What Causes Fibromyalgia?

It is not known precisely what causes fibromyalgia (FM). Most commonly, it is believed to be related to changes in how the central nervous system processes pain messages, possibly due to abnormal levels of certain chemicals in the brain. It is also thought to have a genetic component. FM may also be triggered by physical or emotional trauma, stress, or infection.

This article will discuss the possible causes of fibromyalgia, triggers, and associated conditions.

person sitting with head in hands

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What Are the First Signs of Fibromyalgia?

People with FM may experience:

Do Abnormal Pain Messages Cause Fibromyalgia?

The central nervous system (CNS) comprises the brain, spinal cord, and nerves. The CNS uses specialized cells to transmit information, including pain messages, all over the body.

Some studies have found that people with FM may process pain differently than those without FM. This may be related to lower levels of certain brain chemicals (neurotransmitters)—such as serotonin or norepinephrine—which could cause a higher pain sensitivity and a more severe reaction to pain. Drugs that improve serotonin release—such as selective serotonin reuptake inhibitors (SSRIs) and duloxetine—have been shown to be effective for fibromyalgia pain.

Studies using brain images of people with FM and related chronic pain disorders have found changes in brain function and connections between different areas of the brain.

Imaging brain studies have also found that people with FM may feel pain when people without FM do not.

Other abnormalities in people with FM have been observed, such as elevated levels of excitatory neurotransmitters (like glutamate and substance P), dopamine dysregulation, and altered activity of endogenous cerebral opioids (chemicals in the brain that help control pain).

While it is widely accepted that people with FM process pain differently, why this happens has not been pinpointed.

Fibromyalgia

Do Genetic Mutations Cause Fibromyalgia? 

FM appears to run in families, but a clear inheritance pattern has not been established.

Does Family History of FM Increase Your Risk of Getting FM?

The overall risk of developing FM is about 8 times higher if a person has a first-degree relative (such as a sibling or parent) with the condition.

Other conditions that cause chronic pain—such as headaches, irritable bowel syndrome (IBS), or temporomandibular joint dysfunction (TMD)—appear to be more common in family members of people with FM. It is suggested these disorders share some genetic risk factors with FM, leading to their clustering in families.

There are about 100 genes currently believed to be associated with pain sensitivity or analgesia (inability to feel pain). One theory proposes that genetic and environmental factors (such as trauma, illness, emotional distress, or other triggers) may make some people more likely to develop FM.

More research is needed to examine the role genetics play in FM.

Does Vitamin Deficiency Cause Fibromyalgia?

Some studies have found that many people with chronic pain do not get the recommended dietary intake of most vitamins and minerals.

Vitamin and mineral deficiencies have been associated with FM and other conditions related to chronic pain. It is unknown whether there is a causal relationship or an association between these deficiencies and FM.

Magnesium Deficiency

Magnesium deficiency has been associated with:

  • Muscle pain
  • Fatigue
  • Anxiety
  • Sleep difficulties

These are some of the symptoms of FM.

Some studies have suggested that magnesium deficiency may play a role in the development of FM by reducing muscle adenosine triphosphate (ATP), which fuels muscle contraction. A correlation has also been observed between increased levels of the neurotransmitter substance P (which plays a role in pain perception) with magnesium deficiencies and pain intensity with FM.

Some studies have found that women with FM had a lower dietary intake of magnesium and calcium than those who did not have FM, but blood levels of these minerals did not differ between the groups.

Some evidence suggests a combination of calcium and magnesium may be helpful for some people with FM.

A relationship between magnesium deficiency and FM has not been proven. There are conflicting findings from studies, and there are methodology obstacles. For example, measuring magnesium levels in a person can be difficult—as blood tests and other measures often don't show the whole-body magnesium status and can be misleading. Dietary intake of magnesium has also not been proven to correlate with FM. More research is needed.

Risk Factors for Fibromyalgia

Anyone can get FM, but some factors may increase the chances.

Risk factors for FM may include:

  • Sex: People assigned female at birth are more likely to get FM than those assigned male
  • Age: Most people with FM are diagnosed during middle age
  • Another rheumatic condition: Having another rheumatic (related to the joints) condition, such as rheumatoid arthritis, lupus, or ankylosing spondylitis
  • Family history: Having a close family member (like a parent or sibling) with FM
  • Physical trauma: Trauma to the brain or spinal cord from injury, illness, or accident
  • Emotional trauma: Possible link between FM and eEmotional stress or trauma, such as post-traumatic stress disorder (PTSD)

Common Fibromyalgia Triggers

FM may be triggered by an event that causes stress (physical, emotional, or psychological) in some people. These environmental factors or triggers likely interact with genetic factors.

Possible triggers may include:

  • An infection or illness, such as Epstein-Barr virus or Lyme disease
  • A serious injury
  • Having a major operation
  • A traumatic event, such as a car accident
  • Significant emotional trauma, such as exposure to war or other catastrophic events
  • A history of childhood abuse or neglect
  • Chronic, long-term stress

People with FM can also have flare-ups (periods with worse symptoms). Possible triggers for FM flare-ups include:

  • Hormonal changes, such as during the menstrual cycle or pregnancy
  • Stress, such as the loss of a loved one, work stress, or stressful events
  • Weather, such as heat/humidity or when the temperature drops from hot to cold
  • Changes in medication
  • Travel
  • Illness
  • Too much or too little physical activity
  • Sleep disturbances

Associated Conditions

FM is often associated with rheumatic conditions, such as:

  • Rheumatoid arthritis: Pain and swelling in the joints caused by the immune system mistakenly attacking healthy cells
  • Ankylosing spondylitis: An autoimmune condition that causes pain and swelling in areas of the spine
  • Osteoarthritis: Damage to the joints, causing pain and stiffness
  • TMD: A condition that causes pain in the jaw, cheeks, temples, and ears

FM has also been associated with conditions such as:

  • Infections
  • Diabetes
  • Psychiatric disorders
  • Neurological disorders

Does Fibromyalgia Go Away?

FM doesn't go away, but it doesn't get worse over time and doesn't damage joints, muscles, or organs.

FM can be managed. Your healthcare provider may recommend measures such as:

  • Medication
  • Exercise and physical therapy
  • Massage
  • Relaxation methods
  • Heat or cold treatments

When to See a Healthcare Provider

FM can have similar symptoms as a number of other conditions. If you have symptoms of FM, it's important to talk to your healthcare provider to get a proper diagnosis. FM can be difficult to diagnose, and some people need to see a healthcare provider (or multiple providers) several times, or multiple healthcare providers, to get a diagnosis of their symptoms.

Some questions to ask your healthcare provider may include:

  • How do you know FM causes my symptoms?
  • What treatments are available?
  • If I need to take medication, what are the risks, side effects, and interactions with my other medications?
  • What should I do if my symptoms don't respond to treatment (or get worse)?
  • Where can I go for support (local or online support groups, etc.)?

Summary

It is believed that FM causes pain to be processed in the brain differently, but why this happens isn't known. It may be related to levels of chemicals in the brain or other brain abnormalities. FM is also thought to have a genetic component, which may interact with environmental factors.

Physical, emotional, or psychological stress may play a role in triggering FM.

Being assigned female at birth, being middle-aged or older, having a family history of FM, and/or having another rheumatic condition may increase the risk of developing FM.

Other conditions associated with FM include rheumatic conditions, infections, diabetes, psychological disorders, and neurological disorders.

FM does not go away, but it doesn't get worse over time and can be managed.

13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Heather Jones
Heather M. Jones is a freelance writer with a strong focus on health, parenting, disability, and feminism.