What Is Fibromyalgia? And Why Is It So Confusing?

Fibromyalgia is a complex condition. Some of the main symptoms of fibromyalgia are widespread pain, fatigue, brain fog, and poor sleep, just to name a few.

Doctors may find it confusing because when we feel pain, we naturally want to work out the cause so that we can fix it. If your finger suddenly hurts and you look down and see a paper cut, you see the paper, you see blood, you know what happened. That makes perfect sense.

But with fibromyalgia your foot can start hurting for no apparent reason, and then it can move to your back and shoulders and be so debilitating one moment and disappear the next day... What does the logical brain make of that?

This lack of logical sequences, perhaps combined with a slew medical tests that all come back negative, previously had doctors believing fibromyalgia is all in your head. But scientific evidence shows that fibromyalgia is likely a disorder of the central nervous system. And it affects pain processing and also involves our immune system.

What is fibromyalgia caused by?

What happens to the central nervous system is a phenomenon known as central sensitization. To explain central sensitization, pain researcher Daniel Claw at the University of Michigan likens the experience of pain to the noise produced by an electric guitar. To make it louder, you can either strum the strings harder, or turn up the amplifier. In this analogy, the strings are the nerves carrying sensory information from our organs and tissues, and the amplifier is the brain and spinal cord.

A patient with third-degree burns is having their strings strummed extremely hard, whereas someone with fibromyalgia, their amplifier has been set too loud. People with fibromyalgia can have pain without the strings even having to be strummed—even the softest touch or slight irritation can feel like pain.

Our central nervous system is complex and impacted by many biological, psychological and social factors. Because fibromyalgia is a disorder of the central nervous system, it can affect virtually every part of the body, and symptoms can come and go, and get more or less intense, seemingly at random. This is why you may feel too horrible to get up and walk on Monday, yet able do a full day’s work, see friends, and even exercise on Wednesday.

It’s important to say that people with fibromyalgia are not more 'sensitive' to pain. But their nervous system is burnt out, overloaded, and now misfiring all over the body. And that intensifies the physical level of pain experienced.

How do fibromyalgia symptoms start?

Pain researchers still don't know the cause, but hypotheses are that prolonged activation of nerves that carry pain signals are to blame. Long term injury or infection can cause this to happen.

All this to say that your pain is very, very real.

What is the number one treatment for fibromyalgia?

We know much more about how nociplastic pain works these days, and how to treat it. While we all wish there was one single magic pill to cure chronic pain, research shows that medication alone isn’t enough.

While biological processes contribute to pain, science tells us that pain is not the result of biological or medical factors alone. It’s much more complex than that. Multiple factors influence our pain, and these can include our emotions, thoughts, beliefs, stress, past traumas, our actual physical environment and even whether we have access to caring support. These individual factors aren’t experienced in isolation. We must juggle them all at once, because… life’s like that. Scientists have tried to simplify these factors by lumping them together under the one heading: biopsychosocial.

In other words: biology plus psychology plus social factors equals pain.

It stands to reason then, that to effectively treat pain, we must target not only the biological factors such as tissue damage or diet, but also our thoughts, beliefs, emotions, coping behaviors and lifestyle.

Learning skills from pain neuroscience, cognitive behavioral therapy, mindfulness, and other evidence-based approaches will give you tools to turn the volume down on pain and to regain control over your body.