Causes of Fibromyalgia
Current evidence suggests that fibromyalgia occurs in individuals who are not able or willing to cope with psychological or physical stress [2,3,4,5].
Fibromyalgia is NOT [6,20]:
- A muscle or joint disorder or an autoimmune disease
- An infection or inflammation
- A degenerative nerve disorder 
- A disorder of muscle metabolism 
- A psychiatric disease
- A genetic disease
Mechanism of Fibromyalgia
According to current research, here is how pain and increased sensitivity in fibromyalgia can develop [1,2,3,8,9,15,20]:
You get into a conflict with people or your work but you do nothing to solve it, so the conflict continues, which makes you increasingly sad or angry.
Your brain interprets the continuing unpleasant emotions as a threat and adapts to them by lowering the threshold for pain and other sensory stimuli. This adaptation is known as central sensitization .
Stress may result in constant activation of the sympathetic nervous system, which holds you in a “fight” mode with anxiety, irritability, insomnia, dry mouth or irritable bowel syndrome [15,18]. Such highly activated sympathetic system is less able to react to additional stress, which could explain fatigue, brain fog and a drop in blood pressure upon standing .
Currently, it is not known, if mitochondrial dysfunction in the muscles is involved in fibromyalgia [29,30].
Risk factors for fibromyalgia may include [1,9,10,11,12,13,31]:
- Perfectionism, self-sacrificing or avoidance personality, compulsiveness, catastrophizing, depression
- Obesity, physical inactivity
- Poor job or life satisfaction
- Poor posture [21,36]
- Joint hypermobility 
- Painful experiences as an infant, premature birth, lack of emotional support or being abused as a child, maternal drug (morphine, cocaine) abuse during pregnancy 
- Family history of fibromyalgia or alcoholism 
- Arthritis: osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus or ankylosing spondylitis (spinal arthritis)
- Diabetes mellitus 
- Female sex
Fibromyalgia is not a hereditary disease, so it does not pass directly from parents to children . However, the first-degree relatives of individuals with fibromyalgia are at highly increased risk of developing it .
Low levels of serotonin (a chemical messenger in the brain) have been found in individuals with fibromyalgia and often in their healthy siblings .
Smoking [33,34] and moderate alcohol consumption  do not seem to increase the risk of fibromyalgia.
Triggers of Fibromyalgia Onset
Fibromyalgia can develop due to strong or repeated psychological or physical stress related to [3,6,7]:
- Emotional trauma, such as loss of job or a close person or sexual abuse associated with fear, anger or resentment
- Excessive physical work, especially repetitive heavy lifting or bending
- Monotonous work
- Lack of sleep
According to several studies, Lyme disease may trigger fibromyalgia, but treatment with antibiotics does not improve the symptoms of fibromyalgia .
It is not clear if viruses (Epstein-Barr, HIV/AIDS, hepatitis C, parvovirus) [16,17,18] or Mycoplasma  can trigger fibromyalgia.
Common vaccines used in the United States do not seem to trigger fibromyalgia .
It is also not clear if a physical trauma including whiplash injury, surgery and childbirth, and menopause can trigger fibromyalgia [7,28]. In various studies, after a whiplash injury, tenderness was usually limited to the neck and shoulder girdle area and lasted only for few months [23,24,25].
Fibromyalgia is not likely caused by a deficiency of minerals or vitamins, such as vitamin A, B1, B12, C, D, folic acid and E, calcium, copper, iron, iodine, magnesium, manganese, molybdenum, phosphorus, potassium, selenium, sodium or zinc .
Triggers of Flare-Ups
According to various surveys, the following may trigger fibromyalgia flare-ups, that is a sudden increase in the severity of symptoms [7,8,26]:
- Emotional stress, excessive worrying, family conflicts, war
- Excessive work, strenuous activities, travel, lack of sleep
- Medication side effect
- Rainy, hot or cold weather
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