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Fibromyalgia (FM)

Although chronic fatigue syndrome (CFS) has been defined as a separate syndrome,

up to 70% of patients with fibromyalgia are also diagnosed with CFS and 35-70% of patients with CFS have also been diagnosed with fibromyalgia.

Thus studies of patients with CFS may have clinical relevance to FM.

Every patient with chronic widespread pain requires at the first medical evaluation a complete history, medical examination and some laboratory tests (Hauser et al., 2017):

complete blood count, C-reactive protein, serum calcium, creatine phosphokinase, thyroid stimulating hormone, 25-OH vitamin D) to screen for metabolic or inflammatory causes of chronic widespread pain

Digestive Health

Investigators found small intestine bacterial overgrowth in 100% of 42 patients with FM.

They noted that 30- 75% of patients with FM have also been found to have irritable bowel syndrome (IBS). A confounding factor is that medications prescribed for FM often have gastrointestinal side effects.

Leaky gut has also been detected in patients with FM – which isn’t surpassing since we know approximately 50% of people with small intestinal bacterial overgrowth have leaky gut (Goebel et al., 2008).

You may like to read my article on restoring digestive health, here, and my serious on SIBO, here.

Mitochondrial Health

Increased ROS in CFS and FM, resulting in impaired mitochondrial function and reduced ATP in muscle and neural cells, might lead to chronic widespread pain in these patients. Therefore, targeting increased ROS by antioxidants and targeting the mitochondrial biogenesis could offer a solution for the chronic pain in these patients (Meeus et al., 2013).

In another study (Cordero et al., 2013) the authors concluded that there results lead to the hypothesis that:

inflammation could be a mitochondrial dysfunction-dependent event implicated in the pathophysiology of FM in several patients indicating at mitochondria as a possible new therapeutic target


We found a high prevalence of autoimmune thyroid disease among 207 patients with clinically defined FMS, with TRAb being especially prominent among these patients (Nishioka, 2016).

A significant difference in the night time serum cortisol level was observed among the patients and control groups. It could be concluded that there is an abnormality in circadian secretion of cortisol in female FMS patients (Fatima et al., 2013).

You may like to read our article on the thyroid, here, and cortisol, here.

Immune Health

Viral infections associated with FM have included hepatitis C, in which two studies found an association, and two studies found no association. Associations with FM have also been found with hepatitis B,  human immunodeficiency virus (HIV) and human T cell lymphotropic virus type I.

Mycoplasmal infections have been identified in 52 – 70% of CFS patients compared with 5 to 10% of healthy subjects in North America and Europe (Belgium).

Three studies have found thyroid autoantibodies to be in greater percentages in subjects with FM compared with controls, in spite of normal thyroid hormone levels.

Autoantibodies to serotonin were identified in 74% of 50 patients with FM compared with 6% of 32 healthy (blood donor) controls. Notably, serotonin levels were normal in 90% of the FM patients indicating serotonin receptor involvement.

Normal-weight patients showed higher levels of C-reactive protein (CRP) indicating systemic inflammation is present (Rus et al., 2016).


Emotional trauma may lead to the reactivation of previously controlled infections.


There is converging data in favour of a dysregulation of pain processing in the central nervous system of FM patients, particularly associated with an increase in cerebral glutamate levels. Furthermore, there is evidence to support an association between increased glutamate levels and an increase in FM symptoms (Pyke et al., 2016).


Meditation awareness training may be a suitable treatment for adults with FMS and appears to ameliorate FMS symptomatology and pain perception by reducing attachment to self (Gordon et al., 2017).

Music listening in daily life improved perceived control over pain in female FMS patients (Linnemann, 2015)


Ultimately nutrition recommendations are going to estabisged around any underlying issues picked up. For example is SIBO is detected a FORMAP diet trial may recommended. However there is a little research on nutrition in FM:

This study indicated that antioxidant protection from bioactive compounds present in fruit and vegetables could have an adjuvant role in fibromyalgia treatment (Costa de Miranda et al., 2017)

Vitamin D replacement treatment in patients with nonspecific CWP has provided improvements in musculoskeletal symptoms, level of depression and quality of life of patients. Patients with CWP should be investigated for vitamin D deficiency (Yilmaz et al., 2016).

Dose-response relationship and long-lasting effects of vitamin B12/folic acid support a true positive response in the studied group of patients with ME/fibromyalgia (Reginald et al., 2015)


One over arching theory then is various triggers are followed by prolonged immune activation with subsequent multiple hormonal repression, disrupted collagen physiology and neuropathic pain.


We can conclude quite simply with this quote:

Investigation of potential triggers of chronic immune activation needs to include sources of underlying infection, unresolved physical or emotional trauma, toxins and food sensitivities.



Breeding et al., (2012) Integrative model of chronically activated immune-hormonal pathways important in the generation of fibromyalgia, British Journal of Medical Practitioners, Volume 5, Number 3

Hauser et al., (2017) Management of fibromyalgia: practical guides from recent evidence-based guidelines, Pol Arch Intern Med

Pyke et al., (2016) Measuring Glutamate Levels in the Brains of Fibromyalgia Patients and a Potential Role for Glutamate in the Pathophysiology of Fibromyalgia Symptoms: A Systematic Review, Clin J Pain.

Nishioka et al., (2016) High prevalence of anti-TSH receptor antibody in fibromyalgia syndrome, Int J Rheum Dis

Van Gordon et al., (2017) Meditation awareness training for the treatment of fibromyalgia syndrome: A randomized controlled trial, Br J Health Psychol

Costa de Miranda et al., (2017) Polyphenol-Rich Foods Alleviate Pain and Ameliorate Quality of Life in Fibromyalgic Women, Int J Vitam Nutr Res

Yilmaz et al., (2016) Efficacy of vitamin D replacement therapy on patients with chronic nonspecific widespread musculoskeletal pain with vitamin D deficiency, Int J Rheum Dis

Reginald et al., (2015) Response to vitamin B12 and folic acid in myalgic encephalomyelitis and fibromyalgia, PLoS One

Gobble et al., (2008) Altered intestinal permeability in patients with primary fibromyalgia and in patients with complex regional pain syndrome, Rheumatology (Oxford)

Linnemann et al., (2015) The effects of music listening on pain and stress in the daily life of patients with fibromyalgia syndrome

Rush et al., (2016) Nitric Oxide, Inflammation, Lipid Profile, and Cortisol in Normal- and Overweight Women With Fibromyalgia, Biol Res Nurs

Fatima et al., (2013) Circadian rhythm of serum cortisol in female patients with fibromyalgia syndrome, Indian J Clin Biochem

Meeus et al., (2013) The role of mitochondrial dysfunctions due to oxidative and nitrosative stress in the chronic pain or chronic fatigue syndromes and fibromyalgia patients: peripheral and central mechanisms as therapeutic targets? Expert Opin Ther Targets.

Cordero et al., (2013) Is inflammation a mitochondrial dysfunction-dependent event in fibromyalgia? Antioxid Redox Signal.