What causes fibromyalgia?

The exact cause of fibromyalgia is unknown, but medical research points to an issue with how the central nervous system (the brain and spinal cord) processes pain messages.¹²

Instead of a single root cause, experts view it as a combination of neurological, genetic, and environmental factors:¹²

Main Mechanisms

• Central Sensitization: The brain and spinal cord change how they handle pain signals, amplifying them and causing pain receptors to overreact to both painful and non-painful stimuli.¹²
• Chemical Imbalances: An abnormal increase or decrease in specific neurotransmitters (brain chemicals that signal pain) disrupts normal communication in the nervous system.¹²

Common Triggers

Symptoms often start or worsen after a significant physical or emotional event:¹²

• Physical Trauma: Serious injuries, car accidents (such as whiplash), major surgery, or repetitive strain.
• Infections: Certain illnesses, such as Lyme disease, Epstein-Barr virus, or COVID-19.
• Severe Stress: Major emotional trauma, military combat service, or prolonged life stress.¹²³

Key Risk Factors

• Genetics: The condition tends to run in families, suggesting certain gene changes increase a person's baseline vulnerability.
• Biological Sex: Women are diagnosed with fibromyalgia significantly more often than men.
• Existing Conditions: People with autoimmune or rheumatic disorders—such as rheumatoid arthritis, lupus, or osteoarthritis—are at a higher risk.¹²³⁴

You can read more about patient experiences and guidance on the NHS Fibromyalgia Guide or the Mayo Clinic Fibromyalgia Overview.¹²If you'd like, let me know:

• Are you or someone you know experiencing specific symptoms like widespread pain or fatigue?
• How long have these symptoms been going on?

I can share more details on how doctors diagnose it or what management options exist.

The exact cause of fibromyalgia is unknown, but researchers believe it involves abnormal pain processing in the central nervous system. Instead of a single trigger, it typically develops from a mix of genetics, nervous system changes, and physical or emotional stress.¹²

Key Contributing Factors

• Central sensitization. The brain and spinal cord become overly sensitive to pain signals, a process detailed by the Cleveland Clinic. Irregular levels of brain chemicals amplify these signals, causing pain receptors to overreact even to mild touch.¹²
• Genetics. Fibromyalgia tends to run in families. Certain inherited genes may change how your body regulates and processes painful sensations.¹²
• Infections and illnesses. Certain viral or bacterial illnesses appear to spark the condition or make symptoms worse. Linked infections include Epstein-Barr virus, Lyme disease, hepatitis C, and COVID-19.¹²³
• Physical or emotional trauma. Symptoms frequently begin after a major stressful event, according to the NHS. Common examples include a serious car accident, major surgery, or severe psychological distress.¹
• Other rheumatic conditions. Having an existing joint or autoimmune disorder raises your risk. People with osteoarthritis, rheumatoid arthritis, lupus, or ankylosing spondylitis are more likely to develop fibromyalgia.¹²

Additional Risk Factors

• Biological sex. Women and people assigned female at birth are diagnosed with fibromyalgia much more often than men.
• Prolonged stress. Ongoing, high-level stress at work or home can alter your body's natural stress response and disrupt how the brain handles pain.¹²

If you're exploring this for yourself or someone else, I can walk through common symptoms, how doctors diagnose fibromyalgia, or management options. Which would be most helpful?

Fibromyalgia is thought to be caused by a problem with how the brain and nervous system process pain signals. Essentially, the nervous system becomes unusually sensitive, meaning that sensations that wouldn't normally be painful can feel painful, and ordinary pain can feel much more intense.

This is known as central sensitisation or altered pain processing.

Importantly, fibromyalgia is a real medical condition. It isn't imagined, psychological weakness, or simply being stressed.

What causes fibromyalgia?

There isn't one single known cause. Researchers believe it develops through a combination of factors.

1. Changes in the nervous system

• The brain may amplify incoming pain signals.
• The nervous system may struggle to regulate pain properly.
• The body's natural pain-dampening mechanisms may not work as effectively.
• This can lead to widespread pain, tenderness and heightened sensitivity.

2. Physical or emotional trauma

Fibromyalgia sometimes develops after:

• A serious accident or injury.
• Surgery or a significant illness.
• A viral infection.
• Prolonged emotional stress.
• A particularly traumatic or stressful life event.

These experiences don't cause fibromyalgia in everyone, but they may trigger it in people who are susceptible.

3. Genetics

Fibromyalgia can run in families. Having a close relative with fibromyalgia may increase your likelihood of developing it, suggesting that certain genetic factors influence pain sensitivity.

4. Sleep disturbances

Poor-quality sleep appears to play an important role.

People with fibromyalgia often experience:

• Unrefreshing sleep.
• Frequent waking during the night.
• Difficulty reaching or maintaining deep sleep.

Poor sleep can increase pain sensitivity, while pain itself makes sleeping difficult. This can become a vicious cycle.

4. Hormonal and chemical changes

Research suggests that people with fibromyalgia may have differences in chemicals involved in regulating:

• Pain.
• Stress responses.
• Mood.
• Sleep.
• Energy levels.

These include serotonin, noradrenaline and dopamine. However, researchers haven't established one specific chemical imbalance as the cause. www.nhsinform.scotwww.niams.nih.gov

Can stress alone cause fibromyalgia?

Not necessarily. However, prolonged stress can affect the nervous system, sleep and the body's stress-response mechanisms. In someone who is already genetically or biologically susceptible, it may contribute to triggering the condition.

It is also possible to develop fibromyalgia without experiencing any obvious trauma or stressful event. www.nhs.ukwww.mayoclinic.org

Is fibromyalgia caused by inflammation?

Fibromyalgia is not generally considered an inflammatory or autoimmune disease. It is primarily understood as a disorder of pain processing.

However, it can coexist with inflammatory conditions such as rheumatoid arthritis and lupus.

One thing I'd like to ask you

Are you asking because you have fibromyalgia already, or because you're experiencing symptoms and wondering whether you might have it?

I ask because I can explain more about:

• Why fibromyalgia sometimes develops after years of stress or trauma.
• Whether infections, hormones or menopause can trigger it.
• Why it causes widespread muscle pain and exhaustion.
• Whether it can be reversed or go into remission.

You can tell me a little about what's been happening, and we can explore it together.