Fibromyalgia is an unpleasant condition but at the same time a difficult one to diagnose with no known cause and a wide variety of potential side effects. The main signs symptoms of fibromyalgia are widespread pain, particularly in the muscle and connective tissue and ‘allodynia’ which is a hypersensitivity to pressure – i.e. light pressure causing pain.

Other signs symptoms of fibromyalgia include fatigue, stiffness, insomnia, difficulty swallowing, bowel problems, bladder abnormalities, numbness, tingling and cognitive difficulties; though any number of these symptoms can be present or none at all. At the same time, evidence is mounting to suggest that mood disorders such as anxiety disorders, depression and a condition similar to post traumatic stress disorder may be present.

Fibromyalgia effects roughly 2-4% of the general population, however there is still no known cause, no cure and no objective diagnostic test. This, along with the fact that the signs symptoms of fibromyalgia display significant overlap with other conditions such as chronic fatigue syndrome, has lead to some experts dismissing it as a ‘non-disease’ or a convenient way to diagnose patients with diffuse symptoms.

While there is a lack of consensus within the medical community as to fibromyalgia’s causes, there is strong support building for the idea of fibromyalgia as a psychosomatic disorder. This describes a condition that comes about due to an interplay of the body and mind, and often one triggered by psychological aspects. This is supported by the fact that emotional distress, worrying, family conflicts, stress and even bad weather are correlated with the signs symptoms of fibromyalgia. It may then be that a distributed pain and hypersensitivity forms part of a general ‘learned helplessness’ response, or that depression/stress alters the perception of pain.

At the same however, the signs symptoms of fibromyalgia have also been correlated with infection, exposure to radiation and chemicals, certain medications and lack of physical activity, suggesting that there may also be physical causes of fibromyalgia. This is still confusing however, as any of these conditions could also psychological stress. Similarly there is evidence for a familial link in the signs symptoms of fibromyalgia suggesting a genetic cause. However again this is merely a correlation and cannot prove causality; it may simply be that a disposition to stress is inherited which leads indirectly to an inherited disposition to fibromyalgia.

Brain studies have demonstrated that some patients show a deficiency of dopamine, a neurotransmitter known as the ‘feel good hormone’ with pain killing properties. Again it is impossible to determine whether a low production of dopamine is causing fibromyalgia and depression or whether it occurs as a result of the condition. Either way, patients have been shown to be responsive to dopamine agonists (which stimulate the dopamine receptor cells) which can treat some of the symptoms.

It may be the case that the signs symptoms of fibromyalgia could point to one of two different forms of the condition. Like several other psychosomatic conditions it may be that the illness should be classified by its cause – whether it’s external (secondary) and caused by a lack of movement, by injury or as a reaction to medication or chemical exposure; or whether its internal (primary), caused by a lack of dopamine and/or depression through a genetic predisposition.

Mack LeMouse

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