Answer: The causes of fibromyalgia could be multiple. Many patients express a simple traumatic event (such as, a lifting episode, a car accident, a fall) activating this disease. The first symptoms are expressed as muscle aches & pains and even a flu-like symptom. Interrupted sleep patterns follow and even progressive decline of function is a hallmark that this disease is evolving.

Fibromyalgia can be, and may be, associated with the sympathetic nervous system. This is the adrenaline-like nervous system that is intertwined with something we call the autonomic (or automatic) nervous system. The evidence is a little sketchy on this but I think that as more money and time is spent looking at activation of fibromyalgia, we'll see some positive reinforcement to this consideration. In other words, trivial events are known in medicine to activate this automatic nervous system and lead to progressive pain that is difficult to test and characterize. It is very real and it has been termed many different ways -- reflex sympathetic dystrophy, sympathetically maintained pain, causalgia, complex regional pain syndrome 1 and 2, etc. Once again, trivial events can activate this system inappropriately and perhaps this is an underlying mechanism of fibromyalgia. It is absolutely imperative to try to maintain a pain diary to evaluate evolving symptoms as most fibromyalgia patients can identify a pre-fibromyalgia period where they were healthy and enjoyed life. Something has turned on the switch and turned up the pain amplifier.

Answer: I seriously doubt this. Send me the research. There's a possibility. Not everyone who has an infection has fibromyalgia and vice versa. I need to see the data and I'll look for it, as well.

Answer: I'm not sure how to answer that. It's the old chicken & the egg concept. I do believe that stress has many alterations within the human body that manifest as disease. Specifically, we suspect heart disease, stroke, hypertension, etc. has some component of stress associated with the development of the disease. It's an evolving story. If you had asked somebody 100 years ago if cardiac disease was caused by stress, they would have said "no". I'd like to be more open minded. I'm going to say "yes".

I also believe that certain arthralgias (pain in joints) can be flared by stress. The physiologic mechanism can be explained. This involved [neutrophils] and other inflammatory elements in the blood system. Stress is a necessary part of life and we have to accept some of this. Some people even believe stress can prolong life and cognitive abilities. I believe in "all things in moderation". There must be a balance. Stress is a useful part of life and reality. Accept it. More importantly, learn how to manage it. When stress is controlling your life, this is clearly something that needs to be addressed. I'll talk about stress and fibromyalgia more in the book.