By: By Adrienne Dellwo | Reviewed by Grant Hughes, MD
Inflammation is one of the most common causes of pain, but is it linked to the pain of fibromyalgia?
The role of inflammation in this condition has been the topic of research and debate for decades. In fact, the condition used to be called “fibrositis,” which means “fibrous-tissue inflammation.” Over time, however, an apparent lack of inflammation led the medical community to see fibromyalgia (“fibrous-tissue and muscle pain”) as a more accurate term.
A few decades later, though, we’re taking a second look at inflammation in this condition, thanks to a growing body of work suggesting it may play a role, after all. This line of inquiry could lead to a better understanding of the illness as well as expanded treatment options.
Why the Confusion?
Doctors came to believe fibromyalgia was not an inflammatory disease because it doesn’t present like most inflammatory disease. Joints don’t appear swollen or hot. Typical tests for inflammatory markers, which reveal high levels in diseases such as lupus and arthritis, generally reveal normal or only slightly elevated levels in fibromyalgia. In 2012, researchers studying inflammatory myopathies (pain conditions) labeled fibromyalgia a “false inflammatory myopathy.”
Additionally, anti-inflammatory drugs—both corticosteroids and non-steroidal anti-inflammatories (NSAIDs)—are frequently ineffective at alleviating fibromyalgia pain.
So where does the case for inflammation come in?
The Case for Inflammation
In recent years, researchers have learned a lot about inflammation’s possible role in this condition.
In the spring of 2017, the Journal of Pain Research published a study that looked at 92 different proteins that are known to be related to inflammation.
Researchers say it’s the “most extensive…inflammatory profiling study of FM patients to date.” They reported extensive evidence of inflammation. Not only that, but evidence shows inflammation in the central nervous system (brain and nerves of the spinal cord) as well as systemic.
This work confirmed earlier studies suggesting that certain molecules from the immune system, called cytokines, are high in people with fibromyalgia. That supports the hypothesis that this condition involves immune dysregulation.
The central nervous system has its own immune system, separate from the rest of the body, and the study showed high levels of immune molecules called chemokines, as well.
A 2010 study by Genevra Liptan, MD, suggests that it could be the fascia—a thin layer of connective tissue that surrounds most internal structures—that’s inflamed in fibromyalgia. The researcher concludes that fascial dysfunction and inflammation may be what leads to central sensitization, which is believed to be a core feature of the illness.
Central sensitization occurs when the central nervous system becomes hyper-stimulated and over-reacts to input, including pain and other things detected by your senses, such as light, noise, and odors.
It’s believed to be at least partially caused by constant pain signals bombarding the brain and spinal cord.
A 2012 study in Neuroimmunomodulation investigated the role of a possible systemic inflammatory and stress response in fibromyalgia. Researchers found that there was an inflammatory state that seemed to be tied to an abnormal response to stress. They were unable to determine whether inflammation led to stress dysfunction or vice versa.
In 2013, Spanish researchers led by M.D. Cordero published an hypothesis that inflammation in fibromyalgia could be the result of dysfunction in the mitochondria (parts of your cells that break down nutrients to create energy.) Another 2010 study out of Spain, published in Clinical Rheumatology, showed elevated levels of mast cells—which release inflammatory chemicals in response to various triggers—in the skin of people with fibromyalgia.
Treating Inflammation in Fibromyalgia
Since the primary treatments for inflammation—steroids and NSAIDs—are already shown to be ineffective against fibromyalgia pain, what options do we have for lowering our inflammation and, hopefully as a result, our pain?
A 2017 study suggested that a drug called low-dose naltrexone (LDN) may help lower certain inflammatory markers, which appears to help alleviate pain and other symptoms.
Liptan’s 2010 study on fascial inflammation suggests that manual therapies targeting the fascia may be effective. That includes myofascial release (a type of massage) and a deep-tissue manipulation called Rolfing. However, so far, research on these treatments is limited. Also, depending on symptoms, some people with this condition may not be able to tolerate certain types of massage.
A 2012 study published in Scandinavia suggests that aquatic exercise may improve the cytokine balance in fibromyalgia, and therefore lower inflammation levels and pain. (Before you start any type of exercise, it’s important to learn about the proper way to exercise with fibromyalgia.)
Some people with fibromyalgia say they have good luck with supplements believed to lower inflammation. Anti-inflammatory supplements include:
omega-3 Fatty Acids
We don’t yet have research on an anti-inflammatory diet for fibromyalgia, but many doctors recommend it for inflammatory conditions. Because not everyone’s inflammatory triggers are the same, people often start with a strictly limited diet, then add back in one type of food at a time to determine which foods are problematic.
A Word from Verywell
As we learn more about the role of inflammation in fibromyalgia, we’re likely to uncover new targets for drugs and other treatments, and that could lead to better treatment options down the road.
We don’t know how large the role of inflammation is yet, or whether it’s a cause or result of the condition. These are more questions that may be answered as these lines of research continue to be investigated.
Backryd E, Tanum L, Lind AL, Larsson A, Gordh T. Journal of pain research.
2017 Mar 3;10:515-525. doi: 10.2147/JPR.S128508. Evidence of both systemic inflammation and neuroinflammation in fibromyalgia patients, as assessed by a multiplex protein panel applied to the cerebrospinal fluid and to plasma.
Blanco I, et al. Clinical rheumatology. 2010 Dec;29(12):1403-12. Abnormal overexpression of mastocytes in skin biopsies of fibromyalgia patients.
Bote ME, et al. Neuroimmunomodulation. 2012;19(6):343-51. Inflammatory/stress feedback dysregulation in women with fibromyalgia.
Cordero MD, et al. Antioxidants & redox signaling. 2013 Mar 1;18(7):800-7. Is inflammation a mitochondrial dysfunction-dependent event in fibromyalgia?
Liptan, GL. Journal of bodywork and movement therapies. 2010 Jan;14(1):3-12. Fascia: A missing link in our understanding of the pathology of fibromyalgia.