Fibromyalgia and Genetic Susceptibility

Is fibromyalgia hereditary?

Three generations of Black females embrace.

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The question “is fibromyalgia genetic” comes up a lot because of how common it is for this pain condition to run in families. If you have fibromyalgia, you may worry about passing it on to your children, or you may wonder if you'll have it because your mother does or because several other family members have.

Fibromyalgia is a chronic condition that features abnormal types of pain, extreme fatigue, disturbed sleep, cognitive dysfunction (“fibro fog”), and dozens of other possible symptoms.

For the past few decades, researchers have delved into familial patterns to learn whether fibromyalgia is hereditary and, if so, what genes may be involved. The current belief is that:

  • Familial patterns do, in fact, exist
  • People appear to have a genetic susceptibility (also called a predisposition) to fibromyalgia
  • Researchers have found an association with multiple genetic abnormalities
  • It likely takes a combination of genetics and other causal factors to trigger the illness

Why Genetic Research Matters

Genetic research could have profound effects on the future of fibromyalgia. It could lead to:

  • Diagnostic markers, which would allow healthcare providers to objectively confirm a diagnosis and lend the condition increased credibility
  • Treatments that target specific genetic abnormalities and their effects, thus targeting the mechanisms behind the disease and not just trying to alleviate the symptoms
  • Genetic tests that may reveal which treatments are likely to work best for you
  • Fibromyalgia prevention based on known genetic susceptibilities

These things are all desperately needed, as currently fibromyalgia is difficult to diagnose and existing treatments are inadequate for more than half of the people with this condition. And while healthcare providers can estimate your risk based on family history, right now they don’t know how to prevent fibromyalgia from developing.

Familial Patterns

If you have close relative (parent, sibling, child) with fibromyalgia, you’re 8.5 times more likely to get it than if you have a close relative with rheumatoid arthritis. Given its tendency to show up in multiple family members, it’s logical for researchers to dig into the genetics of fibromyalgia. 

According to a 2017 review of scientific literature on fibromyalgia, credible evidence exists to support the theory that genetics do play a causal role.

In one study, 52% of parents and siblings of someone with fibromyalgia had some clinical evidence of the condition, even though none had previously been diagnosed with it.

Another 22% who had no apparent symptoms had abnormal muscle consistency similar to that found in people with fibromyalgia. That means almost three-quarters of the relatives had physical signs of susceptibility or early symptoms.

In a study of children whose mothers had fibromyalgia, researchers found that 28% of the offspring had fibromyalgia themselves. By comparing siblings, they determined that it appeared to be genetics, and not environmental exposures or psychological factors, that led to the high occurrence rate in the kids.

Evidence suggests the pattern of inheritance in fibromyalgia is autosomal-dominant, meaning you only need one parent to pass along the relevant genes for you to be susceptible. (In autosomal-recessive inheritance, you need a copy of the relevant genes from both parents, which is much rarer.)

Because other fibromyalgia causal factors may include environmental exposures, one study looked at blood relatives versus non-blood relatives, such as spouses:

  • In blood relatives of a person with fibromyalgia, the prevalence rate was 26%. 
  • In non-blood relatives sharing the same environment, it was just 19%.

While that’s still considerably higher than the overall population rate, it suggests that genetics may exert a stronger influence on fibromyalgia’s development than environmental factors do. Additionally, pain sensitivities of blood relatives were significantly higher than those of people in the control groups.

In a study on siblings of people with fibromyalgia, the risk of developing it was found to be just over 27%. Other studies suggest personality traits that are common in people with fibromyalgia also have a genetic component and are part of the predisposition.

Genetic Susceptibility

While you may have inherited a genetic susceptibility to fibromyalgia, that doesn’t mean you’ll end up with it. A genetic susceptibility isn't the same as a hereditary disease. In true genetic diseases, inheriting the gene(s) means you have or will develop the disease. 

In fibromyalgia and many other conditions with a genetic predisposition, you can inherit genes that make it likely for you to develop the condition under certain conditions. If those conditions are never met, you’ll probably never have fibromyalgia.

Some research suggests that about 50% of your susceptibility to fibromyalgia comes from genetic factors.

Associated Genes

Multiple genes have been targeted by researchers for their possible involvement in fibromyalgia. They include genes involved in:

  • Pain transmission by the nerves and neurotransmitters
  • Pain processing by the brain and nerves
  • The catecholamine (COMT) system, which deals with decreased pain threshold 
  • Serotonin receptors, transporters, and regulation
  • Dopamine receptors
  • Adrenergic receptors

More recently, research has shifted more toward genome-wide association studies (GWAS) and microRNAs.

So far, some GWAS have found mutations in genes that deal with: 

  • Immune system proteins called cytokines, which regulate inflammation
  • Myelin cells, which form protective coatings on certain nerves and aid in message transmission
  • Chronic widespread joint pain

MicroRNAs are fragments of genetic material in your cells that prevent particular proteins from being produced by destroying the messenger RNA that make them. 

A 2020 study found abnormalities in more than 220 microRNAs and in the expression of nearly 150 genes. Many of the abnormalities were linked to musculoskeletal disease, immune-system disease, and mental disorders.

Research also suggests a possible genetic component to endocannabinoid deficiency, which is a known feature of fibromyalgia. The endocannabinoid system is named for the substances that affect it—the natural cannabinoids produced by your body and those that come from the cannabis (marijuana) plant, such as cannabidiol (CBD). This system deals with homeostasis.

Multiple related conditions are believed to involve this same dysregulation, including migraine, irritable bowel syndrome, and post-traumatic stress disorder. These conditions and several others fall under the umbrella term “central sensitivity syndromes” (CSS).

Experts believe CSS exist on a spectrum, similar to the autism spectrum, and all involve abnormal pain processing by the central nervous system, which is called central sensitization.

Based on genetic findings, some researchers in 2015 proposed a change in the way the medical community approaches fibromyalgia research, from a single condition to a disease continuum with multiple genetic makeups.

That change has led to a shift away from identifying each specific genetic change related to fibromyalgia to looking across the CSS spectrum. That means looking at the genetics of multiple conditions for valuable clues about the genetics of fibromyalgia and its related conditions.

Other Triggering Factors

Fibromyalgia is believed to have several possible triggering factors that, when combined with a genetic susceptibility, can cause it to develop. These include:

  • Sex: 90% of diagnoses are in those assigned female at birth; hormonal changes and gynecological surgeries can be triggers, which contributes to this disparity.
  • Age: While it can strike at any age, most diagnoses are made between the ages of 20 and 50 (“childbearing years”).
  • History of psychological stress: Traumatic events are believed to lead to long-term physiological changes that can lead to fibromyalgia or other CSS.
  • Sleep disorders: Long-term sleep problems may cause changes in the brain that contribute to fibromyalgia’s development.
  • Chronic pain, especially from autoimmune disease: A constant barrage of pain signals may cause changes in the brain that make it more sensitive to pain (central sensitization).
  • Viral infection: Certain illnesses, including hepatitis, have been tentatively linked to the onset of fibromyalgia.

You don’t have to have all of these factors in order to wind up with fibromyalgia, but it’s believed that most people have at least one of these causal factors on top of genetic susceptibility.

Preventing Fibromyalgia

So far, healthcare providers don't know how to prevent fibromyalgia, but it's possible that treating problems like sleep disorders and pain conditions, managing stress, and leading a general healthy lifestyle (exercise, a healthy diet, and not smoking) may be helpful.

A Word From Verywell

If you believe you have a genetic susceptibility to fibromyalgia, talk to your healthcare provider or try to get in with the healthcare provider who treats your relative(s) with fibromyalgia. They may have ideas for how you can prevent or delay fibromyalgia onset, possibly by focusing on non-genetic risk factors and potential causes.

If you’re worried about passing fibromyalgia on to your children, again, take it up with their healthcare provider to see if they have any advice for you. The good news is that researchers are learning new information all the time, and you and your family members with fibromyalgia—or just a genetic susceptibility—can benefit from that.

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