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Causes of Fibromyalgia
Mark Pellegrino, MD posted:
OK Ali and others, you asked for it! I will discuss causes of FM and follow-up again on this topic next week. I'll get to the questions on the FM treatments in the near future.

In 1993 I wrote in my first book, "the exact cause of FM is unknown." Since that time, a lot of research has been done that shed light on various causes and triggers of fibro. We've learned about neurobiological mechanisms that lead to fibro and ultimately "rewire" our central nervous system. In FM, the cause would be WHY fibro developed. The mechanism would be HOW fibro developed. These can get complicated esp if there are multiple factors involved. The end result is always the same though: we get fibromyalgia! This week: WHY. Next week: HOW.

We now know there are causes, triggers, precipitators, mashed wait....not the last one, of fibromyalgia. Now, one of my pet peeves is the liberal use of the phrase, "the cause of FM is unknown." Sometimes certain people try to equate "unknown cause" with "non-existent condition." That's just silly. We know causes.

Here's my list of causes and the % I see.

1. Genetics. I'm going to say close to 100% have this "default" cause. A number of studies support increased FM in families (ie autosomal dominant, offspring of someone with FM is 8x more likely to have fibro etc) or inherited differences in neurotransmitters (serotonin, COMT enzyme, dopamine, mu-opioid receptor etc) making one more prone to chronic pain/FM. I think most everyone with fibro is genetically susceptible to getting it although a different trigger actually may start the fibro "cascade." But up to 40% of my patients may not have another "trigger", but simply develop FM over time due to prewired genetics.

2. Trauma. This may be physical or emotional trauma. About 40% of my patients also. This includes whiplash injuries, work injuries, post-surgery fibro, catastrophic stresses (war, loss of loved one, loss of job etc) and in this category, a special type of trauma: pregnancy-induced FM. Various researchers in FM including Dr. Romano, Greenfield, Waylonis, Buskila, Wolfe, Clauw have published on FM related to trauma. I see this a lot, unfortunately. Sometimes right before my very eyes and despite my best efforts, a person with a whiplash injury, for example, goes on to develop widespread pain and generalized FM.

3. Inflammatory conditions/connective tissue disease (lupus, rheumatoid arthritis, autoimmune disease, polymyalgia rheumatica etc) Many people get FM associated with another disease such as these mentioned. These conditions trigger the FM and in this case, the FM may be referred to as reactive FM or secondary FM. This is about 10% of my patients.

4. Infection. A number of patients report they were fine, they got an infection, and it was like hitting a brick wall: they developed fatigue and pain ever since. Examples include mono, mycoplasma, chlamydia, cytomegalovirus, Lymes, and more. I estimate 4% of my patients have this category.

5. Hormone alterations (eg hypothroidism, menopause). This is a true "chicken or egg" but I'm going to say 2% of my patients have this cause.

6. Spinal conditions (eg Arnold Chiari malformation, spinal stenosis, arthritis etc) We know there is a relationship between cervical spine conditions esp leading to FM, and I estimate 2% of my patients have this.

7. Toxic exposures. Chemicals, toxins, vaccines etc can trigger an immune reaction and lead to chemical sensitivity syndrome or even FM. 1% of my patients.

8. Other conditions. This category includes peripheral pain syndromes that lead to generalized FM, or neuro conditons like MS or post-polio syndrome that may trigger FM. Many peripheral pain syndromes (like RSD or complex regional pain syndrome) are caused by trauma so if the person gets FM eventually, the cause is really the trauma. Let's call this 1%.

Dr. P

Take the Poll

What caused your fibromyalgia?
  • Genetics
  • Trauma (physical or emotional)
  • Underlying chronic condition (disease, hormone, spine)
  • Infection
  • Toxic exposure
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Socialwrkr responded:
I'd just like to say.....

Holy Crud, you're good!

Thanks Dr. P, from the very heart of my bottom.... I mean bottom of my heart! I don't think any of us can express what it means to have a doc who is truly helping us and truly making a difference. I'm one of the very lucky ones, I have a great doctor, but I'd dump her for you if I lived closer!! LOL!

Thank you!
fibroKimber responded:
i know ive said if before, but thank you for all of your hard work. you are AMAZING. im still newer to the FMily but already im blown away by how wonderful and helpful you are. thank you for all that you do for us. as you know, with FM its easy to feel completely helpless and im sure for many people, your help in this community keeps them going and keeps them hopeful.

fibroKimber responded:
and also, i dont know which of these are my causes. it could be just about any of them. i dont have ANY relatives with FM but i dont doubt that genetics are a huge part of it... ive had many health problems my entire life. also, i had emotional trauma that triggered anorexia and then severe depression, so its possible its related to that also. i dont know if i have underlying chronic conditions that have contributed to or caused FM but its defnitely possible. i had a very bad "mono-like" infection (every symptom of mono but negative for epstein-barr), and toxic exposure is certainly possible especially because im hypersensitive to many chemicals.
if i had to guess i think the most likely for me would be toxic exposure because of the way my body reacts to perfumes, some artificial food ingredients, lawn chemicals, etc. these are some examples that put my pain into overdrive!
pnaturegirl responded:
I agree with all of the above and hope more understanding comes into play on how the autonomic system and condition via Dysautonomia all connect to Fibro as well.

Now, Ya no I just had to plug that!
melissanmike responded:
I love this subject!

Thank you for giving us a "subject" with your input and expertise.

I personally have 3 things that could be the "cause" but, FMS really "came out" with number 3.

1) We believe my Grandpa had FMS and was being tested for everything without yet being diagnosed. He died before being diagnosed. But, his Physician told my Father he thought it was something called Fibromyalgia...a little unknown syndrome. So, that would be genetics for me.

2) I had mono when I was younger and my parents both state that I seemed more fragile from that point. Their little tomboy seemed to not be able to just brush off a fall from a bike or bumping into something.....I complained of pain from age 8 on. Before that, I was a virtual monkey climbing and falling out of trees, playing football and being very physical during play. After mono, not so much....

3) Then, what I believe to be the MAIN thing that "brought FMS out" for me is this: I was in a series of car accidents. 5 rear-end accidents and 1 other. All in the course of 3 and a half years. Basically, 1 every 6 months. (i wasn't driving in 5 of case you wondered-lol) During the pretty much constant Physical Therapy, X-Rays, MRI's, CT Scans and all kinds of other tests....the pain never went away. It was as though I froze in that period of recovery....stuck in pain.

Oh, I hurt all over but the worst of the pain is right where my car accident pain was. That first car accident I was in a little sports car and was rear-ended by a Cadillac going 40mph playing with the radio. I was stopped at a red light. I've never been the same. My neck, left shoulder, back, arm and left leg ALWAYS hurt more than the rest of me.

I enjoyed reading your post, Dr. P. Thank you for writing it.

I'm interested to see what others believe "caused" their FMS.

Thanks again,
An_199208 responded:
I truly believe genetics is the "only" cause of FM, everything else that has been listed are triggers, irritants, or stressors that gradually take your already existing FM to a higher level of pain.

FM isn't secondary, it is just now much more noticeable due to the increased level of pain and other symptoms.

Those of you, who have children, should give them a trigger point test! You may be surprised at what you find! Don't tell them what you are doing. Just casually apply pressure to a trigger point and watch for a reaction.
Fibrosarah replied to An_199208's response:
Mine was from an eletrocution to my left arm, (110 volts)was treated for 6 or 7 months for that, Then eventually this diagnosis.

From this incident, I learned not to wall paper around electrical plug ins with out turning off electric. Glue ran into the outlet, and acted as a conductor. It threw me all the way across the bedroom.
melissanmike replied to Fibrosarah's response:
Holy Moly! You're lucky to be alive!
I'm so sorry for what you went and are currently going through but, really appreciate you sharing this. I will remember that should I ever have the need/desire to wallpaper.
That is just terrible!
What a lesson you just shared with us and still...what a horrific thing to have happen!
Thank you for the warning, Fibrosarah.
alispazz responded:
Dr Mark,

And to think that Tanya thought I was gonna be mad...LOL....I figured if I sat on fingers long enough I would get my answers....You Sir may take a bow....but only if it doesn't hurt.

I think that Anon 21709 is off base, when they say that only genetics, everything else is a trigger.

Though I have had a great deal of medical history, I never suffered any pain, I had a lot of trauma, again no pain, in fact there was a time when people wondered if I felt any kind of, but let me tell you one little car accident and my whole world has changed, from that day forward I have been in pain pain and did I say pain...severe bilateral whiplash was the original dx, and contrary to popular belief, being hit at 60-70 miles per hour will do it...even the seat belt did not help the sideways motion followed closely by front to back....true I had a broken neck as a child and had some arthritic stiffness, but not the never ending pain that I now have.

I think that it can be any or all the above.

Thanks Doc

Socialwrkr replied to An_199208's response:
One clarification about the primary/secondary thing. It's not saying that having secondary fibro means it's any less painful. It's a which came first scenario.

If you are diagnosed with lupus and after a while you develop fibro symptoms as well, that is secondary fibro. It's as real and as painful as fibro that doesn't follow another medical illness.
mischelle360 responded:
I think mine would be from emotional trauma. I was a straight A student until the 4th grade, I was 9 years old at the time.... for 5 years I lived in a living nightmare, and from day 1 my grade average went from being A's to D's and F's. I could not concentrate and I always felt bad, weak...

I believe each flare up I have is due to stress and my overdoing things. I have had much stress in my life over the last several years and the last few have been the worst. My pain has been at it's worst this last year, and constant.

I really think I could write a book... but I think you get my drift.

But who knows, it could be genetic and my emotional trauma caused my first flare, and stress the ones that followed. But no one else in my family has been diagnosed with FM so far that I am aware of.
dollbug responded:
Hello Dr. P.....and thanks for your wonderful information.....I knew when you replied to us on the original post....that you were just "fooling with us".....interesting info here....

MiMi in NC....and I will say that I have been through a lot in my life....from a very young age....until now....but I really did not have anything even close to how I now feel....earlier that I can remember....up until 2004....and so much happened I can say that I truly think my was trauma....but I also think that genetics play a part in this also....and it really worries me since I have 2 sons and a daughter....I can only hope that they will never meet the wrath of the dragon....

I think perhaps that my mother had this and the doctors never figured this out....I can only guess this to be true though...

So I do think that something, no doubt, triggers "it" to surface and make "its" presence known to us....and then once it is "out in the open"....there is no turning back....we are stuck forever....that our only recourse is to learn to accept it and how to cope better with it....that "it" is a "forever enemy"....

I know that I read a lot about cancers....when my husband was sick...and found out that everyone is actually exposed to cancers each and every year.....but some of us do not actually get it....I know that the doctors told my husband....what he had was 1 in a million chances that he would get this.....(I guess it is kinda like the lottery and he won, so to speak-not exactly a great win though)

Thanks for sharing the info....and I will be interested in knowing how the polls results turn out....

TCL38 replied to alispazz's response:
LOL....only mad for being a smart aleck

Hey can you teach me how to sit on my fingers. Chris would really appreciate it I'm sure.

Ditto Anon 21709 genetics can't be the only cause. I have four children and only one has FM. It's like how not everyone who smokes gets cancer even though nicotine is a known carcinogen. There's something else at work for "why" my daughter and I have FM and why my father got lung cancer and died but my mother is still alive when they're both life-long smokers. Or it's like the BRCA gene not everyone who has it will get breast cancer.

TCL38 responded:
Thank you so much Doc!

I copied the text of your message and sent it to my family who think my daughter is being a "drama queen" or a "faker" (they think worse about me) and to some friends who already have co-conditions.

My youngest son is exhibiting signs of FM but my daughter and I can't decide if he's having sympathy pains or if he really is FMing. We're both watching him closely. We've decided that if he's still complaining after we move in just over a week that we're going to haul him to our docs office for our of our appointments but not tell him why he's going. It's sneaky but sometimes it's almost like he feels left out of the "pain club" so we're not really sure what's going on.

Thanks a million!


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