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Dysautonomia and Fibromyalgia: Five Things You Should Know

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What is dysautonomia?

Dysautonomia is a term used to describe a disruption in the way our autonomic nervous system regulates, communicates, and adjusts our body functions so we maintain balance. The autonomic nervous system (ANS) consists of two branches:  the sympathetic and the parasympathetic.

The sympathetic nervous system prepares our body for fight or flight in stressful situations and sometimes seems to give us superhuman powers in fearful or dangerous situations. Certain functions take place, like the release of adrenaline, which cause other things such as an increase in our heart rate so that more oxygen is delivered to our muscles when it’s needed.

It is the parasympathetic arm of our ANS that normalizes things after a threat is gone. Both branches of the autonomic nervous system work “automatically” to provide the body balance and well-being, referred to as homeostasis.

5 scientific advances in understanding dysautonomia and fibromyalgia

# 1
The American College of Rheumatology posed at their annual meeting, Dysautonomia may be the pathogenesis behind fibromyalgia (December 23, 2015). Two groups of patients were part of a study: those with fibromyalgia and those with rheumatoid arthritis. Martinez-Martinez LA, et al., discovered a strong correlation between dysautonomia and the fibromyalgia group. Shirley Pulawski had this to say about the paper.

“A consistent line of investigation suggests that dysautonomia may explain the multi-system fibromyalgia features, and that fibromyalgia is a sympathetically maintained neuropathic pain syndrome,” the researchers wrote. “The sympathetic nervous network is the main component of the stress response system.

Her reference:  Martinez-Martinez LA, et al. Paper #71. Presented at: American College of Rheumatology Annual Meeting; Nov. 7-11, 2015; San Francisco.

# 2
Small fiber neuropathy has been implicated in fibromyalgia dysautonomia once again. In September 2018, Fibromyalgia and small fiber neuropathy: the plot thickens, Martinez-Lavin suggests “The recent recognition of small fiber neuropathy in a large subgroup of fibromyalgia patients reinforces the dysautonomia-neuropathic hypothesis and validates fibromyalgia pain… Skin biopsy and corneal confocal microscopy will probably become useful fibromyalgia diagnostic tests. Dorsal root ganglia sodium channel blockers are potential fibromyalgia analgesic medications. Subgroups of young girls with ‘autoimmune neuropathic fibromyalgia’ may respond to immunoglobulin therapy.”

Side note: In light of the FDA approved clinical trial on the BCG vaccine for fibromyalgia, the plot does indeed thicken and the characters at play are biological. The FM/a test is a multi-biomarker-based blood test that looks specifically at immune system white blood chemokine and cytokine patterns.  The paper by Kenney, M.J.  and Ganta, C.K., Autonomic Nervous System and Immune System Interactions Autonomic Nervous System and Immune System Interactions (2014 July), states that cytokines and other immune factors affect the level of activity and responsivity of discharges in sympathetic and parasympathetic nerves innervating diverse targets. I am in no way a scientist, but I take this to mean immune influences such as those identified in the FM/a test could be a player in our dysautonomia symptoms.

# 3
Reyes-Manzano CF, et al., Multifractal Analysis Reveals Decreased Non-linearity and Stronger Anti-correlations in Heart Period Fluctuations of Fibromyalgia Patients, concluded in August 2018, “When compared to healthy controls, fibromyalgia patients display decreased nonlinearity and stronger anti-correlations in heart period fluctuations.” This reinforces dysautonomia and loss of heart rate variability in fibromyalgia as reported in my 2015 article.

# 4
Autonomic nervous system dysfunction may contribute to poor sleep in fibromyalgia and vice versa according to a 2017 study. The investigators describe it as a vicious circle.

# 5
I found the study, Dermatological Manifestations of Postural Tachycardia Syndrome Are Common and Diverse (2016 Jan.), particularly interesting since many of us experience POTS (a type of dysautonomia called chronic orthostatic intolerance). I suspect I am not alone in this one since so many of us also complain of unusual rashes, Raynaud’s, and livedo reticularis. Note: Raynaud’s and livedo reticularis are thought to be dysfunctions in the sympathetic arm of our autonomic nervous system.


There is sufficient evidence to correlate dysautonomia and fibromyalgia. If you have symptoms of dysautonomia, discuss it with your physician. Diagnosis needs to be made in order to explore possible treatments that will ease your symptoms and improve your health.

Additional reading:

Fibromyalgia – Orthostatic Intolerance (NMH & POTS) Made Easy

This article was first published on ProHealth.com on October 11, 2018 and was updated on May 2, 2021.

Celeste Cooper, RN, has been a frequent contributor to ProHealth.  She is an advocate, writer and published author, and a person living with chronic pain. Celeste is lead author of Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain and Broken Body, Wounded Spirit, and Balancing the See Saw of Chronic Pain (a four-book series). She spends her time enjoying her family and the rewards she receives from interacting with nature through her writing and photography. You can learn more about Celeste’s writing, advocacy work, helpful tips, and social network connections at CelesteCooper.com.

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2 thoughts on “Dysautonomia and Fibromyalgia: Five Things You Should Know”

  1. Kathleen S Henschke says:

    This is all so interesting to me! I have been dx. with Fibro. Have trouble walking these days. Some days are worse than others. I was to see a neurologist and am scheduled for and MRI series of my back and spine, Cervical, Thoracic, and Lumbar. I can not have any IV Dye due to allergy. I am wondering what is going on, and honestly more than a little afraid! I wish that more Dr’s would read up on these conditions and current findings and studies! It would do those of us that suffer a world of good if they were more informed. I had seen a Rheumatologists, he got in my face, was very rude, and said boldly. “we do not treat Fibromyalgia” Well needless to say I never went back to him either! A doctor treating me with such disrespect and rudeness doesn’t get me any results and only ruins his reputation. If there are current findings are they released to most Doctors for updating them and learning purposes? I would personally be very happy to be informed! Thanks for the educational material!


    My Dr appears to not know what to do to relieve my pain, at all. I am super sensitive to all the normal prescribed drugs and am getting fed up with no alternative therapies or drugs being suggested. I feel constricted and unable to do many thing sin my life and want positive help, not perhaps and maybes, as suggestions for treatment. Restrictions in the muscles is something I’ve felt has been a cause of Fibro for years and is something that should be followed up more and acted upon.

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