Fibromyalgia in many ways can be looked on as a puzzle. What you feel and what is actually happening in your body can be two very different things. You can feel like something is seriously wrong with a joint or muscle, yet tests may find nothing there to explain the level of pain. So I thought I would investigate what is going on in the body and why Fibromyalgia can make it react the way it does.
Does Fibromyalgia Damage Your Body?
A person with Fibromyalgia can feel like they have broken a leg or sprained an ankle. Yet when the pain is coming from Fibromyalgia itself, X-rays or scans may show no injury or inflammation to explain it.
Fibromyalgia does not cause tissue inflammation or damage to the muscles and joints in the way some other conditions do. That doesn't mean the pain isn't real. It means that the source of the pain is more complicated than something physically damaging the place where you feel it.
So from a musculoskeletal point of view, So from a musculoskeletal point of view, Fibromyalgia itself is not considered to damage your muscles or joints. Of course, having Fibromyalgia doesn't stop us from having an actual injury or developing another condition as well, so new or unusual pain shouldn't automatically be blamed on Fibro.
Fibromyalgia Changes How Your Body Processes Pain
A major part of how Fibromyalgia pain is currently understood involves nociplastic pain and central sensitisation. These are complex-sounding terms, but basically they mean that the nervous system changes the way it processes pain. The International Association for the Study of Pain describes nociplastic pain as pain that arises from altered pain processing when there is no clear evidence of tissue damage or a problem with the sensory nerves to explain it.
Rather than pain always being a straightforward warning that something has been damaged, the body's pain system can become over-sensitive. It is almost as though the volume has been turned up too high, so your brain interprets signals as more painful than you would normally expect.
This can mean feeling pain when there is no obvious injury to explain it. Fibro can also intensify pain, so something that is slightly uncomfortable for someone without the condition can be agonising for someone with it.
A perfect example of Fibro-intensified pain for me would be the smear test. Almost everyone without Fibromyalgia I hear talking about it describes it as either pain-free or slightly uncomfortable. This is very far from my experience. During my last one, I literally cried out in pain.
When Ordinary Sensations Become Too Much
As well as pain, other elements of the sensory system can be affected by Fibromyalgia. A gentle touch in the wrong place can feel as bad as a slap. A change of temperature by a few degrees can feel like you have just stepped into a freezer unit.
Loud music or noises can overwhelm you, bright light can become uncomfortable and a strong smell can make you feel like you can't breathe. Fibromyalgia is recognised as causing increased sensitivity to a range of sensations and environmental triggers.
The important thing is that the sensation itself may not be harmful, but your nervous system can react to it far more strongly than you would expect. It is another example of the body's sensory processing seemingly having its volume turned up too high.
What Fibromyalgia Does to Sleep and Energy
Fibromyalgia and sleep can enter into a vicious circle. Pain can keep you awake or repeatedly disturb your sleep, while poor-quality sleep can make Fibro pain feel worse. Even when you have slept for plenty of hours, Fibromyalgia can leave you waking up feeling as though your sleep has not refreshed you properly.
This is often referred to as non-restorative sleep. Instead of waking with your battery recharged, you can start the day already feeling tired.
Fatigue is also a symptom of Fibromyalgia in its own right, so poor sleep is not necessarily the whole reason we have so little energy. However, when fatigue, pain and disturbed sleep are all happening together, they can feed into one another and leave you feeling completely drained.
I describe this feeling as having a flat battery in my Fibromyalgia Symptoms post.
What Fibromyalgia Can Do to Your Brain
Concentration, memory and processing can all be impacted by Fibro. This collection of cognitive problems is commonly termed Fibro Fog. According to the NHS, Fibro Fog can make it harder to remember or learn new information, stay focused, and sometimes even affect how quickly or clearly you speak.
The significance of Fibro Fog can vary enormously. It can range from the very typical "what is the word for..." or "why did I come into this room?" to moments when you struggle to remember information you would normally know without thinking, such as your own address.
It isn't always about forgetting something either. Sometimes the information is there but it feels as though your brain is taking much longer to find or process it. Following a conversation, taking in new information or trying to concentrate when several things are happening at once can suddenly become much harder.
Researchers still don't completely understand why Fibromyalgia affects our thinking in this way. Pain, fatigue and poor sleep may all contribute, which is another example of how the different effects of Fibro can become connected rather than existing as completely separate symptoms.
Why Do My Muscles and Joints Hurt If They Aren't Damaged?
One of the confusing things about Fibromyalgia is that pain can feel as though it is coming directly from a muscle or joint. Naturally, if your ankle suddenly feels like you have sprained it, you assume there must be something wrong with your ankle.
With Fibromyalgia, where you feel the pain does not necessarily mean that there is damaged or inflamed tissue in that spot. The National Institute of Arthritis and Musculoskeletal and Skin Diseases explains that people with Fibromyalgia have an increased sensitivity to pain. The way the nervous system processes and amplifies pain can therefore make a perfectly real pain feel as though something has happened to the part of the body that hurts.
As discussed in Fibromyalgia Symptoms, you can be walking steadily across a room and suddenly it feels like you have sprained your ankle. Nothing happened. You didn't go over on it and there may be no injury there at all, but the pain you feel is still very real.
I think this difference between where you feel pain and what is causing that pain is one of the hardest things about Fibromyalgia to get your head around.
Is Fibromyalgia Only About the Central Nervous System?
Scientists have been researching Fibromyalgia for some time, and new information is continuing to come to light, but they still don't understand everything that is happening in the body.
For many years, much of the focus has been on the central nervous system and the way the brain and spinal cord process pain. However, current research suggests that the picture may be much more complicated. Researchers are also looking at the peripheral nervous system, the autonomic nervous system and the immune system.
One particularly interesting area of research involves autoantibodies. Studies have found evidence that antibodies may play a part in Fibromyalgia in at least some people, although there is still a great deal to learn before we can say exactly what this means.
So, tentatively, the answer to whether Fibromyalgia is only about the central nervous system seems to be no. What we don't yet have is one complete explanation that tells us exactly how all these different pieces fit together.
Why Fibromyalgia Can Feel Like a Whole-Body Condition
When we consider everything that can be involved with Fibro, including pain, unusual sensitivity, problematic sleep, exhaustion and Fibro Fog, it is easy to understand why it can feel like your whole body is under attack.
Then there are the other conditions that commonly sit alongside Fibromyalgia, such as Irritable Bowel Syndrome. These are separate conditions rather than Fibromyalgia simply spreading into another part of the body, but when you are living with several of them at once that distinction may not feel very important on a bad day.
The different effects of Fibromyalgia can also overlap and feed into one another. Pain can disturb sleep, poor sleep can leave you more exhausted and sensitive to pain, and fatigue can make concentrating even harder. If something isn't causing a problem today, there is a good chance something different may well do on another day.
That combination is why Fibromyalgia can feel like so much more than a condition that simply causes widespread pain.
Understanding Your Fibromyalgia Body
Understanding what is happening in your body doesn't remove any of the symptoms, but it can help some of the more confusing parts of Fibromyalgia make a little more sense.
Knowing that the pain can be very real without Fibromyalgia itself damaging your muscles and joints can also be reassuring. A painful area may feel as though something is seriously wrong, even when the problem lies more in how your nervous system is processing that pain.
Of course, that doesn't make the pain any easier to live with. But understanding more about why your body reacts the way it does can make Fibromyalgia feel slightly less confusing.
If you would like a wider overview of the condition, I suggest checking out my post What Is Fibromyalgia?.