Last updated: May 17, 2008
pain-stimuli-responses
Researchers in 2002 reported that when the thumbs of fibromyalgia patients were pinched, their brain activity showed that they felt far more pain than a control group experiencing the same pressure. (DANIEL CLAUW)
Researchers are finally beginning to understand the underlying cause of the painful symptoms of fibromyalgia. Three to six percent of the general population are estimated to have the condition. That's as many as 18 million people and most of them—eight out of 10, according to the National Fibromyalgia Association (NFA)—are women. Yet, in part because it is not well understood, fibromyalgia is still under-recognized by many doctors.


Not all doctors are up to speed with fibromyalgia
"We just did some market research, and we found that it depends on who you're talking to: If you're talking to rheumatologists, probably 85 percent understand that fibromyalgia does exist," says Lynne Matallana, president of the NFA. "But, if you're talking to a doctor who specializes in ob-gyn, for example, it's more like 35 to 40 percent, because they haven't had the same continuing medical education or experience."

Which presents challenges to patients who experience the symptoms of fibromyalgia and need sympathetic, nuanced care. Because there is no definitive lab test for fibromyalgia, doctors also need to rule out other conditions that share some of the same symptoms, such as hypothyroidism.

A new understanding of the mechanism
What is now widely agreed upon is that a fibromyalgia sufferer's nervous system is much more sensitive than that of a healthy person. It signals high alert even when there's little pain stimulus. This is known as "pain amplification."

professor-daniel-clauw
Daniel Clauw, MD, director, Chronic Pain and Fatigue Research Center, University of Michigan
(DANIEL CLAUW)
This was sharply demonstrated by a study in 2002. Daniel Clauw, MD, director of the Chronic Pain and Fatigue Research Center at the University of Michigan, in Ann Arbor, and his colleagues carried out an experiment in which they pinched the thumbs of both fibromyalgia sufferers and a control group, and looked at certain areas in their brains where pain is processed. Results showed conclusively that with very little pressure, the fibromyalgia patients felt far more pain than the control group.

"Many physicians think the only reason for pain is that there is something wrong with the body, but it's not," says Dr. Clauw. "There are two types of pain, pain that comes from an inflammation or problem with the body and then the pain with fibromyalgia. The analogy I always use is that in fibro patients it's like the volume control is turned up too loud on pain filters."

"You slam your door on your finger, and certain areas in the brain light up," says Robert Bonakdar, MD, director of pain management at the Scripps Center for Integrative Medicine in San Diego. "But in a person with more chronic pain, those areas would light up excessively and wouldn't quiet down. It kind of puts an ongoing 911 signal in the brain. There's nothing wrong, but the brain keeps saying that there is."


Why the pain system has broken down
It's becoming clear that fibromyalgia is akin to a pain response system breakdown, and there are different theories about why the system malfunctions. Some believe that chemicals in the brain (neurotransmitters such as substance P, seratonin, and dopamine) or hormones like cortisol may be at abnormal levels.

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"Fibromyalgia sufferers don't release dopamine, the brain's chief painkilling neurotransmitter," explains Patrick Wood, MD, a senior medical adviser to the NFA, whose research focuses on dopamine. "It's a natural analgesic. So here you have a brain in which, when you hurt the individual, the painkiller is not released."

What the research is showing is that there is definitely something physiologically going on in patients with fibromyalgia. It is most definitely not "all in their heads," as many patients have been told over the years. But the precise cause of pain amplification is not known. Genetic factors may be at play, but it may take an illness or injury to trigger the actual condition.

There may be no cure for fibromyalgia, but there are treatments. To find out about them, visit "Learn How to Manage Your Fibromyalgia."