Fibromyalgia: The Neuroscience behind Pain


What is Fibromyalgia?

Fibromyalgia (FM) is defined as a chronic overlapping pain condition (COPC) in which a person experiences numerous symptoms, such as widespread musculoskeletal, joint and peripheral pain, that can cause significant functional impairment. Falling under the umbrella of central sensitivity syndromes, FM leads to permeant activation of, not only the alarm system, but the sustained motor, autonomic and neuroendocrine reactions.

Stand up too long? Pain. Sit down too long? Pain. Sometimes even a fingertip touching the point of swelling can lead to heightened sensory responses.

There is currently no cure for the condition, but a wide use of strong pain medication, constant exercise, physiotherapy, and even Cognitive Behavioural Therapy, seems to result in improvement in the quality of life of sufferers (Barrenengoa-Cuadra, Muñoa-Capron-Manieux, Fernández-Luco et al., 2021).

Systematic reviews have suggested that anxiety and depression remain at a high in those who live with Fibromyalgia, and there may be impairment in inhibitory control, attention, sleep patterns and working memory (Mendonça, Silva, Busatto and Dias, 2021).

How does it happen?

Uprising in the 1980s, Central Sensitization was described as a spinal mechanism of augmenting painful stimuli (hyperalgesia- increased pain to normally painful stimuli, and allodynia- pain to normally non-painful stimuli). Throughout the following years, researchers have discovered that parts of the brain are also involved. A mix of triggers have made themselves known: genetic, environmental, and having pre-existing autoimmune diseases (Clauw and Tzadok, 2021).

Neuroimaging studies show constant structural changes, mainly in the central nervous system (the brain, spinal cord and nerves), due to alteration in chemical neurotransmitter concentration, both heightened (excitatory) and reduced (inhibitory). The main problem does not arise from specific body parts however, but instead in the pain processing pathways in the central nervous system.

A study predicted that the FM brain network includes specific sensory processing regions, such as the insula, and found that functional imaging showed that there was an increase of glutamate in the posterior and bilateral anterior insulae regions in the majority of the participant sample of 40 middle-aged women. There were also reports of hyperexcitability in visual areas, motor areas and the temporal lobe.

Once upon a time, Fibromyalgia was surrounded by susceptibility. Now, research has reported and will continue to report, how we can support those who have to deal with FM every day of their lives, and how to improve/fulfil their lives.


Barrenengoa-Cuadra, MJMuñoa-Capron-Manieux, MFernández-Luco, M, et al. (2021)., Effectiveness of a structured group intervention based on pain neuroscience education for patients with fibromyalgia in primary care: A multicentre randomized open-label controlled trialEur J Pain2021251137– 1149

Clauw D.J., Tzadok R. (2021) The Neuroscience of Fibromyalgia and Central Sensitization. In: Ablin J.N., Shoenfeld Y. (eds) Fibromyalgia Syndrome. Springer, Cham.

Mendonça, B. T. V. d., Silva, G. G., Busatto, L. M., & Dias, N. M. (2021). Executive functions in fibromyalgia: A systematic review. Psychology & Neuroscience. Advance online publication.

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Edited by: Sophie

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