Inflammation in Fibromyalgia

What is Its Role?

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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." The medical community came to use fibromyalgia ("fibrous-tissue and muscle pain") instead, believing it was more accurate due to an apparent lack of inflammation.

However, we now have a growing body of work suggesting inflammation 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. 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 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.

A 2010 study 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 stimuli, including pain and other sensory input 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 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 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 study out of Spain, from 2010, showed elevated levels of mast cells—which release inflammatory chemicals in response to various triggers—in the skin of people with fibromyalgia.

Also in 2012 and 2013, multiple studies revealed several markers of inflammation in fibromyalgia, including high levels of C-reactive protein and pro-inflammatory cytokines.

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?

The 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. Learn more in Manual Therapy for Fibromyalgia and Choosing a Manual Therapist.

A 2012 study published in Scandinavia suggests that aquatic exercise may improve the cytokine balance in fibromyalgia, and therefore lower inflammation levels and pain.

Learn more about Exercising with Fibromyalgia.

Some people have good luck with supplements believed to lower inflammation. Anti-inflammatory supplements include:

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.


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 Apr 6. [Epub ahead of print] Can Coenzyme Q10 incprove clinical and molecular parameters in fibromyalgia?

Cordero MD, et al. Antioxidants & redox signaling. 2013 Mar 1;18(7):800-7. Is inflammation a mitochondrial dysfunction-dependent event in fibromyalgia?

Kadetoff D, et al. Journal of neuroimmunology. 2012 Jan 18;242(1-2):33-8. Evidence of central inflammation in fibromyalgia—increased cerebrospinal fluid interleukin-8 levels.

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.

Ortega E, et al. Scandinavian journal of medicine & science in sports. 2012 Feb;22(1):104-12. Aquatic exercise improves the monocyte pro- and anti-inflammatory cytokine production balance in fibromyalgia patients.

Xiao Y, et al. Rheumatology international. 2013 May;33(5):1259-64. Elevated serum high-sensitivity Creactive protein levels in fibromyalgia syndrome patients correlate with body mass index, interleukin-6, interleukin-8, erythrocyte sedimentation rate.

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