Unclear etiology and current hypotheses of the pathogenesis of fibromyalgia

Abstract

Introduction and purpose: Fibromyalgia is a chronic condition affecting almost 2% of the general population, mostly women. The main symptoms are chronic diffuse musculoskeletal pain or stiffness, tiredness,  nonrestorative sleep, anxiety, depression and cognitive dysfunction. The etiology of fibromyalgia remains unclear and has been the subject of debate and scientific investigation. The aim of this article was to collect and analyse current and new information on the etiology of fibromyalgia and present the most popular hypotheses.

Brief description of the state of knowledge: Pathogenesis of fibromyalgia is multifactorial. Genetic factors, in addition to environmental factors, such as psychical stress and various types of infection, are considered to be the triggers of the disease. Central sensitization became a commonly accepted hypothesis of the fibromyalgia’s pathogenesis. However, the newest finding of small fiber neuropathy in patients with fibromyalgia supports another hypothesis, in which the disease is presented as stress-related dysautonomia with neuropathic pain features.

Conclusions: Understanding the pathogenesis of fibromyalgia is essential to provide the best care to the patients with fibromyalgia. Although there are multiple evidence for central sensitization hypothesis, new findings continue to emerge and question commonly accepted paradigm. Despite numerous findings on etiology of fibromyalgia, more studies are needed.