The brain and nervous system in fibromyalgia

Research is beginning to show that fibromyalgia (FMS) is not a rheumatologic syndrome, but rather a neurological one. As a result, it is finally recognized that the root causes of FMS, while still a mystery, are based in the nervous system rather than joint or other tissues.

It also means that the brain and the nervous system will be central to understanding and managing the symptoms. Not only are there the obvious physical symptoms, like pain, but there are more subtle symptoms that affect your ability to concentrate and otherwise think clearly. We will go through various symptoms and their connection to the nervous system and brain sensation in patients.


Everyone with FMS will be familiar with pain, but we need to recognize that this pain largely arises from dysfunction in the nervous system. That is why neurological medications like anti-depressants work to relieve FMS pain. While there are still more questions than answers regarding fibromyalgia, it is believed that FMS pain is related to issues with the same neurotransmitters that can cause depression, so it’s not a surprise that drugs that treat those chemicals will be helpful for the treatment of FMS.

It is also thought that at least some of the pain experienced in FMS is caused by something called hyperalgesia in the nervous system. This is a condition that causes you to feel more pain than you ought to. It can be thought of that the nerves that sense pain and your pain receptors are “hyperactive” sending more pain signals than they need to, and experiencing pain more severely than is necessary.


Another kind of pain that FMS sufferers often experience is chronic headaches. These can be severe, ranging from a dull ache to the migraine type of headache. In fact, 75% of those seeking treatment for fibromyalgia will also be migraine sufferers. Unlike most FMS pain, migraines are caused by inflammation in the arteries around the brain, however it is thought that the resulting headaches are more severe in part because of the heightened sensitivity to pain that FMS patients already have.

Brain sensation in Fibromyalgia

Sleep Difficulties

One of the most challenging of FMS symptoms is the difficulty that patients have sleeping. This can often take the form of having issues with even getting to sleep in the first place, but it can also manifest as waking up far too early and not getting back to sleep.


A common complaint that both FMS sufferers and people with Chronic Fatigue Syndrome have is that what sleep they do manage to get is of low quality. So not only will it be hard to get to sleep in the first place, but people with these conditions also sleep poorly and don’t get any real rest from their sleep. Both sleep deprivation and fatigue will exacerbate your pain, making a situation that’s already difficult, even more so. Thankfully, more and better sleep will also improve the pain, so while none of the problems will disappear completely, they can be easier to manage than some other symptoms.

Brain Fog

Brain Fog or fibro Fog are terms that actually cover a variety of cognitive difficulties that can come with fibromyalgia. These symptoms include vocabulary issues—difficulty finding the right word, or the tendency to mix words up and use the wrong word. It might also be used to describe confusion, memory lapses and issues with concentrating.

There are a number of things going on at the same time as FMS which are capable of causing these symptoms. As a result, researchers can’t be sure that the cause of brain fog is actually FMS, or whether it is caused by the sleep deprivation that often comes along with chronic pain.

Further research has shown that the brain fog symptoms are most likely a separate issue. However, at least some studies have shown that FMS sufferers also experience limited blood flow in the brain, and are therefore starving parts of the brain of oxygen. Another theory holds that chronic pain affects the brain itself. The part of the brain used for emotional response is constantly active, which may distort the brain itself. Neurons get worn out sooner than they should because this part of the brain won’t “shut off” when it ought to.

Concentration and Distraction

FMS can affect your ability to concentrate on the task in front of you. It can make you more susceptible to distraction. So it will be necessary to work with mental “blinders” so you’re able to focus on the task in front of you.


The syndrome can also cause you to have a more limited vocabulary than you once had. Finding the word you’re looking for can be difficult. It also often happens that you’ll confuse words, so that instead of using the word that you were actually thinking of, you’ll use something related but not really what you meant.


It’s also common for FMS sufferers to have issues with memory, especially short-term memory. Unfortunately, this is often the most obvious and can cause the most stress. It will affect your ability to remember things that just happened or were just said.


While math is a bit of a problem for many people, the FMS sufferer can have very specific issues with simple equations and remembering sequences or numbers. This can make day-to-day living difficult.


Like math, this can be a challenge anytime, but for FMS patients, it can be even more of a challenge to remember which direction is which. This can cause difficulty completing seemingly simple tasks, since going to the store or driving depend on it.

Depression or Anxiety

Again, like other symptoms, it is not clear whether this is brought on by chronic pain, or is a direct result of FMS. In any case, it occurs regularly in conjunction with fibromyalgia. For this reason, the anti-depressants that might have been prescribed for pain can also be helpful with improving your state of mind.


Because it is now recognized that fibromyalgia is a neurological condition, many drug treatments now focus on the brain and nervous system. While anti-inflammatory drugs and opioids are still used, more success is coming through the use of drugs that directly act on the nervous system. These include both over-the-counter drugs and medications that you’ll need a prescription for.


An effective over-the-counter painkiller for FMS is acetaminophen or paracetamol. These are just different names used in different countries for the same substance. Patients in North America will probably be more familiar with “acetaminophen.”

This drug works not by subduing inflammation, but by acting directly on the nervous system to block pain sensations from the nervous system to the brain. Because it focuses on the neurological aspect of the condition, it has enjoyed more success as a painkiller for FMS.


Fibromyalgia has a long and unfortunate history of being taken for a psychosomatic condition, so patients might be excused if they are a little suspicious when they are prescribed an anti-depressant. However, these drugs work to improve the balance of neurotransmitters in your brain, which can definitely help relieve pain.

Further, it isn’t uncommon for people suffering the chronic pain of FMS to also exhibit depression as well. This doesn’t mean that fibromyalgia is “in your head” or anything else. It’s simply recognition of the realities of the situation.

Finally, anti-depressants can help with sleep issues. This is especially true of the older, tricyclic anti-depressants. You might be prescribed something called Amitriptyline, which is one of these drugs. These drugs are prescribed in what’s called an “off-label” manner, since they haven’t been specifically made or authorized by the FDA for the treatment of fibromyalgia. However, a doctor can prescribe any medication that he or she believes will be helpful, so your doctor can prescribe anti-depressants or any other drug that will help you.


These drugs are specifically designed to reduce spasm, but they also act to calm the nervous system. Thus, they can keep nerves from sending too many pain signals to the brain, which is a major issue in FMS. The first drug certified by the FDA for fibromyalgia treatment is called Lyrica, which is the trade name for the drug pregabalin.

Lyrica binds to a part of the nerves and it is thought that this reduces the ability of nerves to send pain messages to each other. It also slows down impulses in the brain that cause seizures, and affects chemicals in the brain that send pain signals across the nervous system.

Fibromyalgia is increasingly being recognized as a neurological disorder rather than a rheumatologic disease. Symptoms of the syndrome have made it clear, and the treatments that are used also reflect that reality

Further Reading

“Brain Fog/Fibro Fog in Fibromyalgia & Chronic Fatigue Syndrome: What Causes It & What to Do About It.” by Adrienne Dellwo.


“What is Fibromyalgia?” The American Fibromyalgia Syndrome Association, Inc.

“The Fibromyalgia and Migraine Comorbidity.” by Kerry Trotter. HeadWise: A Voice for People with Migraine and Headache Disorders.