Why is my Fibromyalgia pain getting worse?

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Written By Dr. Marcus Yu Bin Pai

MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.

Fibromyalgia, a widely misunderstood disorder, is characterized by widespread pain throughout the body, along with symptoms such as increased sensitivity to pain, difficulty sleeping, numbness, and cognitive issues.

Despite being a controversial diagnosis with debated causes, fibromyalgia is not a delusion. In this article, we will explore the complexity of diagnosing and understanding fibromyalgia, its possible causes, and recent research that sheds light on this often-misunderstood condition.

Fibromyalgia: A Complex and Controversial Diagnosis

Fibromyalgia is a chronic condition with widespread symptoms, making diagnosis difficult, as these symptoms can also be attributed to other conditions like arthritis.

Furthermore, identifying the causes of fibromyalgia is challenging, with numerous factors potentially triggering or contributing to its symptoms.

Psychological and Environmental Factors

Significant physical injuries or psychological trauma, especially during childhood, have been linked to an increased risk of developing fibromyalgia. However, not everyone with fibro has experienced trauma.

Genetics also play a role, with the disorder running in families and studies showing relationships between fibromyalgia development and dysfunctional genes controlling neurotransmitters such as serotonin, dopamine, and norepinephrine.

Fibromyalgia and the Role of the Central Nervous System

Fibromyalgia, once a highly stigmatized and misunderstood condition, is now recognized as a prime example of nociplastic pain. This type of pain is distinct from pain caused by inflammation or nerve damage and is characterized by altered pain processing in the central nervous system.

The International Association for the Study of Pain has acknowledged the significance of nociplastic pain in various chronic pain conditions.

The Amplifier Analogy

Pain processing can be likened to the workings of an electric guitar. Just as the guitar’s amplifier can be turned up or down to control the sound, the brain and spinal cord act as an “amplifier” for pain. Each person has a unique amplifier setting, which can be influenced by factors such as genetics, sleep, exercise, and stress.

A higher amplifier setting results in increased pain sensitivity, even in the absence of any structural abnormality.

Furthermore, the amplifier setting affects not only pain processing but also sensitivity to other sensory stimuli such as light, odors, and side effects of medications. This connection highlights the intricate relationship between the central nervous system and various aspects of sensory perception.

Classifying Fibromyalgia: A Heated Debate

The difficulty in diagnosing and understanding fibromyalgia has led to disagreements among psychologists about its classification. Some argue that it should be considered a somatic symptom disorder, where psychological issues manifest as physical symptoms.

Others believe it should be classified differently, as it can be triggered by biological or environmental factors.

The Biopsychosocial Approach

Today, many scientists propose the biopsychosocial approach, which considers fibromyalgia in the context of biological, psychological, and social factors combined.

This approach suggests that traumatic events, possibly in combination with genetic predisposition, may lead to the extreme response to pain and other symptoms associated with fibromyalgia. The exact mechanics of how these factors play out in the body are still unknown.

Dispelling the Delusion Myth

A common misunderstanding about fibromyalgia is that patients are suffering from a delusion of pain, rather than experiencing actual pain.

This misconception has made it difficult for those with fibro to access treatments, as they are often not taken seriously. However, recent research has provided evidence that there is nothing delusional about fibromyalgia.

‘Explosive’ Brains: A Breakthrough in Understanding Fibromyalgia

A 2018 study used EEGs to test ten female fibromyalgia patients, revealing signs of electrical instability in their brain waves.

The researchers considered the possibility that these unstable brain waves were similar to a phenomenon known as explosive synchronization (ES), a dramatic, synchronized reaction across a network usually observed in fields like physics.

The study’s computer models of fibromyalgia brains reacted to pain stimuli in the same explosive manner reported by patients, suggesting a physical overreaction to pain stimuli in their brains.

Understanding the Amplifier in Chronic Pain

Chronic pain can cause individuals to experience heightened sensitivity, leading to what is known as a higher “amplifier setting.” Treatment options for chronic pain often aim to turn down this amplifier, focusing on reducing pain rather than addressing the specific cause of the pain, such as inflammation in the knee. It’s important to recognize that chronic pain is not an either-or situation; individuals may experience different types and degrees of pain simultaneously.

The majority of people with autoimmune diseases, such as spondylitis, may also have some degree of fibromyalgia or nociplastic pain – pain caused by alterations in the central nervous system’s processing of sensory information. This provides an opportunity for physicians to explore alternative treatment options beyond those that target the immune system.

Three Types of Pain and Their Treatments

  1. Nociceptive pain: This type of pain results from damage or inflammation in the body. Treatments for nociceptive pain include nonsteroidal anti-inflammatory drugs (NSAIDs), injections, and surgery. However, it is essential to recognize that these treatments may not always be effective, as some patients may have pain originating from the central nervous system, rather than the area being treated.
  2. Nociplastic pain: Also known as central sensitization or fibromyalgia, nociplastic pain is caused by alterations in the central nervous system’s processing of sensory information. This type of pain is more widespread and is often accompanied by sleep problems, fatigue, memory issues, and sensory sensitivity. Treatment for nociplastic pain may involve different medications and a more aggressive approach to non-drug therapies.
  3. Chronic overlapping pain conditions: The National Institutes of Health (NIH) has identified a group of pain conditions that share similarities in their underlying pain mechanisms, including headache, fibromyalgia, irritable bowel syndrome, temporomandibular joint disorder (TMJ), and others. These conditions predominantly involve nociplastic pain and may differ in location and specific symptoms.

Identifying and Assessing Nociplastic Pain

To identify and assess the presence of nociplastic pain, physicians may use tools such as the fibromyalgia survey, which asks patients to mark different areas of the body where they experience pain and rate the severity of key symptoms, including fatigue, memory problems, and sleep issues.

The higher the score, the greater the likelihood that a significant portion of the individual’s pain is coming from the central nervous system.


Although the causes of fibromyalgia remain unclear, recent research has helped dispel misconceptions and provided a better understanding of this complex condition.

With continued research, we may be able to develop new treatments for fibromyalgia, offering hope to those affected by this often-debilitating disorder.

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MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.

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