Familial and Genetic Factors in Fibromyalgia

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This topic was concisely reviewed by David A. Williams, and Daniel J. Clauw in 2009. (Understanding Fibromyalgia: Lessons from the Broader Pain Research Community. J Pain. 2009 Aug; 10(8): 777–791 available in full online at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2741022/.) They noted that the family members of people with fibromyalgia are “more tender than are the family mem-bers of controls, and family members of individuals with FM are much more likely to have other disorders related to FM such as IBS, TMD, headaches, and other regional pain syndromes.”

Familial clustering of cases[edit]

It is often assumed without justification that if a disease is familial, then it is therefore genetic. This is not true. Dysfunctional families, for example seem to “pass” the stress from one generation to another but the pass is not of genes. Child beating can occur in success generations within a family. The passage is not genetic. It is of behavioural patterns related to aggression and abuse.) It is conceivable that the familial clustering of fibromyalgia may relate more to considerations such as if a person grows up in a stressful environment which is chaotic and in which their parents have high stress and poor sleep, then this puts them at risk for psychological difficulties and poor sleep, which are main drivers for fibromyalgia.

Williams and Clauw noted: “First degree relatives of individuals with fibromyalgia display an eight-fold greater risk of developing fibromyalgia than those in the general population.” (Understanding Fibromyalgia: Lessons from the Broader Pain Research Community, David A. Williams, Ph.D.1 and Daniel J. Clauw, M.D.2 J Pain. 2009 Aug; 10(8): 777–791. They reference Arnold et al., 2004.)

Arnold et al. found that their study indicated that “fibromyalgia and reduced pressure pain thresholds aggregate in families, and that fibromyalgia coaggregates with major mood disorder in families.” (Family study of fibromyalgia. Arnold LM, Hudson JI, Hess EV, Ware AE, Fritz DA, Auchenbach MB, Starck LO, Keck PE., Jr. Arthritis Rheum. 2004;50(3):944–952 available in full online at: http://onlinelibrary.wiley.com/doi/10.1002/art.20042/full.)

Suggestions for doctors assessing patients with family history of possible or definite fibromyalgia[edit]

Because of eight-fold greater risk in first degree relatives (Williams and Clauw, 2009), part of the history taking process should include these questions:

Presently or in the past were any of your first degree (blood) relatives (parents, brothers or sisters or children) chronic pain patients with sleep problems?

Were any of them diagnosed with fibromyalgia?

Given the theoretical possibility of a parent in pain influencing the future course of pain in a child, the treating health care worker should attempt to explore the nature of their interaction by asking about childhood pain experiences such as physical discipline or cruelty.

Genetic polymorphisms associated with fibromyalgia[edit]

  • Serotonin 5-HT2A receptor polymorphism T/T phenotype,
  • serotonin transporter,
  • dopamine 4 receptor, and
  • COMT (catecholamine o-methyl transferase) polymorphisms.

Williams and Clauw commented in 2009 that: “All of the polymorphisms identified to date involve the metabolism or transport of monoamines, compounds that play a critical role in the human stress response, heightened pain sensitivity, and affective vulnerability.”

For further information on genetic factors in fibromyalgia see[edit]

The T102C polymorphism of the 5-HT2A-receptor gene in fibromyalgia. Bondy B, Spaeth M, Offenbaecher M, Glatzeder K, Stratz T, Schwarz M, De Jonge S, Kruger M, Engel Rr, Farber L, Pongratz De, Ackenheil M. Neurobiol Dis. 1999;6(5):433–439.

An association between fibromyalgia and the dopamine D4 receptor exon III repeat polymorphism and relationship to novelty seeking personality traits. Buskila D, Cohen H, Neumann L, Ebstein Rp. Mol Psychiatry. 2004;9(8):730–731 available in full online at: http://www.nature.com/mp/journal/v9/n8/full/4001506a.html

The genetics of fibromyalgia syndrome. Buskila D, Sarzi-Puttini P, Ablin JN. Pharmacogenomics. 2007;8(1):67–74.

Possible association of fibromyalgia with a polymorphism in the serotonin transporter gene regulatory region. Offenbaecher M, Bondy B, De Jonge S, Glatzeder K, Kruger M, Schoeps P, Ackenheil M. Arthritis Rheum. 1999;42(11):2482–2488.

Genetic architecture of human pain perception. Diatchenko L, Nackley AG, Tchivileva IE, Shabalina SA, Maixner W. Trends Genet. 2007;23(12):605–613. [PubMed]

Genetic basis for individual variations in pain perception and the development of a chronic pain condition. Diatchenko L, Slade GD, Nackley AG, Bhalang K, Sigurdsson A, Belfer I, Goldman D, Xu K, Shabalina SA, Shagin D, Max MB, Makarov SS, Maixner W. Hum Mol Genet. 2005;14(1):135–143. [PubMed])