We hear more and more about fibromyalgia because it is now a disease recognized by the World Health Organization. Unfortunately, many people were followed in psychiatry because it was thought that it was simply a psychic disorder.

It is now known that this is a disease that can result from many causes and cause a variety of symptoms and problems. It is advisable to consult your doctor. Do not rely solely on information you find on the internet or an equivalence of symptoms; it is important to consult. In this article we will not resume the advice of the first article, but we will dwell on the explanations of known causes.

There are 3 causes quite well described now and we will take the time to explain what characterizes them:

Central hypersensitivity: a chronic source of pain (different types of pain) that eventually causes a disturbance in the management of pain by the brain that then begins to interpret different stimuli (often perception) as pain.
Too much pressure in the cerebrospinal fluid.
A destruction of small peripheral fibers (peripheral neuropathy).
There are also what could be called aggravating factors, which are not necessarily causes, such as the imbalance of the gut microbiota. We will come back to it.

Central hypersensitivity
The principle is relatively simple: too many continual pains perceived by the brain end up causing an imbalance of sensations management. The brain is, in a way, no longer able to differentiate between what is really pain and what is not. He then interprets different types of stimuli, such as the proprioceptors (receptors that tell us about the position of the limbs) or the receivers to touch the skin. The brain is no longer able to distinguish between what is a banal sensation (eg the weight of your sweater on your shoulders) and a feeling of pain.

It is possible that some people have a deficit or overproduction of certain neurotransmitters that would facilitate the development of central hypersensitivity. Some factors may play an important role such as inflammation, diet and sleep. Quality sleep is essential for the recovery of healthy levels of different neurotransmitters in the brain each day. Sleep problems caused by pain can therefore contribute to the development or maintenance of central hypersensitivity (a vicious circle). A recent study (Kosek et al., 2018. Brain, Behavior, and Immunity, September 2018) has demonstrated an important role of brain inflammation that is directly correlated with the level of fatigue of people with fibromyalgia.

The pressure of the cerebrospinal fluid
Another recent study proposes this new hypothesis for some people with fibromyalgia or unexplained generalized pain (Hulens et al, 2018. Annals of Physical and Rehabilitation Medicine, July 2018). The cerebrospinal fluid is a clear liquid that bathes the brain and cerebellum. It has a structural role in maintaining the shape of the brain and protection against shocks by creating a form of damper between it and the skull. The study by Hulens et al. Demonstrated relief of a large number of fibromyalgia symptoms within a few hours, up to 8 weeks, by collecting cerebrospinal fluid to reduce the pressure. Too much fluid pressure would cause drainage through the nerve envelope of the base of the brain, which would irritate the envelope and cause widespread pain.

The destruction of small peripheral fibers
A recent meta-analysis (a study that includes several studies) has determined that a pathology of small peripheral fibers is present in approximately 50% of fibromyalgia cases (Grayston et al, 2018. Seminars in Arthritis and Rheumatism, August 2018). The small peripheral fibers are the ends of the nerve fibers that allow the detection of sensations (heat, touch, sight, etc.). The causes of their destruction or malfunction are not known. It could very well be for some people a consequence of the development of a central hypersensitivity or, for others, a cause.

Indeed, studies in animals have shown that the development of hypersensitivity to neurotransmitters by poor proportions can cause the decline of small peripheral nerve fibers. On the other hand, researchers have speculated that some cases of fibromyalgia could be caused by malfunctions of smallperipheral fibers. The small fibers could, among others, be attacked by the immune system. If a person’s immune system accidentally attacks their small peripheral fibers (autoimmune disease), it would result in a large amount of messages that are difficult to interpret by the brain that would cause the development of a central hypersensitivity. Aggravating factorsAll people affected Fibromyalgia seems to have a big deficit in antioxidants, but it’s not clear if it’s a cause or a consequence. The restoration of a normal level of systemic antioxidants (throughout the body) through diet (rich in fruits and vegetables) and / or the intake of quality supplements, would reduce the pain felt and improve sleep Some studies have also demonstrated the involvement of mitochondria (the energy factories of our cells). A malfunction of the mitochondria would be present in many cases of fibromyalgia. Here again, this points to a greater need for what can improve the functioning of energy plants, but it is not known whether they can be part of the cause or be a resultant example of chronic fatigue. may play a major role in the pain felt, but also in the development of the causes mentioned previously, all that influences the inflammation is to be considered. These include diet (which has a significant impact on gut microbiota), body weight, sleep quality, stress, and physical activity. Healthy living habits can therefore help a lot. Several possible causes = several possible solutions These explanations help to understand that according to the person with fibromyalgia, approaches to relieve pain and improve his condition may not have the same results. We must try and keep hope.


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