Fibromyalgia Causes

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The Universal Guide to Fibromyalgia Causes: Everything you ever wanted to know, straight from the experts.

In This Article: What Is Fibromyalgia?   |    Causes   |    Comorbidities  |    Additional Risk Factors   |    Flare Triggers   |    Lowering Your Risk   |    FAQs   |    Sources


If you live with fibromyalgia – a.k.a. “fibro” – then you know it can be unpredictable, even perplexing sometimes. Sure, fibro has a simple definition: a chronic illness that causes widespread muscle pain and tenderness. But that probably doesn’t come close to describing your experience with this condition.

Pummeling exhaustion? Check. Cloudy thinking? Likely. Pain when your waistband touches your skin? Possibly. Zaps in your brain? It happens. And you can feel awful one day and so much better the next, for no apparent reason. 

Woman against a blurred background, using modern DNA structure 3D rendering.Genetics may play a role since fibromyalgia seems to run in families. Photo Source:

Experts aren’t exactly sure why fibromyalgia develops, so you can’t prevent or cure it. You just have to manage the roller coaster of symptoms. The good news is that providers are rapidly learning more about the disease—including treatments that work. Here’s what we know so far about fibro and its causes.

What Is Fibromyalgia?

About 4 million American adults have fibromyalgia, according to the Centers for Disease Control and Prevention. Although it’s not a form of arthritis, fibro is considered a rheumatological condition. In fact, it’s the second most common one, after osteoarthritis.

If you have (or think you have) fibromyalgia, you’ll be treated by a primary care physician, likely a rheumatologist, probably a physical therapist and possibly a physiatrist or pain management specialist. You may also benefit from a psychologist or a psychiatrist, since this disease is tricky to diagnose, treat, and live with. This might feel like a lot of doctors, at least at first. But there’s a reason for having a team.

“Unlike some medical conditions that have a specific biomedical cause that is easily detectable with testing or imaging, fibromyalgia is more complex in its cause, presentation, and treatment,” explains psychologist Alison Vargovich, PhD, an assistant professor in the Department of Medicine, Division of Behavioral Medicine at the University at Buffalo in New York.


Widespread musculoskeletal pain (with no clear cause) is the hallmark feature of fibromyalgia. Most people with fibro also experience other symptoms that affect both body and mind, including fatigue, sleep troubles, concentration problems, and mental health issues.

Pain. People with fibromyalgia seem to feel pain differently than other people. They may be in perpetual pain or have an outsized response to painful things. They may also react to sensations that don’t usually trigger pain, like temperature changes or bright light.

Fibro pain and discomfort can strike anywhere, but these are some common hot spots:

  • Back
  • Neck
  • Base of the skull
  • Shoulders
  • Elbows
  • Hips
  • Buttocks
  • Knees

Fatigue. Most people who have fibro also experience fatigue. This isn’t run-of-the-mill tiredness, necessarily. When you have fibromyalgia-related fatigue, you may feel exhausted even when you get plenty of sleep.

Cognitive issues. Everyone can remember a time when it was hard to concentrate. (Just think back to all those high school classes you didn’t like.) But when you have fibro, it can be a constant problem. So-called “fibro fog” makes it hard to focus on mental tasks as simple as unloading the dishwasher.

What Causes Fibromyalgia?

Fibromyalgia is not fully understood, even by scientists. It’s not considered an autoimmune disease, since it doesn’t cause your immune system to target your own healthy cells. There is no permanent damage done to muscle or joints, either, and it’s not life-threatening.

Many experts describe fibromyalgia as a chronic pain condition, or a disorder that causes constant pain for a long time. They think it’s most likely set off by a combination of environmental, biological and psychological factors.

Central Sensitization

Doctors believe the central nervous system (CNS)—your brain and spinal cord—plays a key role in fibro. They suspect that when you have the condition, your CNS amplifies your perception of pain. This is called central sensitization.

“When there is chronic pain of any type, the nerves become sensitized because they don’t have a chance to relax and heal,” says Perry Herman, MD, FPMR, a physiatrist in Plainsboro, NJ. “That can occur at the peripheral nerves [the nerves outside your CNS], or it can occur at the central nervous system.”

Traumatic Triggers

Sometimes fibromyalgia develops after a physical trauma. Research suggests that common triggering events may be an injury or infection, medical experiences like giving birth or an operation, or accidents,” explains Dr. Vargovich.

Studies show that long-term psychological stressors can trigger fibromyalgia, too. These include:

  • Post-traumatic stress disorder
  • A history of childhood abuse or neglect
  • Toxic personal relationships
  • Prolonged job anxiety

Causes of fibromyalgia traumaPhysical and psychological trauma may cause fibromyalgia, suggests some evidence.

While many people can point to a particular trigger, it’s not the case for everyone. “Fibromyalgia may not be ‘triggered’ by any specific event and can develop gradually due to other factors,” says Dr. Vargovich. “If a triggering event is involved, it is only one part of a complex cause.”

Biological factors

 Genetic influences, gender and more may all play a role – separately or collectively – in your risk of fibromyalgia. These include

  • Gender. The vast majority of people diagnosed with fibromyalgia are women, though some research suggests the condition may be underdiagnosed in men.
  • Age. Though you can develop fibro at any age, most people are diagnosed after age 20 and before turning 50.
  • Family history. Fibromyalgia can run in the family. That means if you have a parent, brother or sister with the disorder, you’re more likely to develop it yourself.
  • Genes. Some genes or genetic mutations may increase your risk for fibromyalgia and related health problems.

What Conditions Occur with (or Are Sometimes Confused for) Fibromyalgia?

Conditions Occurring with FibromyalgiaThe conditions occurring with and often confused with fibromyalgia.

Often, people with fibromyalgia have a long chronic pain history or other health problems that are associated with pain. Experts aren’t sure why this happens. But it’s possible that these conditions sensitize you to pain, contributing to the eventual development of fibro.

You are more likely to have fibro if you are diagnosed with one of the following.

  • Rheumatoid arthritis (RA) is an autoimmune disease. It causes pain, inflammation and tenderness in joints—especially in your hands, wrists and feet, but also in the facet joints in your back. Without treatment, RA can permanently damage your joints and cause serious problems with your eyes, lungs, and more. About 21% of people with RA also had fibro in a 2018 review and meta-analysis in the journal Rheumatology.
  • Osteoarthritis (known as spondylosis when it’s joints of the spine) affects more than 30 million American adults according to the CDC, making it the most common form of arthritis in the U.S. It’s frequently caused by joint damage or wear and tear.
  • Ankylosing spondylitis is an inflammatory form of arthritis chiefly affecting the spine. Pain and stiffness in the lower back, hips and buttocks are especially common.
  • Lupus frequently causes pain, stiffness and swelling in joints and muscles throughout the body—including the back—as well as fatigue. Like RA, lupus is an autoimmune disease. It can sometimes be distinguished from fibromyalgia by a butterfly-shaped facial rash.

Several other conditions are linked to fibro, as well. These include:

  • Temporomandibular joint disorder (pain around and difficulty moving the jaw)
  • Chronic fatigue syndrome
  • Endometriosis
  • Migraines and other headaches
  • Irritable bowel syndrome
  • Painful bladder syndrome
  • Depression and anxiety

Sometimes, some of these disorders can be mistaken for fibromyalgia, and vice versa. Your doctor will check you for them as part of the diagnosis process.

Are There Any Additional Fibromyalgia Risk Factors?

Other factors may worsen symptoms of fibromyalgia. Researchers are exploring whether some of these could even raise the risk of developing the condition.

  • Obesity. Being obese has been linked to increased odds of fibro in some research. For example, obese participants had a 60%-70% higher chance of developing fibro compared to normal-weight participants in one 2010 Arthritis Care & Research study.

    Obesity has also been associated with more severe symptoms, including worse pain and poorer sleep. A sedentary lifestyle, in which you get little regular physical activity, also factors into risk.
  • Poor sleep. Fibromyalgia and sleep are part of a vicious cycle; poor sleep may be a risk factor for fibro, and fibro may lead to poor sleep. Sleep apnea, in which your breathing is interrupted while you sleep, is very common for people with the condition.

Like obesity, disrupted sleep is also strongly associated with more intense fibro symptoms, such as fatigue and pain. Why? “Patients are unable to get down into that restorative sleep where they heal and cell rejuvenation occurs,” says Dr. Herman.

  • Repetitive injuries. When you place stress on certain parts of your body over and over again—such as your knee or your back—it may raise your odds of developing fibro.

What Can Trigger Fibromyalgia Flares?

Like a lot of other chronic pain conditions, fibromyalgia can have peaks and valleys. Some days, symptoms will be manageable, and you might feel pretty good, all considering. Other days? It’s just the opposite—the pain will be worse, and even small, seemingly harmless stuff can set it off.

Fibromyalgia flare causesHere's what can trigger fibromyalgia flare-ups

These periods of increased symptoms are called flare-ups, and they can last for days or even weeks. Flares may occur out of nowhere, or they may have a specific trigger. Some common triggers include:

  • Increased physical or mental stress levels
  • Changes in diet, exercise or sleep
  • Hormone shifts (especially during your period or while you’re pregnant)
  • Altered schedules or more traveling
  • Specific kinds of weather, or changes in weather
  • Treatment adjustments for your fibro

Once you are diagnosed with fibromyalgia, you can work with your healthcare provider on identifying triggers and frequently, heading them off at the pass.

Can You Lower Your Risk of Fibromyalgia?

Since scientists don’t know exactly what causes fibromyalgia, there’s no surefire way to prevent the disorder. You may be able to lower your risk, however, by adopting healthy habits.

“What may be best is to maintain a healthy lifestyle through diet, exercise, and proper sleep, and to address any concerns related to depression or anxiety with the help of healthcare professionals,” explains Dr. Vargovich.

In the meantime, scientists are continuously learning more about the causes of and risk factors for fibro. And the more they understand, the better your odds of a pain-free future.


Diagnosing fibromyalgia can be difficult and often takes years. “[There’s] no single blood or other tests that clearly makes the diagnosis,” says Jacob Teitelbaum, MD, author of Real Cause, Real Cure and The Fatigue and Fibromyalgia Solution.

Instead, it depends on a physical exam, medical history and blood tests. Physicians must also rule out other possible illnesses, as well, such as rheumatoid arthritis and lupus (which, by the way, also frequently cause back pain).

To be diagnosed with fibro, the following has to happen:

  • Your doctor must gauge your pain during the previous week, including its location and intensity. Other symptoms including fatigue, waking up tired, and fibro fog are taken into account, too.
  • The symptoms have to be present three months or longer.
  • There can be no other medical explanation for what’s happening.

Once these factors are considered, your physician can narrow down the cause of your symptoms—and whether it’s likely to be fibromyalgia. Then, you can discuss treatment options and how to handle your condition moving forward.

Ultimately, there’s still a lot to learn about what exactly causes fibromyalgia. But working towards a better understanding of its roots helps us to better grasp the disease itself, making it easier to diagnose, treat and manage from day to day.


What causes fibromyalgia flare ups?

Fibro flares can happen with no real warning or triggering event, or they can be set off by something specific. Triggers differ from person to person, but common ones include changes in stress levels, diet, exercise, sleep, schedules, hormones and fibro treatments themselves. Some people are even triggered by the weather.

Why is fibromyalgia more common in women?

Women are diagnosed with fibro much more often than men, and scientists aren’t exactly sure why. It could be that women pain experience differently, and that hormones play a role. Culture could factor in, too. Some research suggests that fibro is underdiagnosed in men, possibly because men are socialized to keep their pain quiet, or because they don’t want to be thought of as having a “women’s disease.”

What are fibromyalgia tender points?

Tender points are penny-sized areas located near certain joints that can be especially painful when pressed. Scientists aren’t quite sure what causes them.

Who is at risk for fibromyalgia?

Women, people with particular gene mutations, and people with a family history of fibromyalgia are at higher risk. Those between the ages of 20 an 50 also have an increased chance, as well, as do people who have certain other conditions, such as rheumatoid arthritis and lupus. Some factors, like obesity, poor sleep, and repetitive injuries are thought to play a role in risk, too.

Updated on: 03/30/21
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Fibromyalgia Symptoms
Perry Herman, MD
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