Fast Five Quiz: How Much Do You Know About Fibromyalgia?

Herbert S. Diamond, MD


July 18, 2016

Certain biological variables contribute to the development and persistence of fibromyalgia, although none as a single element explains all facets of fibromyalgia. Certain variables (eg, physical trauma, exposure to toxins) have been widely incriminated by the public, particularly in medicolegal settings, but are actually of little significance in the etiology of fibromyalgia, as shown by prospective studies.

The extremely important genetic contribution to fibromyalgia and related central sensitivity syndromes was first suggested by family studies. Subsequently, the application of sophisticated genotyping and statistical methodology has provided a detailed view of this relationship. For example, altered serotonin metabolism in a subgroup of patients with fibromyalgia has been linked to a genotype of the promoter region of the serotonin transporter gene.

Trauma as a trigger of fibromyalgia has been a highly contentious and medicolegally charged issue in US society. Until recently, physical trauma as a causative factor in the development of fibromyalgia was an open question because properly designed prospective studies had not been performed, and little experimental evidence explained the presence of pain in the absence of tissue injury.

Setting aside case series and other anecdotal observations that do not provide valid evidence concerning causation, numerous controlled investigations on this issue are now available. The preponderance of current evidence does not support physical trauma as a significant causative factor in the development of fibromyalgia.

Sex-related effects are important in fibromyalgia and pain in general. Central pain modulatory systems in females are influenced by phasic alterations in reproductive hormone levels.

For more on the etiology of fibromyalgia, read here.


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