Is Fibromyalgia All in My Head?

A Common Question

Question:

Is Fibromyalgia All in My Head?

My husband thinks I'm a hypochondriac, my friends tell me I'd feel better if I had a more positive attitude, and my doctor keeps talking about depression. Some days, I'm confident that I really am physically ill and it's not a mental thing. Other days, though, my symptoms just don't make any sense and I start to question myself. Is fibromyalgia all in my head?

Answer:

The short answer to your question is, "No, it's not all in your head." Now for the longer answer.

It's true that some doctors still believe that fibromyalgia is a form of depression or may mistake its symptoms for those of depression. Granted, the symptom profiles are similar, but studies have confirmed that the fibromyalgia diagnostic criteria can differentiate between the two conditions. Additionally, while some people do have both fibromyalgia and depression, not everyone with fibromyalgia fits the diagnostic criteria for depression.

The many symptoms of this illness and the way they can come and go make it difficult for people to accept that they are real. People expect someone who's sick to do one of two things:

  1. Be sick for a while and then get better, or
  2. Be consistently sick all the time.

When they see you functional one day and incapacitated the next, it's hard for them to understand -- and therefore believe -- that you're legitimately ill.

However, fibromyalgia is not the only condition that relapses and remits. No one questions whether multiple sclerosis (MS) is real, and yet people with MS can have extreme symptoms that come and go, often without a warning or an obvious cause.

A growing body of research shows that fibromyalgia involves multiple abnormalities in the brain, including:

Yes, those dysfunctions are literally in your head, but not in the way people mean when they use that phrase.

Research has shown abnormalities in other areas of the body as well. Hormonal irregularities, immune-system dysfunction, digestive problems, nutritional imbalances, blood-flow dysregulation, and cellular dysfunction are all hypothesized to play roles in fibromyalgia.

The role of stress is often singled out by people who want to label this condition as psychological. It's important to note that the body's stress response is physiological, through a complex set of interactions between two regions of the brain (the hypothalamus and pituitary) and the adrenal glands that sit on top of the kidneys. This is called the HPA axis, and evidence suggests that it doesn't function properly in people with fibromyalgia.

The idea that fibromyalgia is "all in your head" is outdated. While we don't yet fully understand this condition, it's clear that multiple physiological factors are involved in creating the symptoms. It's confusing and hard to understand, but it's not something you're imagining or inflicting upon yourself, and it's not due to psychological problems.

Sources:

Guedj E, et al. Journal of nuclear medicine. 2008 Nov;49(11):1798-803. Clinical correlate of brain SPECT perfusion abnormalities in fibromyalgia.

Hapidou EG, Rollman GB. Pain. 1998 Aug;77(2):151-61. Menstrual cycle modulation of tender points.

Jensen KB, et al. Molecular pain. 2012 Apr 26;8(1):32. Patients with fibromyalgia display less functional connectivity in the brain's pain inhibitory network.

Napadow V, et al. Arthritis and rheumatism. 2010 Aug;62(8):2545-55. Intrinsic brain connectivity in fibromyalgia is associated with chronic pain intensity.

Okifuji A, Turk DC, Sherman JJ. The journal of rheumatology. 2000 Jan;27(1):212-9. Evaluation of the relationship between depression and fibromyalgia syndrome: why aren't all patients depressed?

Ostensen M, et. al. Scandinavian journal of rheumatology. 1997;26(5):355-60. The effect of reproductive events and alterations of sex hormone levels on the symptoms of fibromyalgia.

Wolfe F, et al. Arthritis Care & Research. 2010 May;62(5):600-10. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity.

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