Is Fibromyalgia Hereditary?

One of the most important breakthroughs in medicine over recent years has been in the understanding of genes. Many diseases have been shown to have a genetic link, including fibromyalgia syndrome (FMS)[1], however, as is often the case with FMS, the story is a bit more complicated. To truly understand whether fibromyalgia is hereditary, we need to dive into the fascinating world of epigenetics.

What is epigenetics?

Think of your DNA as an instruction manual for your body. Every cell has the same DNA, so in order for a brain cell to develop differently to a skin cell, only a specific page of the DNA manual will be “expressed” for the cell to read. This process takes place all over the body, and affects not only physical characteristics (height, eye colour etc), but also things like personality, interests and even happiness!

Of course, our environment has a major impact on all of these characteristics too, and the two things are intricately linked. Researchers have found that environmental factors such as stress, physical injury or infection can actually change which parts of our genetic code are expressed, meaning that genes which had previously been dormant may become active, or vice-versa. This can have major effects on our bodies, and can often be the trigger that begins a disease process.

The process of our DNA expressing different parts of our genetic code is known as epigenetics, but it does not always relate to negative effects. Eating a healthy diet, for example, has been shown to cause epigenetic changes which are related to increased life-expectancy, and meditation can cause mood improving epigenetic changes. The key point to remember is that our genes and our environment both play a role in shaping our health.

What about fibromyalgia?

Fibromyalgia is a good example of how both genetic and environmental factors combine to cause a disease. It has been known for some time that FMS appears to run in families, however the link was not as strong as in some other conditions. Several genes have been identified which appear to be related to FMS, although many people have these genes and never go on to develop the condition. This was a fascinating finding, which led researchers to search for reasons why these genes became active in some people, but remained dormant in others.

Researchers gathered as much data as they could on the lives of FMS patients before their symptoms started, and found that in a significant number of cases there was some kind of traumatic event that precipitated the development of their condition[2]. These ranged from physical trauma (vehicle accidents, broken bones etc) to psychological trauma (physical or sexual abuse/assault), and also included post-traumatic stress disorder.

Traumatic events such as these have been shown to change the balance of several hormones in the bodies of people affected by them, as well as leading to certain alterations in brain activity, both of which are typical of findings in FMS patients. This alone, however, does not explain the whole picture, as these changes are usually short lasting, whereas FMS is a chronic condition. In summary, most people make good recoveries from physical or psychological trauma, and don’t get left with chronic pain.

So what is happening in FMS?

One hypothesis is that these traumatic events lead to epigenetic changes, meaning that the genes involved in regulating hormonal and neurological messaging are permanently altered[3]. The dormant, less beneficial set of instructions are expressed by the DNA, meaning that the associated changes to the hormones and brain become essentially “hardwired”.

This explanation takes into account both the genetic and environmental factors that have been shown to play a role in this complex condition, and is widely accepted as the current best explanation for what causes FMS. This may sound disheartening, as a genetic change can be difficult to undo. While this is true, it is also the case that by improving our understanding of the condition, we have a better chance of successfully treating it, and new, effective treatment approaches are being developed all the time thanks to this important research.

For more information of how rTMS can help improve your FMS symptoms, click here.

[1] Park, D. J et al (2015). Exploring Genetic Susceptibility to Fibromyalgia. Chonnam medical journal, 51(2), 58–65.

[2] Yavne, Y et al (2018). A systematic review of precipitating physical and psychological traumatic events in the development of fibromyalgia. Seminars in arthritis and rheumatism, 48(1), 121–133.

[3] Gerra, M. et al. (2021). DNA Methylation Changes in Fibromyalgia Suggest the Role of the Immune-Inflammatory Response and Central Sensitization. Journal of clinical medicine, 10(21), 4992.

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