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Yassin Mustafa MD, *Bowirrat Abdalla MD., Ph.D, and Youssef Awni MD.


Background: Fibromyalgia (FM) is a multifactorial neurological disorder associated with chronic extensive pain that belongs to an extended family known as Affective Spectrum Disorders (ASDs). Pathophysiology of fibromyalgia includes abnormalities in the neuroendocrine, autonomic nervous systems, genetic factors, psychosocial variables, and environmental stressors. These abnormalities are involved in other disorders, such as irritable bowel syndrome and temporomandibular disorder. In fact, fibromyalgia refer to central augmentation of sensory input rather than central sensitization of pain. Genetic researches explain the variability in the perception of pain. Recent evidence suggests a role for the genetic polymorphisms in the serotoninergic, dopaminergic and catecholaminergic systems in the pathogenesis of FM pain. The interplay between genetic and environmental risk factors may strengthen the breakthrough mechanism in understanding the pathogenesis of FM. Francis Galton on 1875 invented the term “nature (genes) versus nurture (environment)” to explain the interindividuals variability of pain using twin studies. Conclusion: Investigations indicate that the most likely way of inheritance of FM is polygenic; it’s not means minimizing the role of monogenic mendelian mode of inheritance of pain. Sophisticated genetics technology is warranted to get on shared biological mechanism of the pathways of nociception and to enlighten the heritability in pain differences and the susceptibility to pain and its related components such as the pathophysiology and behavioral disturbances. Indeed, well-made genetic and epigenetic investigations in the field of human pain will help to estimate risk factors manipulating pain perception and how they can be influenced via epigenetic processes. The novel technologies using genome-wide association study can reveal gene loci and signaling pathways and the Micro RNAs are progressively more harnessed for the study of the chronic pain and the pathogenesis of FM. When we completely elucidate the nature and nurture of human pain, we will be able to control it. This manuscript comes to shed light on the pathogenesis of a discreet complex condition, difficult to diagnose, characterized by pain centralization and chronification.

Keywords: Fibromyalgia; Affective Spectrum Disorders; polygenic disorder; neurotransmitters and hormones.

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