Saturday 1st January, 2022

What is the root cause of fibromyalgia

Fibromyalgia word cloud
What is the root cause of all this? Lets find out


Fibromyalgia is understood to be a malfunction of the nervous system that causes pain to be increased plus a host of other symptoms. Therefore, when we look at the cause of fibromyalgia we need to look at two levels:

  1. What is the malfunction of the nervous system that causes the symptoms, and
  2. what causes that malfunction?

The cause of the symptoms

Although the cause of fibromyalgia is said to be unknown, scientists understand in general terms that the symptoms are caused by a sensitisation of the nervous system causing it to act like an amplifier. Because of this normal stimuli becomes painful and pain becomes much worse. Also, because the nervous system control practically everything in your body it can cause a host of seemingly unrelated symptoms.

The cause of the malfunction (Sensitisation)

The cause in general

Your nervous system is extremely complex and processes a wide range of information, so it’s function can be affected (sensitised) by a wide range of things ranging from diseases and chemical imbalances through to emotional stress.

Specific causes

Issues such as emotional stress and traumatic events are known to be important causes. However, scientists have found that the biggest cause is prolonged pain from another source. Arthritic joints and even tennis elbow have been identified. However, scientists have found that by far the most common source of this pain is un-diagnosed or inadequately treated (Myofascial) Trigger Points , which are those tender lumps in your muscles that therapists find.

Duration and summation

Generally with any form of sensitisation the duration of exposure is important and the effects of exposures can add together. It is not uncommon for a person to be exposed to one form of stress for a long time, then some sort of incident or trauma acts as the proverbial straw that broke the camel's back.

Causes or symptoms?

While issues such as trigger points, arthritic joints and prolonged emotional stress appear to be genuine causes of sensitisation we have a range of things that could be causes or symptoms. For example say you have a food intolerance and modifying your diet helps with fibromyalgia symptoms. Is the food intolerance stressing your nervous system causing it to become sensitised, or has the issues with your nervous system affected your digestive function? We have no way of really telling.

Treating the cause of fibromyalgia

Treating the cause of the symptoms

In general, medics believe that the cause of fibromyalgia is sensitisation of the nervous system. Because of this they have lots of chemicals that slow down or suppress your nervous system. However, your nervous system performs a great many useful functions and these get suppressed too.

Treating the cause of the malfunction (sensitisation)

The good news is scientist have found that if you remove the cause of the sensitisation your nervous system will tend to re-program itself and go back to normal. They have actually done this in a clinical trial where trigger points were injected with anaesthetic to (temporarily) stop them bombarding the nervous system with pain. This considerably relieved the fibromyalgia symptoms. We will discuss this in detail in the next section.

Fibromyalgia facts
Facts about fibromyalgia from the American College of Rheumatology website

What is fibromyalgia

The medical definition

Fibromyalgia is a collection of symptoms including wide spread pain for which doctors cannot find a cause.

What a diagnosis means

Although a diagnosis of fibromyalgia gives the impression that doctors have found your problem and understand it, it actually means all their tests have come back negative so they really don’t know what’s going on. However a diagnosis of "fibromyalgia" gives them a name to call it so it sounds like they do, and a shopping list of drugs and a shopping list of drugs and therapies they can use to try and relieve the symptoms with (1–4)⁠.

This is really true

This may sound hard to believe, but is confirmed by this excerpt from the American College of Rheumatology website. As we will see scientists do have a better understanding, but in this case keeping doctors ignorant is good for selling symptom relieving drugs.

Fibromyalgia overview
An overview of fibromyalgia

Sensitisation of your nervous system

This diagram shows you what generally happens with fibromyalgia. You can see that the nervous system is acting like an amplifier. A small amount of pain is going in but the volume is turned way up so it feels really bad. Also, as the nervous system controls practically all your body’s functions you get can get some seemingly unrelated symptoms (5–9)⁠.

Why trigger points are by far the biggest cause of sensitisation

What are trigger points

Trigger points are those tender lumps in your muscles that therapists find. For more information please see our article Your Complete Guide To (Myofascial) Trigger Points .

Why trigger points are the biggest cause of sensitisation

As stated above your nervous system can be sensitised by a host of inputs, and it is very important to remember that exposure over time is important and sources can add together. However, for the following reasons it is trigger points that commonly bombard nervous systems with pain over long periods of time:

  1. trigger points are arguably the greatest cause of pain syndromes such as back, neck and shoulder pain,
  2. they are often not diagnosed, and
  3. they are often inadequately treated.
Doctor studying
Conscientiously studying, but practically all sources of medical information rely on drug company funds

Trigger points are often not diagnosed

Despite being so common and a massive cause of pain this information usually does not get to doctors. As an example, a study of shoulder pain found that trigger points were the major cause and that treating them gave excellent results (10)⁠. Despite this, examples of medical journal articles on how to diagnose and treat shoulder pain make no mention of trigger points (11–13)⁠. Instead doctors are advised prescribe drugs and therapies that do not address the problem. This is very bad for people with shoulder pain, but great for drug companies.

Trigger points are often inadequately treated

Prescribing pain killing drugs obviously does not address the trigger points, but what happens when they are identified and treated with therapies such as needles, laser or one of the many manual therapies? As we discuss in our article Why trigger points keep coming back most treatments for trigger points merely temporarily relieve their symptoms but do not eliminate the trigger points. As a result the pain eventually comes back, and as scientists have found even when temporarily not hurting points still bombard your nervous system with sub threshold levels of pain (8).

How the scientists successfully relieved fibromyalgia

Basic principle

Sensitisation is usually caused by prolonged exposure to pain or some other form of stress. Simply, what the scientists did was remove this source of pain, allowing the nervous system to normalise.

Fibromyalgia treatment: scientific
The way the scientists successfully treated fibromyalgia

The trigger point experiment

Before this trail was done there was a lot of research done to work out how sensitisation was happening and that trigger points were the likely cause. You can read more about this here .

As this diagram shows, what the scientists did was to inject the trigger points with anaesthetic. As you can see this stopped the trigger points bombarding the nervous system with pain. The nervous system settled down and the fibromyalgia symptoms were relieved (14)⁠.

Practical advice

It is very important to understand how fibromyalgia typically develops as a result of un-diagnosed and poorly treated trigger points.

How fibromyalgia develops

Early stages

In the early stages people develop trigger points which result in typical musculoskeletal pains such as back, neck and shoulder pain. These are typically dealt with by:

  • self medicating with pain killers
  • doctors prescribing drugs and ineffective therapies
  • trigger point therapies that only provide temporary relief

Middle stages

As the trigger points continue to develop pain worsens, and becomes more constant and widespread. Usually similar “treatments” are continued, though as the condition has worsened it needs either stronger or more frequent medication, or more therapy to provide relief. At this although sensitisation is not yet an issue the person still has widespread pain and tenderness due to the trigger points. Even though, as mentioned doctors are not trained to recognise trigger points so having widespread pain with no recognisable cause some doctors will start diagnosing fibromyalgia.

Later stages

After a long period of time the person will have widespread pain due to trigger points, plus his or her nervous system will become sensitised making the condition much more painful and complicated. The doctors were unable to identify and deal with the issues earlier, but now they can tell you that you have this condition called fibromyalgia that has no known cause but a shopping list of symptom relieving drugs they can try.

What you can do about it

You need to actually get rid of the trigger points

The scientists who relieved fibromyalgia by injecting trigger points with anaesthetic have made an extremely valuable contribution. Their research has shown that pain from trigger points is the major cause of the sensitisation, and that by eliminating that pain the nervous system will settle back down. However, if you have ever had a dental anaesthetic you will understand that anaesthetics wear off after a while. It is completely impractical to keep injecting trigger points with anaesthetics. We have to actually get rid of the trigger points.

How to get rid of your trigger points

As previously discussed, trigger point therapies and treatments too often just temporarily relieve trigger points but do not eliminate them. However, there are effective ways you can deal with trigger points, including very effective treatments that can be self applied. This is very important because you will likely need regular treatments over a long period of time, which if all done professionaly would be very inconvenient and expensive. For details please see our article How to massage fibromyalgia . Please see our video below for a practical demonstration.


  1. Sarac A, Gur A. Complementary and Alternative Medical Therapies in Fibromyalgia. Curr Pharm Des. 2005;
  2. Lauche R, Cramer H, Haüser W, Dobos G, Langhorst J. A Systematic Overview of Reviews for Complementary and Alternative Therapies in the Treatment of the Fibromyalgia Syndrome. Evidence-based Complement Altern Med. 2015;2015(August).
  3. Fitzcharles MA, Boulos P. Inaccuracy in the diagnosis of fibromyalgia syndrome: Analysis of referrals. Rheumatology. 2003;
  4. Di Franco M, Iannuccelli C, Bazzichi L, Atzeni F, Consensi A, Salaffi F, et al. Misdiagnosis in fibromyalgia: A multicentre study. Clin Exp Rheumatol. 2011;29(6 SUPPL. 69).
  5. Fernández-De-Las-Peñas C, Dommerholt J. Myofascial trigger points: Peripheral or central phenomenon? Curr Rheumatol Rep. 2014;16(1).
  6. Giamberardino MA, Affaitati G, Fabrizio A, Costantini R. Effects of treatment of myofascial trigger points on the pain of fibromyalgia. Curr Pain Headache Rep. 2011;15(5):393–9.
  7. Shah J et al. Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective. HHS Public Access. 2015;7(7):746–61.
  8. Giamberardino MA, Affaitati G, Fabrizio A, Costantini R. Myofascial pain syndromes and their evaluation. Best Practice and Research: Clinical Rheumatology. 2011.
  9. Franklyn KL, Guymer EK, Littlejohn GO. Targeting fibromyalgia pain: Brain-spinal cord and peripheral contributions. International Journal of Clinical Rheumatology. 2011.
  10. Bron C, De Gast A, Dommerholt J, Stegenga B, Wensing M, Oostendorp RAB. Treatment of myofascial trigger points in patients with chronic shoulder pain: A randomized, controlled trial. BMC Med. 2011;9.
  11. Holmes RE, Barfield WR, Woolf SK. Clinical evaluation of nonarthritic shoulder pain: Diagnosis and treatment. Phys Sportsmed. 2015;43(3):262–8.
  12. Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J. Chronic shoulder pain: Part I. Evaluation and diagnosis. Am Fam Physician. 2008;77(4):453–60.
  13. Burbank KM, Stevenson JH, Czarneck GR, Dorfman J. Chronic shoulder pain: Part II. Treatment. Am Fam Physician. 2008;77(4):493–7.
  14. Affaitati G, Costantini R, Fabrizio A, Lapenna D, Tafuri E, Giamberardino MA. Effects of treatment of peripheral pain generators in fibromyalgia patients. Eur J Pain. 2011;

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Dr Graeme

About Dr Graeme

Several years ago Dr Graeme, a Chiropractor practicing in Victoria, Australia was looking for a serious hand held massager his patients could use at home to get the extra quality massage they needed. The ones he found in the shops and on-line for home use looked nice but were not serious, and... read more

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