in a large amount of messages that are difficult for the brain to interpret, which could lead to the development of central hypersensitivity.

Aggravating factors

Every individual with fibromyalgia seem to have a large antioxidant deficit, but it is unclear whether this is a cause or a consequence. Restoring a normal level of systemic antioxidants (throughout the body) through diet (rich in fruits and vegetables) and/or taking quality supplements would reduce the pain felt and improve sleep.

Some studies have also demonstrated an involvement of the mitochondria (the energy powerhouses of our cells). Malfunction of the mitochondria would be present in many cases of fibromyalgia. Again, this points to an increased need for what can improve the functioning of energy powerhouses, but it is unclear whether they can be part of the cause or a result of, for example, chronic fatigue.

Since inflammation can play a major role in the pain felt, but also in the development of the causes mentioned above, everything that influences the inflammation should be considered. These include diet (which has a significant impact on the gut microbiota), body weight, quality of sleep, stress and physical activity. Healthy living habits can help a lot.

Several possible causes = several possible solutions

These few explanations help to understand that depending on the person with fibromyalgia, approaches to relieve pain and improve their condition may not have the same results. So you have to try and remain hopeful.