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Fibromyalgia Explained: Why the Pain?

To understand fibromyalgia and why so many doctors tell their fibro patients, “All your tests are normal,” you need to think about serotonin, the brain chemical that acts as a buffer against stress.

Women have lower levels of serotonin than men, and as a consequence they’re more vulnerable to stress of any kind. Some women have it worse, coming from families at the very low end of the serotonin curve, and they have an even higher rate of low-serotonin disorders.

By way of background: women whose low serotonin makes them particularly susceptible to stress are sensitive to everything. They feel potentially painful stimulus (like an inflated blood pressure cuff) more strongly than others and are unusually sensitive to certain foods, chemicals, and drug side effects. They’re also extremely aware of changes in their body, know their hormones, feel when a food is wrong for them, and sense negative energy from an indifferent or impatient physician. Interestingly, low-serotonin women are often creative and highly intuitive, frequently needing to explain what’s obvious (to them) to their otherwise clueless life partners.

Men, of course, are not immune to low-serotonin disorders, but statistically women far outnumber them.

It’s also worth noting that all the low-serotonin disorders were once thought to be psychological in nature. The list includes depression, anxiety, panic attacks, obsessive thinking, compulsive behaviors, social anxiety, post-traumatic stress disorder, anger issues (common in men), and self medication tendencies using food (especially carbs), alcohol, and other drugs.

Why are the herb St. John’s wort and the SSRI family of meds (Prozac, Zoloft, Lexapro, et al) effective against these disorders? Because they boost serotonin levels within the brain.

Let’s discuss the pain
The physical manifestations of low-serotonin disorders occur when your body itself experiences unchecked stress. Your fight-or-flight response is meant to be a quick “on-off” system that gets you out of trouble. It’s supposed to shoot you full of adrenaline so you can move with lightning speed to avoid an oncoming car, for example. But for stressed-out low-serotonin women, it’s like the fight-or-flight “on” button is pressed down and held there, putting their stress response systems into constant overdrive. After a time, the body simply can’t cope.

Most people first notice the physical manifestations of stress as constant tension in the muscles of their neck and upper back. These muscles fan out over the top of the head (tension headaches), jaw (jaw-clenching TMJ), and face (pressure sensation, often incorrectly diagnosed as sinus headache). Migraine headaches are involved here, too, when arteries deep in the brain start contracting in response to stress messages. If you observe women in a workplace, someone’s always reaching behind to massage a knot in her shoulder or tilting her head back to dig in and loosen her neck muscles.

When muscles start tightening up over your entire body, you’re entering fibromyalgia territory.

The extremely painful tender points of fibro are small areas on bones where muscles are attached. Once tender points are activated, it becomes painful to sit for long periods, find a comfortable way to sleep, or even to fall asleep at all. A diagnosis of fibromyalgia depends on the existence of these tender points, and doctors who understand fibro will apply about ten pounds of fingertip pressure to them to illicit a response like “Gee doc, that REALLY HURTS!”

Here’s a fibro diagnosis in a nutshell: Three or more months of widespread muscle pain and chronic tiredness, 11 of 18 tender points elicit an “Ow!” response and the tender points have a right-left symmetry and the tender points are above and below the belt-line.

Each of these low-serotonin symptoms is a physiological response to stress–not a disease. As crazy as it may seem, your body is reacting in the way it’s supposed to react, given the excessive stress and insufficient stress buffer. But because your body’s response is not a disease, finding a cause for these symptoms flies under the radar of blood tests, x-rays, and other diagnostic tests.

In other words: “Your tests are normal.”

A few review notes:
• Fibro is one of the low-serotonin disorders, a group of often disabling conditions that manifest themselves among genetically susceptible people (mainly women) after a period in their lives of unchecked stress.
• Because of the relationship between serotonin and estrogen, the severity of any low-serotonin disorder (but especially fibro) parallels your estrogen level. Hence, symptoms worsen during PMS days and perimenopause, when estrogen levels are dropping. Most women feel a shade better the week after their periods, when estrogen (and serotonin) levels are rising. Most patients feel better in summer than winter because sunshine boosts serotonin levels.
• Low-serotonin disorders can begin at any age when stress exceeds stress buffer. My youngest fibro patient was eight years old. Serotonin disorders like childhood depression and anxiety have reached epidemic proportions.
• From a biographical perspective, fibromyalgia usually follows a “year from hell” in a woman’s life, a perfect storm of a stressful job, stressful family situation, and, these days, a stressful world.
• “Time heals all wounds” ought to apply. Most stressful life events recede, given enough time. But for fibro patients, they’re replaced by the stress of fibromyalgia itself with its relentless widespread pain, profound fatigue, unrefreshing sleep, and a medical system (“We can’t find anything wrong with you”) that doesn’t know how or exactly what to treat (“I’m referring you to a …”). Soon the quest to simply feel “normal” again becomes life’s major source of stress.

Fibro begins with stressors that trigger painful muscle contractions. Now that same pain exacerbates stress, which further increases pain levels: an evil snowball of pain, rolling down a mountain, larger and larger, out of control.

Hang in there–later in this series I’ll discuss treatment.

Next week: Why am I so tired? Is this chronic fatigue syndrome?

Click here for Part 3.

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  1. Suzanne Kush says:
    May 25, 2010 at 9:03 am

    Thank you so much for taking the time to write these. I am living proof that one can fully recover from Fibromyalgia and CFS after having them for many years and being misdiagnosed. Dr. Edelberg has been critical on my path to recovery. Don’t give up hope or your efforts to recover! Everyday I have to do the right things that keep them from returning. I cannot change my susceptibility to them, but I can change how I take care of the susceptibility and myself.