What Caused My Fibromyalgia?

It goes without saying that everyone’s fibromyalgia is different: different locations and fluctuations in pain, and differences in symptoms like fatigue, brain fog, anxiety and depression. The things that led to your fibromyalgia are also different to the things that led to someone else’s fibromyalgia. Despite these differences, we now have a very sensible theory that can help make sense of fibromyalgia and guide appropriate therapy. The theory is relatively simple but does take a bit of explaining.

First, I must explain the concepts of homeostasis and allostasis.

Stop and think: What’s all the stress about?

Did you know that more than half of people with FM have a history of physical and/or psychological trauma, with many even meeting the diagnostic criteria for post-traumatic stress disorder^1,2,3? While not everyone has this history, it does give us some clues that stressful events or prolonged stress, may trigger changes in the body that, eventually, may result in FM symptoms in some people. And it is facts like this that led to the theory I’m about to explain.

What is homeostasis & allostasis?

When all our body systems are running within a normal range—our body temperature is between 36.5 and 37, our various hormone levels are normal, and there is balance in the neurotransmitter chemicals in our nervous system—we are said to be in ‘homeostasis’ (homeostasis=literally our biology is at home-staying’!).

However, any physically or psychologically stressful event, such as; a sickness, injury, or death in the family will result in a shift in many of these systems outside of their normal range. And when this happens, we are no longer in homeostasis. Instead, we are said to be in allostasis.

Once in allostasis, the body works to restore the balance we call homeostasis. Usually, a certain amount of stress is good for us because humans are ‘anti-fragile’ which means we actually get stronger in response to stress in the right dose. However, not everyone returns quickly and perfectly back to homeostasis after a stressful event….and with an accumulation of stressful events (even over many decades) we can reach a state of ‘allostatic overload’.  

What is allostatic overload & what does it have to do with fibromyalgia?

Frequently we talk about the pain of fibromyalgia as largely relating to changes in the body (e.g., low grade inflammation) and changes in the nervous system (e.g., central sensitization). These changes amplify signals from the body—contributing to the likelihood of having pain even though there are no injuries in the body. Talking about inflammation and central sensitization explain WHY there is pain in the absence of injury, but we also need to explain HOW it is persistent inflammation and central sensitization come about in the first place. And this is where the idea of allostatic overload comes in.

Allostatic overload is the body's response to accumulated stress.

Let’s look at how stressful events affect the body and nervous system, to understand what this has to do with fibromyalgia.

All stressful events (that move us out of homeostasis and into a state of allostasis) involve changes in our bodies chemistry such as: the release of stress hormones like cortisol, activation of the autonomic nervous system, an increase in inflammation in the body, and changes in neurotransmitters in the nervous system.

This creates a situation where:

1. Inflammation increases sensitivity of nerves in the body and therefore signaling to the central nervous system AND

2. An amplification of those signals within the nervous system itself. If one or both of these systems fails to return to baseline (homeostasis) then allostatic overload has taken effect.

In short: Psychological and physical stressors can change our body systems in ways that promote pain. If these systems don’t return to baseline then pain may arise and persist.

‍Stop and think: Do you relate?

Can you relate the beginning of your fibromyalgia, or that of a friend, to a history of one or more stressful events? Physical, psychological or sexual trauma? A flu virus or other illness? A car accident? A legal proceeding? A divorce? A period of sleep deprivation? A work-place bullying incident? A death in the family? A drug reaction? Financial stress?

The event(s) could be recent, or could date back as far as childhood. How many of these things did you relate to? Can you think of other types of stressful events not mentioned here?

Can I reduce my allostatic load, & will it help me?

Yes, and yes.

In general, you need to create the conditions that will best support your body's physiological systems to return towards baseline. The most sensible approach to do this is to work through a program with a therapist to identify and address contributors to allostatic load. This might include identifying and addressing stressors, and improving your psychological and physical resilience. You may also need to address sleeping issues, diet and weight, insufficient movement, and generally learn to look after yourself in a new way to further help you move back out of allostasis and toward homeostasis.

Here I wanted to focus on the concepts of homeostasis and allostasis and their link with fibromyalgia. The analogy below may help explain further.

Still confused? The ‘Home Heating’ analogy might help

Consider a home air-conditioner. In such a system, a thermostat senses differences between the set temperature, and the actual room temperature. A detection of a difference triggers various systems within the air-conditioner to work harder to correct the temperature. Here, a change in temperature represents some kind of physical or psychological stress or ‘allostatic load’.

In this analogy, allostatic load would increase if a window was left open, if the weather was extreme, or if the air-conditioner was trying to cool at the same time as someone left the gas heater on.

The air-conditioner might be frequently or even continuously activated—contributing to stress on the air-conditioner’s parts and systems.

Of course, no analogy is perfect, and while an air-conditioner might then break down over time with ‘wear and tear’, continuous stress on our body systems might have other consequences. That is, unlike a device, our body systems might adapt in ways that result in their over-activity (e.g., overactivity in systems related to pain and anxiety) while other systems might be suppressed (e.g., underactivity in systems related to energy, digestions, sleep)

Stop and think: Can I assess my allostatic load and do I need to?

Scientists have come up with various ways to try and measure allostatic load. This involves a number of different laboratory studies screening for changes in biological markers (hormones etc). For example, the “Allostatic Load Index” involves measuring 10 different things to come up with a total score.

These biomarkers are divided in to four ‘primary mediators’: dehydroepiandrosterone-sulfate (DHEA-S), epinephrine, norepinephrine, cortisol; and six ‘secondary outcomes’, systolic-blood pressure (SBP), diastolic-blood pressure, cholesterol, high-density-lipoprotein (HDL), glycosylated haemoglobin (HbA1c), and waist-hip ratio (WHR).

In the real world however, this may have limited practical application. A more important approach would be to identify factors that are in the past or present that might be contributing to allostatic overload and simply get to work on overcoming them.