What Causes Fibromyalgia Syndrome (FMS)?

We do not know. However, research over the last twenty-five years indicates that the problem starts with an imbalance in the neurotransmitters in the brain that control your sensitivity to pain, sleep, and muscle metabolism, including the muscles that control your gut and blood vessels.

The current belief among all leading researchers in this field is that an imbalance in neurochemicals in the central nervous system (brain and spinal cord), especially serotonin and Substance P, results in a variety of mental and biologic abnormalities, which explains the signs and symptoms of fibromyalgia syndrome. This process is now called central or sensory sensitization. It results in the person perceiving normal sensations, such as light touch or normal stretching, as painful.

Most people with fibromyalgia syndrome report that their mood is irritable; when this occurs their whole nervous system is irritable: muscle, gut, bladder, skin and sensitivity to the environment. Hypersensitivity and irritability are the same thing.

Functional Definition of Fibromyalgia Syndrome

FMS results from hypersensitivity throughout the entire body associated with a non-restorative sleep disorder or insomnia. The characteristic symptoms may include: pain, tenderness, fatigue, anxiety, depression, diminished focus and memory, headaches, and altered function of the stomach, bowel, skin, nerves, muscles, tendons, sinuses, heart and eyes.

Disease or Syndrome?

It is not a disease; it is a syndrome (a pattern of symptoms). It is an imbalance of the nervous system chemistry, which can be re-balanced. You can have it for twenty years, but still rebalance and normalize your chemistry. There is no degeneration or inflammation with FMS. If you are familiar with fibromyalgia, you know that many doctors, authors and web sites refer to fibromyalgia syndrome as chronic and incurable. It does appear to be so, when the only treatment is medication. However, as most medications cause adverse effects (e.g. fatigue, insomnia, nausea, and headaches) they keep the body out of balance. (See Medication Issues and Behavioral Treatment for more info) Solutions for Wellness, in contrast, has developed a program for rebalancing the nervous system. For thirty-two years, we have been helping people with fibromyalgia syndrome recover without medication by helping them regain restorative sleep naturally, exercise safely, use food to increase energy and mental sharpness, and learn how to cope more effectively with pain and stress.

The key to getting well with fibromyalgia syndrome is fully correcting the sleep disorder without medications. The goal is to be calm and sleepy before bed, to wake fully and mentally rested 5 out of 7 mornings and to have peak energy in the morning. This is called fully restorative sleep. When a person can maintain this routine for three months, they become physiologically hardy and symptoms of FMS start disappearing. Interestingly, widespread pain resolves before tenderness leaves. Some people with FMS believe they do not have a sleep disorder because they fall asleep easily and sleep through the night. They wake up very tired and believe the fatigue is from the fibromyalgia. This person actually has a non-restorative sleep disorder. They are not sleeping deep enough and this is promoting their FMS. This type of sleep disorder can be corrected through behavioral sleep retraining.

Our experience leads us to a very clear conclusion: people can recover from fibromyalgia syndrome in the same way that people can recover from serious depression or any other chemical imbalances. Because FMS does not degenerate or inflame muscles, or directly affect the immune system, it is not a form of arthritis in the muscles, nor is it an autoimmune disorder. The only reason that it gets connected with these diseases/disorders is because of common symptoms such as pain or tenderness in muscles or tendons around the joints.

Who Gets Fibromyalgia Syndrome?

  • Fibromyalgia syndrome affects 2% or more of people (adults and children) in the United States. It can affect 10% of specific high-risk populations, such as women between twenty-five and sixty years of age.
  • It is the second most common rheumatic disorder after osteoarthritis, and it is twice as common as rheumatoid arthritis.
  • It affects women more than men, approximately six to one, though the cause is not known.
  • It primarily affects people between the ages of twenty-five and sixty, but it can occur in all populations.
  • For some people there is a genetic predisposition.

How is it Diagnosed?

In 1990 the American College of Rheumatology(ACR) identified the criteria for selecting participants for fibromyalgia research studies. These became the American College of Rheumatology Fibromyalgia Syndrome Classification Criteria. They required eleven of eighteen tender points to be tender to light touch. The criteria was not designed to be a diagnostic criteria, but doctors started using it as such because nothing else existed.

There has been a lot of controversy about this. In the past, many doctors believed that the number of tender points (See the important terms section for a definition) can vary from zero to eighteen in patients with classic fibromyalgia syndrome. As a result, many doctors refused to make the diagnosis unless the person had eleven out of eighteen tender points. Consequently this resulted in patients being denied disability insurance and treatment in the worker’s compensation system.

In 2010 the ACR published new diagnostic criteria. These criteria eliminated the requirement for positive tender points. The tender points are not part of fibromyalgia. They exist in everyone’s body and are tender under strong pressure. The difference is that in fibromyalgia patients the points can be tender under light pressure. They are a barometer of how sensitive a person is. Tender points are never treated. Trigger points are completely different. They are abnormal and can be treated. A person with eighteen out of eighteen tender points and no widespread pain does not have fibromyalgia; they have sensitive tender points. The new criteria also emphasizes the importance of restorative sleep and cognitive impairment in the diagnosis of fibromyalgia.

The New American College of Rheumatology FMS Diagnostic Criteria 2010

  1. Fatigue, waking un-refreshed, and difficulty thinking (cognitive fog).
  2. Widespread pain index (WPI) between three to six body regions from a specific list.
  3. Symptom severity (SS) scale score equal or greater than nine. (This is the sum of the severity of the top three core symptoms plus the score from a symptom list.)
  4. Symptoms have been present for more than three months.
  5. The patient does not have another disorder that would explain the pain.

Go here for the full criteria.