Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain, along with tenderness throughout the body, accompanied by affective disturbances, cognitive deficits, and sleep disorders. While fibromyalgia can affect anyone at any age, it is more prevalent in women.
The precise processes underlying fibromyalgia remain poorly understood. The pathophysiology of this condition may involve dysfunctions at the level of the autonomic nervous system, immune system, or the hypothalamic-pituitary-adrenal axis. These processes mirror those occurring in response to traumatic events.
Presently, fibromyalgia is understood as a disorder marked by heightened sensitivity to pain, with research suggesting that the body’s response to trauma may act as a trigger for its development.
General symptoms of fibromyalgia:
- Chronic, diffuse body pain located axially, affecting both sides of the body
- Sensations of pain, pulsation, or burning
- Persistent fatigue
- Sleep difficulties
- Gastrointestinal issues
- Concentration challenges (referred to as “brain fog”)
- Short-term memory lapses
- Sensitivity to temperature, sound, light, and smell
- Numbness in limbs
- Touch sensitivity
- Stiffness in joints and muscles
- Anxiety
- Depression
- Profound mood alterations
Can trauma lead to fibromyalgia?
The exact causative factors of fibromyalgia remain elusive, but trauma and psychological injuries are considered significant triggers and perpetuators of its symptoms.
A comprehensive review of 51 studies from 2018 revealed that a majority of individuals living with fibromyalgia reported a substantial association between the onset of symptoms and experiencing emotional or physical trauma.
The quality of the data pool was insufficient to draw further conclusions, but experts noted that emotional trauma was more prevalent than physical trauma.
Why does this occur?
The manner in which psychological trauma translates into chronic pain may be linked to the body’s response to extreme stress, activating the fight-or-flight response. It is essential to recognize that trauma extends beyond the event itself; it encompasses a psychophysiological reaction occurring within our nervous system, persisting in the body for years. This dysregulation within the nervous system influences pain perception, heightening painful experiences at the central nervous system level.
Research indicates that trauma initiates a sequence of neurobiological reactions that may impact brain structures, alter neurological synapses, and potentially influence gene expression.
Additionally, secondary to fibromyalgia, pain may alter communication at the central nervous system level. Modified nerve pathways can distort pain perception and contribute to other frequently observed symptoms, such as impaired cognitive function, sleep disturbances, and fatigue.
Is fibromyalgia associated with childhood trauma?
While fibromyalgia is not exclusively linked to childhood trauma, adverse childhood events (ACEs) may be correlated with fibromyalgia.
A small-scale study from 2018 involving 136 women found that ACEs were significantly more prevalent among individuals living with fibromyalgia.
A large-scale population-based study in 2020 revealed that childhood psychological injuries were associated with a 2.06 times higher risk of developing fibromyalgia later in life.
Another study of women in 2022 demonstrated that 88.2% of those with fibromyalgia had experienced childhood trauma.
We now understand that exposure to numerous stressors during youth can adversely affect the development of our stress response, increasing susceptibility to stress-related disorders.
How is post-traumatic stress disorder (PTSD) related to fibromyalgia?
PTSD is a mental disorder characterized by a reaction to extremely stressful events that exceed an individual’s coping abilities, resulting in an inability to conclude the fight-or-flight response cycle.
PTSD symptoms include re-experiencing in the form of flashbacks and rumination, avoidance, anxiety, or emotional reactivity.
Although chronic physical pain is not a defining symptom of PTSD, these two disorders often coexist.
Another study from 2020 found that PTSD was associated with major clinical symptoms of fibromyalgia, with the majority of individuals living with fibromyalgia reporting PTSD symptoms prior to chronic pain diagnosis.
It remains unclear whether fibromyalgia manifests as chronic pain in PTSD or whether PTSD exacerbates symptoms of existing fibromyalgia; both disorders may interact. Some participants reported heightened pain sensitivity before experiencing traumatic events, even in childhood, which worsened following the event.
The co-occurrence of fibromyalgia and anxiety/depression
Up to 50% of individuals with fibromyalgia live with anxiety or depression at the time of diagnosis, with mental health disorders considered the primary symptom of fibromyalgia.
It is natural for afflicted individuals to experience rapid mood changes; living with chronic pain presents numerous challenges. If fibromyalgia impedes one’s ability to engage in enjoyable activities and disrupts basic functions, maintaining a positive outlook becomes exceedingly difficult.
Feelings of anxiety and depression due to fibromyalgia represent just one aspect of how this disorder affects mood. Profound feelings of sadness, anxiety, anger, and guilt may be more prevalent in fibromyalgia due to changes in the brain that heighten pain sensitivity.
This suggests that individuals sensitive to painful stimuli will experience more intense emotional reactions.
Treatment of fibromyalgia
Given the diverse presentations of fibromyalgia and the lack of insight into its exact causes, there is no standardized treatment.
Effective treatment plans typically involve a multidisciplinary approach, including:
- Pharmacotherapy
- Physical therapy
- Psychotherapy
- Physical exercise
- Complementary and combined therapies (e.g., acupuncture, massage, oxygen therapy)
- Mind-body exercises (e.g., yoga, tai chi)
- Dietary adjustments
Fibromyalgia often occurs alongside many other physical conditions. It is commonly observed in individuals also living with irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and chronic headaches. Addressing these conditions is also a part of fibromyalgia treatment.
Immunology and genetic therapies are also under investigation for their potential use in fibromyalgia, though it is not currently considered a genetic or autoimmune disorder.
A healthcare professional will devise a tailored plan based on specific symptoms and medical history.
Changes in the central nervous system may serve as a link between fibromyalgia and trauma. When the body enters survival mode, it may experience long-term changes in brain function and structure that heighten pain sensitivity. Therefore, psychological interventions such as cognitive-behavioral pain therapy or trauma therapy based on nervous system regulation, such as Somatic Experiencing therapy, can provide immense relief from symptoms and enhance the quality of life for patients.
Not everyone who has experienced trauma will develop fibromyalgia, and not all individuals living with fibromyalgia have a history of trauma.
Trauma represents just one of the many potential causes identified in fibromyalgia research. Given the broad array of clinical symptoms, a multidisciplinary and personalized approach to fibromyalgia treatment is generally necessary.
