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Possible Physiologic Causes of Fibromyalgia
- Altered microcirculation in muscle tissue. This may contribute to muscle hypoxia and ischemia, causing the fatigue, muscle tenderness, and pain patients experience 24 to 48 hours after exercise.
- A disruption in restorative deep sleep (REM) and low levels of serotonin and tryptophan. Serotonin is needed for deep sleep; when it is depleted, the patient has less deep sleep.
- Human growth hormone, needed for homeostasis and fat metabolism, is primarily secreted during deep sleep. Reduced HGH secretion may account for the sudden weight gain reported by many patients with fibromyalgia.
- Increased pain perception because of more substance P, a neuropeptide that carries pain signals. Substance P helps nervous system cells communicate with each other about painful stimuli. An increased level of substance P leads to increased pain perception. A study also found that patients have less blood flow to two areas of the brain that regulate the amount of pain signals received by the brain, giving them less ability to control pain.
- Trauma. Some patients report symptoms beginning after physical or emotional trauma, such as a motor vehicle accident, divorce, or death of a loved one.
- Genetics. It may be familial in nature. Studies show that a high prevalence of patients have family members with the disease, particularly mothers (83%), sisters (63%), and daughters (26%). Interestingly, 19% of patients have husbands who also have fibromyalgia, indicating a possible environmental, dietary, or lifestyle component.
- Depression. This is a chicken or egg issue: Does depression cause fibromyalgia or does fibromyalgia cause depression?
As stated above, it is usually diagnosed by ruling out other conditions such as rheumatologic syndromes, hypothyroidism, etc., and by obtaining an accurate and detailed patient history.
The American College of Rheumatology lists these fibromyalgia diagnostic guidelines and criteria:
- pain in the upper and lower body, bilaterally, and on the spine, and persisting for 3 or more months
- pain on palpation in at least 11 of the 18 tender points
| Anterior Tender Points |
Posterior Tender Points |
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The patient may suffer with some of the following symptoms and/or conditions:
- stiffness exacerbated by inactivity
- swelling in the soft tissues
- muscle spasms and/or palpable nodules in affected muscles
- mood swings and depression
- difficulty with memory and concentration
- paresthesia
- hypoglycemic-like syndrome
- irritable bowel or bladder syndrome
- migraine headaches
- chronic fatigue and decreased endurance
- sleep disturbances and the inability to obtain deep level sleep
- dysmenorrhea
- disequilibrium
- environmental sensitivity
Continue to page 3: Treatments for Fibromyalgia
Back to page 1: HGH and Fibromyalgia
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