(FM) is a condition that is characterized by widespread pain, fatigue and an
increased pain response. Symptoms can include tingling of the skin, muscle
spasms, weakness in the arms and legs, nerve pain, muscle twitching, bowel
disturbances, chronic sleep disturbances, and more. So, what can cause such a
widespread, whole body condition? Though the “cause” of FM is unknown, several
hypotheses have emerged. Here is what we know:
1. The brains of FM patients: Structural and functional differences
have been identified in the brains of FM vs. healthy individuals. What is
unclear is whether these identifiable brain changes cause the FM symptoms or
are the result of an unknown cause. Some experts have reported that the
abnormal brain findings may be the result of childhood stress, or prolonged,
severe stress at any time in life. An area commonly affected is called the
hippocampus, which plays a crucial role in maintaining cognitive functions,
sleep regulation, and pain perception.
Lower pain threshold: Due to an increased reactivity of
pain-sensitive nerve cells in the spinal cord and brain (called “central
sensitization), FM patients feel pain sooner and worse than non-FM subjects.
Genetic predisposition: It has been reported that FM is often
found in multiple family members. This genetic propensity also includes other
conditions that often co-exist in FM patients such as chronic fatigue syndrome,
irritable bowel syndrome (IBS), and depression.
Stress & lifestyle: Stress by itself may be an important
cause of FM. It is not uncommon to develop FM after suffering from
post-traumatic stress disorder. An association between physical and sexual
abuse both in childhood and adulthood has also been identified. Poor lifestyle
issues including smoking, obesity, and lack of physical activity increase the
risk of developing FM.
5. Dopamine dysfunction: Dopamine is a chemical needed for
neurotransmission and plays a role in pain perception. It is also connected to
the development of restless leg syndrome (RLS), which is a frequent complaint
of FM patients. Medications found effective for RLS such as pramipexole (also
used for the treatment of Parkinson’s disease) can be helpful for some FM
6. Abnormal serotonin metabolism: Another neurotransmitter, serotonin,
regulates sleep patterns, mood, concentration, and pain and can be involved in
causing FM. Decreases in other neurotransmitters (especially norepinephrine),
when combined with serotonin depletion, can especially cause FM (more so in
women than men). Hence, medications like duloxetine (Cympalta) originally used
to treat depression and painful diabetic neuropathy, have been found to help FM
patients, especially women.
Deficient growth hormone (GH) secretion: Abnormal levels of GH have been found in
FM patients, but studies report mixed results when treating FM with GH.
Strong evidence supports
the association of FM and depression. Similarities include neuroendocrine
abnormalities, psychological characteristics, physical symptoms and similar
treatment benefits using the same approach (medication, counciling, etc.).
Physical Trauma: Trauma can increase the risk of FM. One
report found a direct association with neck trauma and increased risk of
bowel bacterial overgrowth:
This can contribute to FM and may explain the association with IBS. The
autoimmune response to the presence of bacteria resulting in FM symptoms has
been hypothesized in these cases.
As previously stated, it is clear that a “team” of providers is needed to
effectively treat FM. We’d be honored
to be part of your team and we have medical doctors that specialize in FM that we can refer you to if needed.
If you, a friend or family member
requires care for FM, we sincerely appreciate the trust and confidence shown by
choosing our services!
To schedule an appointment with one of our San Francisco Fibromyalgia experts please call 415-392-2225. Our chiropractors are capable of quarterbacking or just being a part of your FM team.