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Deborah Cummings's avatar

I was diagnosed with fibromyalgia in the mid "90's a year or 2 after a car accident with spiral acceleration force vectors. My 5 children were all in the accident, and had similar symptoms. We spent 10's of thousands of $$ on chiropractic, PT, neuropsychoimmunology, trigger point therapy, clinical psychology, biofeedback--and through the entire process, I felt my doctors were consistently trying to dismiss the physical damage to my body and brain in the MVA as the cause of my pain, trying to give me drugs for something I didn't have that they knew how to treat, instead of acknowledging the impotence of their diagnostic and treatment scope to accurately assess what was happening n my body. I am an OT trained in neurodevelopmental work, and one day in the midst of all this I tried to log roll down a hill with my children, and became violently nausesous, which was not normal for me, and I wondered what had changed in my neurological organization to precipitate such an event; I had dreams about playing counterpoint on the piano, and then discovered that I could no longer play Bach Inventions I knew by heart, and that I couldn't french braid my daughter's hair. I consulted with a NDT practitioner in Seattle, and after about a month on a 20 minute a day movement program that targeted injured neurological patterns in the pons and midbrain primarily, my pain was gone and function restored. That was more than 30 years ago.

Hannah's avatar

Fibromyalgia is frequently mischaracterised as a condition with no biological basis, yet a large body of research demonstrates clear and reproducible abnormalities across the central nervous system, peripheral nerves, immune signalling and molecular pathways. It is accurate to say that there is no single, SIMPLE diagnostic test available in routine clinical practice, HOWEVER this is very different from saying that there are no biomarkers at all.

Functional MRI and PET studies repeatedly show heightened activation in the insula, anterior cingulate cortex and somatosensory regions in response to mild stimuli, along with reduced activity in descending inhibitory pathways. These findings reflect central sensitisation rather than an absence of objective abnormalities. PET imaging has also revealed increased binding of glial activation markers, indicating neuroinflammation in pain‑processing regions. Cerebrospinal fluid studies have shown elevated levels of substance P and altered concentrations of glutamate and other neurotransmitters involved in nociception. Molecular research has identified distinct cytokine patterns and immune signatures, including increased IL‑6 and IL‑8 in many patients, and multi‑omics studies have demonstrated characteristic metabolic and transcriptomic profiles. Gene expression work has produced diagnostic models based on markers such as DYRK3, RGS17 and ARHGEF37, which can distinguish fibromyalgia from healthy controls with strong accuracy. Peripheral evidence is equally compelling. A substantial proportion of patients show reduced intraepidermal nerve fibre density on skin biopsy, consistent with small‑fibre pathology, and autonomic testing often reveals measurable abnormalities in heart‑rate variability, baroreflex sensitivity and orthostatic responses. These findings demonstrate that fibromyalgia has multiple biological signatures, although they are not yet consolidated into a single test suitable for everyday clinical settings.

The claim that fibromyalgia is diagnosed solely on subjective reports or that the brain becomes overwhelmed and shuts off signals is also contradicted by current evidence. People with fibromyalgia often struggle to pinpoint the source of their pain because the nervous system becomes hyperresponsive and poorly regulated. Instead of shutting down, the brain amplifies and misprocesses sensory input, producing noisy, exaggerated and poorly differentiated signals that are difficult to localise.

Neuroimaging studies show that the sensory cortex becomes less precise in mapping incoming information, and quantitative sensory testing demonstrates lowered pain thresholds and abnormal temporal summation.

This explains why pain feels widespread, shifting and hard to map. The idea that pain in fibromyalgia represents a symbolic choice of the body to avoid numbness has no support in neuroscience. The pain arises from altered neurophysiology involving central sensitisation, impaired inhibitory control, neuroinflammatory activity and peripheral sensory abnormalities. Far from being a condition defined only by subjective experience, fibromyalgia is increasingly understood as a complex, multisystem disorder with measurable biological underpinnings that current clinical tools are only beginning to capture. It is very sad.

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