Chicken or the egg causality dilemma
Before listing any of of the causes or triggers, most important is that we are in a chicken-and-egg-dilemma: Any biomarker, symptom etc. that may be present can be an effect or a cause or both, or a vicious circle.
The 2012 editorial by Ann Gardner in Nutrition “Fibromyalgia: unknown pathogenesis and a “chicken or the egg” causality dilemma” may be referring to that, a stub of which I’ve found here
stub
In this issue of Nutrition, Cordero et al. [1] describe the alleviated symptoms in a woman with fibromyalgia during treatment with coenzyme Q10. The endogenous production of Q10 decreases with age [2], thus increasing the importance of nutritional intake. Q10 has been approved by the U.S. Food and Drug Administration for the treatment of mitochondrial disease in research. The restored mitochondrial function as described by Cordero et al. [1] during Q10 treatment suggests that, in this case, mitochondrial dysfunction is likely to be the effector, and possibly even the primary, pathophysiologic mechanism. The hypothesis that mitochondrial dysfunction is involved in fibromyalgia has existed for some time, as exemplified by themention of the word mitochondria 18 times in a 10-page review article published in 2000 [3]. In an 11-page review article published in 2011, there was no mention of mitochondria [4]. Diagnosing mitochondrial disease/dysfunction is cumbersome because there is no single test that will prove or disprove an abnormality [5]. As in fibromyalgia, mitochondrial disease manifests in symptoms involving several tissues or organs and include personality and psychiatric disorders. Muscle pain is a hallmark of mitochondrial disease, but there have been only three case reports of patients with mitochondrial disease and fibromyalgia [6–8]. Three studies of psychiatric disorders in mitochondrial disease have been published, with all reporting increased prevalences, mostly depressive disorder. It has been suggested that the possibility of mitochondrial disease should be considered in patients with psychiatric disorders if other symptoms, e.g., muscle pain, are present [9–11]. Perceived stress, and neuroticism (the enduring tendency to experience negative emotional states), which has a relatively strong relation with depression, have been associated with key symptoms of fibromyalgia [12]. Neuroticism has been shown to have a moderate additive genetic component and a substantial non-shared environment component [13]. The designation “central sensitivity syndromes” has been proposed for a large continuum of disorders with epidemiologic and clinical overlaps, including fibromyalgia, tension-type headache, migraine, and irritable bowel syndrome, all of which overlap with psychiatric disorders. The current diagnostic labels for central sensitivity syndromes have been suggested to be arbitrary because there is no objective tissue pathology to which “disease” can be anchored. The unknown pathophysiology of central sensitivity syndromes underlies the construct of “somatization,” the notion that somatic
The case study that editorial refers to:
Oral coenzyme Q10 supplementation improves clinical symptoms and recovers pathologic alterations in blood mononuclear cells in a fibromyalgia patient. [Nutrition. 2012] here.