Summary: Fibromyalgia affects about 2% of the population. Insulin resistance is also very common. New data from large groups of people suggest that people with insulin resistance are more likely to have fibromyalgia. Doctors still do not fully know what causes it. So this is a step forward. It means treating insulin resistance could be a way to manage fibromyalgia-related chronic pains. It is a leading cause of chronic pain and mood problems. It causes body-wide aches, hyperalgesia (too much pain from small triggers), depression, fatigue, sleep problems, headaches, and more. Studies suggest that it affects about 2% of the population. It is more common in women and in people with chronic illnesses1. But getting relief from fibromyalgia pain is hard for many reasons. First, it is still poorly understood. Second, it is a diagnosis of exclusion. That means doctors first rule out other known disorders that can cause chronic body aches. Third, doctors are still unsure what causes fibromyalgia. Still, in recent years, our understanding has improved. It seems chronic illness, autoimmune disorders, and other painful conditions may change the brain in ways that cause hyperalgesia. So neuroinflammation (inflammation in the brain and nerves) plays a key role in these hard-to-explain chronic pains. Know this: fibromyalgia is not just about body aches. It also changes appetite and mood, brings depression, and causes other health problems. But doctors still do not understand fibromyalgia well enough. They do not know what causes it or exactly how the disease works. So doctors struggle to treat it. Often, doctors try several treatments before they find one that works. Today many people have more than one painful condition at once. So doctors think diabetes and the insulin resistance behind it may raise the risk of fibromyalgia. Diabetes is one of the most common metabolic diseases. Yet it is still poorly understood. There are many types of diabetes, but most people have type 2 diabetes (90% of cases). Type 2 diabetes is driven by insulin resistance. That may slow tissue repair and cause many complications. There is no doubt that people with diabetes are more likely to have chronic pain. Diabetes is the leading cause of diabetic peripheral neuropathy, disease of large and small blood vessels, and more. It may also upset the body’s automatic controls (the autonomic nervous system). Now studies suggest insulin resistance may be one factor behind the rise in fibromyalgia. In one of the largest population-based studies, researchers analyzed the data of 4.4 million people. They looked at which diseases often come with fibromyalgia. People with fibromyalgia were much more likely to have diabetes than people without it2. We do not call this a major finding, since fibromyalgia seems common in people with many health conditions. Still, it is a step forward. It confirms that people with diabetes are at higher risk of fibromyalgia. It also shows insulin resistance may be one cause. So treating insulin resistance may help manage the condition. It also shows why we should study how hormones affect chronic pain and fibromyalgia. Insulin resistance also raises the risk of depression and poor sleep. Both are common in fibromyalgia. So managing diabetes well in its early stages may help prevent fibromyalgia. We also need to study insulin sensitizers. These drugs help the body respond to insulin. Do they cut pain in fibromyalgia? We need to know. Take metformin. It may help lower blood sugar and is an excellent insulin sensitizer. It also has many other benefits, like weight loss.
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Frequently asked questions
Is insulin resistance a cause of fibromyalgia?
Insulin resistance looks like one factor, not the whole story. Doctors still do not know exactly what causes fibromyalgia. A study of 4.4 million people looked at this. People with fibromyalgia were much more likely to have diabetes. That link points to insulin resistance as one piece of the puzzle. It makes it a target worth treating.
Is fibromyalgia linked to type 2 diabetes?
Yes. One of the largest studies of its kind covered 4.4 million people. In it, fibromyalgia showed up far more often with diabetes. Type 2 diabetes makes up about 90% of diabetes cases, and insulin resistance drives it. People with diabetes also have more chronic pain, such as diabetic peripheral neuropathy. So the two conditions often overlap.
Can treating insulin resistance help fibromyalgia pain?
It may. If insulin resistance helps drive fibromyalgia, treating it has a role in managing the condition. Insulin resistance also raises the risk of depression and sleep problems, both common in fibromyalgia. Managing diabetes well in its early stages may even help prevent fibromyalgia. Insulin sensitizers such as metformin deserve study for pain relief in fibromyalgia.
Why is fibromyalgia so hard to treat?
Three reasons. It is still poorly understood. It is a diagnosis of exclusion, so doctors first rule out other conditions that cause body aches. And no one yet knows its exact cause or how the disease works. That is why doctors often try several treatments before one works. Newer research points to neuroinflammation: changes in the brain that make the body more sensitive to pain.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
