Fibromyalgia is a functional pain disorder; though subgroups may also have affective disorders

Fibromyalgia and Depression
– Source: Pain Research and Treatment, Nov 19, 2011

By Richard H Gracely, Marta Ceko, M Catherine Bushnell

[Note: The full text of this article is available free at]

Fibromyalgia and depression might represent two manifestations of affective spectrum disorder. They share similar pathophysiology and are largely targeted by the same drugs with dual action on serotoninergic and noradrenergic systems.

Here, we review evidence for genetic and environmental factors that predispose, precipitate, and perpetuate fibromyalgia and depression and include laboratory findings on the role of depression in fibromyalgia.

Further, we comment on several aspects of fibromyalgia which support the development of reactive depression, substantially more so than in other chronic pain syndromes.

However, while sharing many features with depression, fibromyalgia is associated with somatic comorbidities and absolutely defined by fluctuating spontaneous widespread pain.

Fibromyalgia may, therefore, be more appropriately grouped together with other functional pain disorders, while psychologically distressed subgroups [may be] grouped additionally or solely with affective spectrum disorders.

Source: Pain Research and Treatment, Nov 19, 2011. PMID:22191023, by Gracely RH, Ceko M, Bushnell MC. Center for Neurosensory Disorders, University of North Carolina, Chapel Hill, NC, USA; Alan Edwards Centre for Research on Pain, Integrated Program in Neuroscience, and Departments of Anesthesia and Neurology & Neurosurgery, McGill University, Montreal, QC;, Canada.[ Email:]

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4 thoughts on “Fibromyalgia is a functional pain disorder; though subgroups may also have affective disorders”

  1. shafm says:

    Pain and depression are part of fibromyalygia, as is sleep deprivation/restlesness due to pain and discomfort. with definate research knowing via EMG studies since 2005 that the FM+CFS brain cortex looks different to any other person’s (ill or well), and the thymus gland too is 4cm, instead of 8cm’s in ONLY FM’ics, from birth to demise. The CNS and ANS are v respinsible for the dystunctioning of those and therefore the endocrisne, pineal gland, hyperthalusmus, sensory, para and sympathetic brain systems, causing central sensitisation overload, abnornormal cortisol, insulin et al hormonal levels, adrenal function to both brain and body, and then in turn, from the brain;s muskular/skeletal area dysfunction, allowing for further bodily pain, lympharic , immune, enteric nervous system dysfunction. SO WE KNW THE PAIN BEGINS IN THE BRAIN AND ENDS UP AFFECTING THE CELLS< MUSCLES< LIGAMENTS< FUNCTIONALITY OF BOTH BRAIN AND BODY. TO restore FUNCTION must be the aim of Healthcare Provicder(s)!2. CAUSATIVES of the individual patients' personal difficulties, from pain relief, to CBT, to clinical nutrition correction, correcting and teaching diaphragmatic deep, relaxation breathing, educating about the needs of taking 'self responsibility' in all the areas a patient is actually able to, is paramount to allowing the notion that the patient IS NOT TO REMAIN A VICTIM BUT CAN, OVER TIME WITH CORRECT FUNCTIONAL MEDICAL APPROACH, BECOME AN ACUTE, NO LONG ER CHRONIC SUFFERER, LIVE AS A FUNCTIONAL FM IN A REAL WORLD SITUATION ETC. Much love and light to all those still in THE DARK. May 2012 allow you all to seek out the holistic, integrative help to make this possible. I was CHRONIC for 24yrs and have been in remission from all the attached debilities, for 19th yr in 20112, and am South africa's Healthcare Educator, Support system, from every angle that Functional Medicine insists on. I've seldom had any flare ups of pain, adrenal fatigue, ME/CFS?CFIDS during this time. Should I take this illness for granted and forget WHAT TO DO CORRECTLY FOR MYSELF EVERYDAY AND NIGHT, I take full responsibility that I will not be so well and thus I am still in charge of my life. SHaron Levin

    1. nleer says:

      I am looking for a dr. to do functional medicine.
      I have taken prednisone for 45 years. A doctor let my pneumonia go when I was 13 causing irreversable damage, especially to my left lung.

      I now have secondary addison’s disease, agammaglobulemia, hypothyroidism, pineal gland is calcified, Hypothalmus and cortisol insuf. and more.

      Finding someone that can help to replace what I am lacking and getting things balanced is crucial to my survival. There is so much to balance it will take a while for me to feel better, but my cortisol and ACTH levels aren’t even registering and that directly effects my thyroid function and so on.

      I am in bed 95% of the time. And eating right is a challenge since I am by myself and sleep most of the day and don’t have anyone to check and see if I have eaten or have water to drink, etc. I would like to have someone come in and help me just for 4 hours a day but that costs money which I don’t have!!

      Your knowledge of this disorder is so helpful to us, and I am praying that I will get better as time goes on.

      Thank You,


    2. KerryK says:

      I think the authors of the research are trying to be even handed and are not trying to discount the suffering of those of us with FM. I also do not think it is wrong to pursue the possibility that FM is a psychiatric disease. After all, many such diseases are very serious and require serious treatment. However, the article relies on a lot of conjecture. One prominent item of proof of their hypothesis is that depression and FM both respond to NSRI’s and amitryptiline. Interestingly, depression does respond to SSRI’s, but FM does not. Also interesting is that the evidently real diseases of peripheral neuropathy also respond to NSRI’s and TCA’s. So, one could, on the authors’ arguments, conclude just as validly that FM is a peripheral neuropathy. It is my own belief that FM will be proved to be a peripheral neuropathy eventually if it has not already been (look at recent research on mastocytes, keratinocytes, trpv1 channels etc). Maybe there is a commonality with depression. It may even be that the brain turns on something in the periphery to produce pain. So, saying that FM is ultimately caused “in the head” is not the same as saying it is a psychological problem. I also applaud ProHealth for publishing the things researchers say about FM that we may not like to see. That is also useful information.

    3. KerryK says:

      I find this research report to be a more useful explanation for our problems that in a way, ties some of the disparate hypotheses together without relying on conjecture:

      “Moderate Exercise Increases Expression for Sensory, Adrenergic, and Immune Genes in Chronic Fatigue Syndrome Patients But Not in Normal Subjects.” Alan R. Light et al.

      The abstract can be seen at The full article can be found at

      According to this, there is likely a blood test coming soon.

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