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In the past, many health care professionals believed that the origin of the primary symptoms of fibromyalgia (e.g., widespread musculoskeletal pain; persistent fatigue; generalized stiffness; sleep disturbances) was psychological rather than physiological because currently there are no available objective medical tests to establish the diagnosis. In the past, it was not unusual for patients with fibromyalgia symptoms to be told by their health care provider that "it's all in your head". Research conducted in recent years, however, strongly suggests that specific physiological events or abnormalities may, to a great extent, account for the primary symptoms experienced by people with fibromyalgia, including:

• Widespread musculoskeletal pain
• Sleep abnormalities
• Chemical and hormonal abnormalities
• Autonomic nervous system disturbances

Widespread Musculoskeletal Pain

The physiological events that may account for the widespread musculoskeletal pain experienced by people with fibromyalgia include:

• Tightening of the myofascia - The myofasia is the thin fibrous connective tissue that surrounds muscle tissue and holds muscles together. Tightening of the myofascia produces myofascial pain by constricting the blood vessels and nerves that run through the muscle.

• Researchers have found abnormally high levels of a neurotransmitter (chemical messenger) called substance P in the cerebrospinal fluid of people with fibromyalgia. Substance P is associated with increased pain perception and is thought by some experts to play an important role in the abnormal pain response that is a hallmark feature of fibromyalgia.

Sleep Abnormalities

Most people with fibromyalgia (75% to 90%) experience chronic sleep disturbances and, therefore, do not get a refreshing nights sleep. The chronic sleep disturbances experienced by people with fibromyalgia is also a major contributing factor to the chronic pain and persistent fatigue characteristic of the syndrome. Physiological abnormalities that may account for sleep disburbances in people with fibromyalgia include:

• Researchers have identified an abnormal sleep brain wave pattern in people with fibromyalgia called the alpha-delta sleep anomaly ,whereby the normal "delta waves" that are associated with deep, refreshing sleep are interrupted by "alpha waves" that interfere with deep sleep.

• Studies have also shown that a disorder called _periodic limb movement of sleep (PLMS), a condition in which the leg muscles contract 2 to 4 times every minute during sleep, occurs more frequently in people with fibromyalgia than in the general population.

Chemical and Hormonal Abnormalities

Research has shown that fibromyalgia can be associated with various chemical and hormonal abnormalities that include:

• Low levels of serotonin - Serotonin is a neurotransmitter (chemical messenger) that regulates a variety of important physiological events including feelings of well being (e.g., depression), sleep, and pain. Lower than normal levels of serotonin have been found in people with fibromyalgia that may account for some of the major symptoms of the syndrome. In fact, drugs known as selective serotonin reuptake inhibitors (SSRIs), that boost the levels of serotonin, are a mainstay of drug therapy for fibromyalgia.

• Lower than normal levels of other chemicals and hormones that regulate important physiological processes that have been identified in some people with fibromyalgia include:

  • dopamine
  • cortisol
  • epinephrine and norepinephrine
  • growth hormone