Just as our caveman forebears were frail in the face of
predatory animals, we are frail in today’s society of
childhood neglect or abuse, bumper-to-bumper traffic,
frustration at work, and multiple daily hassles.
neuroendocrine systems and pain regulatory mechanisms
protected early man during acute stress are still encoded in
our genome, but may be maladaptive in psychologically and
physiologically vulnerable people faced with chronic stress.
Many patients with fibromyalgia become vulnerable because of
the long-lasting psychological and neurophysiological effects
of negative experiences in childhood. Ill-equipped with
positive cognitive, emotional, and behavioral skills as
adults, they display maladaptive coping strategies, low
self-efficacy, and negative mood when confronted with the
inevitable stressors of life.
Psychological distress ensues,
which reduces thresholds for pain perception and tolerance
(already relatively low in women) even further. Converging
lines of psychological and neurobiological evidence strongly
suggest that chronic stress-related blunting of the HPA,
sympathetic, and other axes of the stress response together
with associated alterations in pain regulatory mechanisms may
finally explain the pain and fatigue of fibromyalgia.
Vulnerable people who can be classified by the ACR criteria as
having fibromyalgia do not have a discrete disease. They are
simply the most ill in a continuum of distress, chronic pain,
and painful tender points in the general population.