What is known about the causes of fibromyalgia?

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Experts currently believe that fibromyalgia is caused by a combination of different factors, including abnormal pain-processing in the brain.

But it isn’t easy to do research on the causes and risk factors of fibromyalgia. One reason for this is that a lot of people who have fibromyalgia also have medical conditions such as rheumatoid arthritis, other pain syndromes or mental health problems. So it isn’t clear whether their symptoms are being caused by fibromyalgia or something else. What’s more, a lot of the research results in this area aren’t fully reliable. This is because, for instance, the studies didn’t have enough people in them, or they didn’t have comparison groups or didn’t follow the participants for long enough.

Abnormal pain messages

One thing that is believed to cause fibromyalgia is a problem with the processing of electrical signals in the brain. Even weak signals are then felt as pain. This theory is supported by the fact that people who have fibromyalgia often also have other medical conditions that affect pain processing in the central nervous system, such as migraines, (IBS) and certain conditions affecting the jaw muscles and joints (craniomandibular disorders). In some people with fibromyalgia, local (peripheral) pain signals from the bones or muscles play a role too – for instance, if they also have rheumatoid arthritis or osteoarthritis.

Genetic factors and pain processing

Fibromyalgia runs in some families. It is known that certain types of genes are more common in people who have fibromyalgia than they are in other people. These genes are important for the function of certain chemical messengers (neurotransmitters) that are involved in the physical and psychological processing of pain. Examples of such chemical messengers are noradrenaline (norepinephrine) and serotonin. But there’s no such thing as a “fibromyalgia gene” that is clearly responsible for the disease.

Psychological stress

Some studies have shown that psychological stress or depression can contribute to the development of chronic pain syndromes like fibromyalgia. A lot of people who have fibromyalgia report that they experienced distressing or traumatic events in their childhood or teens, or were exposed to psychological stress at home or at work for many years.

Abuse in childhood – of a sexual or other nature – was also found to be somewhat more common in women who have fibromyalgia. But not everyone who has fibromyalgia also has psychological problems or traumatic experiences.

Other factors

There is currently no scientific that infectious illnesses like Lyme disease or injuries (e.g. from accidents) play a role in the development of fibromyalgia.

There is also no proven link between fibromyalgia and other factors that are sometimes mentioned – including problems with the thyroid gland, sex , muscles or nerves.

What kind of disease is fibromyalgia?

It is currently thought that fibromyalgia is caused by a combination of physical, psychological and biological factors working together. So it isn’t possible to pinpoint particular biological or psychological causes.

One-sided explanations can lead to wrong treatment decisions.

To avoid these problems, the scientific medical societies in Germany have agreed on a neutral category for this disease: Fibromyalgia is considered to be a “functional somatic syndrome.” This means that it’s an illness that is defined based on the typical physical symptoms (somatic syndrome) but it isn’t caused by tissue damage, for instance in the bones or muscles.

Aaron LA, Buchwald D. A review of the evidence for overlap among unexplained clinical conditions. Ann Intern Med 2001; 134(9 Pt 2): 868-881.

Afari N, Ahumada SM, Wright LJ et al. Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis. Psychosom Med 2014; 76(1): 2-11.

Arnold LM, Hudson JI, Hess EV et al. Family study of fibromyalgia. Arthritis Rheum 2004; 50(3): 944-952.

Deutsche Schmerzgesellschaft. Definition, Pathophysiologie, Diagnostik und Therapie des Fibromyalgiesyndroms (S3-Leitlinie, Kurzfassung). AWMF-Registernr.: 145-004 (under revision). 2022.

Fitzcharles MA, Ste-Marie PA, Goldenberg DL et al. 2012 Canadian Guidelines for the diagnosis and management of fibromyalgia syndrome: executive summary. Pain Res Manag 2013; 18(3): 119-126.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on May 24, 2022

Next planned update: 2025


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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