Causes of fibromyalgia

The causes of fibromyalgia are unknown, but over the past decades, statistically confirmed data have accumulated that set certain vectors in the direction of fibromyalgia research.

FMS - fibromyalgia exists in two forms approved by the American Rheumatology Association.

Primary fibromyalgia is one of two clinical forms of a syndromic, poorly understood disease characterized by myofascial pain and depressive state. Primary fibromyalgia is formed for reasons that have not yet been established and specified by medicine, but as a disease it is considered an independent nosological unit, unlike another form of FMS - secondary, which is formed against the background of the main pathology.

The names of primary fibromyalgia may vary and differ from each other, since there is still no consensus in the medical world regarding the etiological causes. However, starting in 1977, thanks to the developments of Smith and Moldovsky, the diagnostic criteria for fibromyalgia began to be systematized, which were subsequently specified twice - in 1981 (Yunus criteria) and finally - in 1990 by the American College of Rheumatologists. Also, European and American doctors put forward concepts of the origin of the disease, which do not contradict, but only complement each other. The difference is only in the designation of the etiological factors related to the forms of fibromyalgia: primary fibromyalgia has truly unspecified causes, secondary fibromyalgia is considered to be better studied and the underlying causes that provoke it are much easier to establish.

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Here are some possible versions and concepts of the causes of fibromyalgia.

1. According to a group of Israeli rheumatologists, for whom fibromyalgia has become a topic of clinical observations, its causes are hidden in post-traumatic factors. Trauma is considered not only an accident, a crash, but also a serious disease, as a result of which the central nervous system is damaged. Beginning in 1997, rheumatologists observed patients with cervical spinal injuries, and established a clear relationship between these injuries and the "onset" of myofascial syndrome. Most often, fibromyalgia had causes related to damage to the cervical spine or head injury. This version, of course, relates to the study of the etiology of secondary fibromyalgia.
2. Colleagues of Israeli doctors, specialists from the American University of Alabama, are convinced that not all cases of fibromyalgia are associated with a post-traumatic trigger. They found that fibromyalgia can also have hereditary causes, since a family pattern of muscle pain formation was observed in 45-50% of the patients studied. Thus, the work of American doctors provides grounds for geneticists to work and the opportunity to get an answer to the question of why primary fibromyalgia develops.
3. Some US scientists are inclined to adhere to the theory of fibromyalgic symptoms as a consequence of spinal compression. These doctors also suggest considering and more closely studying the infectious cause of fibromyalgia and the appearance of myofascial syndrome.
4. There is a version of European researchers, according to which fibromyalgia has its causes in the sphere of disruption of neurotransmitter connections, in particular – lack of serotonin and, as a consequence, manifestation of increased sensitivity to pain symptoms. Such a theory is at the stage of experimental study, but over the past five years, since 2008, information has already been accumulated on the effect of serotonin deficiency on allodynia (increased perception of pain). This concept is directly related to such a form of the disease as primary fibromyalgia.
5. Doctors from the University of Michigan Medicine have put forward a theory about the influence of the neuroendocrine system on the development of fibromyalgia. Unlike their European colleagues, their attention was drawn not to serotonin, but to dopamine, histamine, endorphin, norepinephrine and gamma-aminobutyric acid. The studied group of patients with fibromyalgic pain showed insufficient production of the necessary hormones by the hypothalamic-pituitary system and adrenal glands during examination. Thus, Michigan scientists are inclined to the version of the stressful origin of fibromyalgia. Indeed, muscle pain intensifies after psycho-emotional shocks, this is confirmed by scientists from Oregon who found a low level of somatotropin in patients with fibromyalgia. Somatotropin is a polypeptide hormone that is necessary in childhood for the growth of the body. In adults, and fibromyalgia, the causes of which continue to be studied, develops mainly in people over 20 years of age, somatotropin is responsible for anabolic resources, and also affects the activity of cognitive, cognitive functions of the brain.
6. A group of Mexican scientists has identified a direct relationship between the development of fibromyalgia and the presence of hypothyroidism in female patients. It has been established that fibromyalgia most often affects women, the percentage of male patients is 65/35%. According to Mexican endocrinologists, it is the insufficient amount of thyroid hormones that provokes changes in the functioning of the central nervous system, which leads to muscle pain and other symptoms of fibromyalgia.
7. Fibromyalgia causes, according to one version, may be in chronic fatigue syndrome. This is also an insufficiently studied disease, but many doctors in Europe, Asia and the USA are increasingly inclined to this option. In those countries where FMS - fibromyalgia is not singled out as a separate nosological unit, it is considered one of the leading symptoms in the diagnosis of CFS.
8. The theory that insomnia is a triggering factor for fibromyalgia has ceased to be considered objectively confirmed over the past five years. However, there is statistical evidence of a link between low levels of somatotropin, which should be normal in the deep sleep phase, and the development of fibromyalgia.

According to some sources, the pathophysiological development of fibromyalgia occurs in stages, from a trigger – stress, trauma or acute infectious disease – to the formation of persistent diffuse muscle pain and depression.

Fibromyalgia causes in its anamnestic manifestation demonstrate the following:

• A person is in a state of chronic stress, constant mobilization and tension of the nervous system, obviously, acts as a trigger for the development of fascial muscle pain, especially in impressionable, nervous people. In people with an adequately tuned nervous system, stress, even very acute, causes active resistance and encourages certain actions. In people with a weak nervous system, a stressful situation only depletes the already depleted and weak mobilization resources. Compensatory, the body begins to mobilize muscle tissue, which also cannot cope with the load. Pain appears, the endocrine immune and nervous systems are depleted even more. These factors directly affect such a form of the disease as primary fibromyalgia.
• A person (usually a woman) suffers from a latent form of hypothyroidism, which does not manifest itself with obvious symptoms and, accordingly, is not diagnosed in a timely manner. Developing hypothyroidism provokes a disruption in the functioning of the central nervous system.

The subclinical form of the disease also provokes depletion of the immune system, which can lead to infection with agents such as:

1. Herpes viruses types 1, 2, 6.
2. EBV is a herpes virus type 4, Epstein-Barr virus.
3. Cytomegalovirus.
4. Herpes virus type 3 or VZV is the varicella-zoster virus that causes chickenpox or shingles.
5. Mycoplasmas.
6. Chlamydia.
7. Toxoplasma.
8. Streptococcus.

Fibromyalgia causes also suggest an infectious nature. If the body is infected with the above-mentioned viruses or bacteria, the weakened immune system is unable to adequately respond to the invasion of infection, and begins to attack its own tissues - tendons and muscles - with secreted antibodies. Typical fibromyalgic pains appear.

Among the factors that provoke FMS – fibromyalgia syndrome, there are certainly certain conditions, diseases that have already been systematized and collected into etiological groups. Among them, doctors name the following:

1. Chronic or acute stress.
2. Injuries.
3. Hormonal imbalance, in women this is often associated with menopause.
4. Neurological disorders, diseases that are related to “minor” psychiatry.
5. Immunodeficiency.
6. Endocrine pathologies.
7. Infectious diseases, mainly TORCH infections.
8. Physical overload.
9. A hereditary factor that can result in primary fibromyalgia.

Also, in a statistical sense, it was possible to find out that fibromyalgia causes manifest themselves in this way:

• Children and adolescents – from 9 to 15 years old in 30% of cases of all diagnosed syndromes. Primary fibromyalgia is most often diagnosed in children.
• Traumatic injuries - in 25% of cases of the total number of diagnosed patients, with 40% of all traumatic causes being injuries to the cervical spine, 30% to injuries to the lumbar spine.
• The onset of the disease with diffuse pain symptoms in the legs – 65%.
• Fibromyalgia in men (55-65%) of all cases is associated with physical overload and sports injuries.

Summarizing the diversity of etiological variants that result in both primary fibromyalgia and the secondary form, they can be systematized into the following categories:

• The primary cause in the pathogenesis of the disease is a change in the sequence of perception of pain sensations.
• The primary cause in the pathogenesis of fibromyalgia is a pain focus localized in trigger points, which subsequently generalizes into typical symptoms of fibromyalgia - diffuse pain, sleep disturbance, depression, decreased physical activity.
• There is also a concept that describes an imbalance in neurochemical communication, in particular, a deficiency in serotonin levels, which, according to the authors of the version, provokes the formation of fibromyalgia syndrome. There is a theory that primary fibromyalgia is a consequence of genetic disorders and is inherited.
• The remaining concepts, which include the traumatic factor, endocrine and infectious nature of the disease, relate more to the second form of FMS – secondary fibromyalgia.

More and more scientists and doctors are leaning towards the version that claims that fibromyalgia has its causes in the sphere of mitochondrial connections and serotonin metabolism disorders. The efforts of rheumatologists, neurologists, immunologists and endocrinologists today are aimed at integrating the received diverse and sometimes contradictory information into a single system that will help to find out why fibromyalgia develops, the causes of which still remain a "secret behind seven seals"