How is pathophysiology of fibromyalgia?

Central sensitization Genetic (familial, COMT polymorphism affects central pain) Altered pain mechanism (noxious stimuli like heat, electric, pressure painful more than normal control, substance P increased in CSF) Sleep disturbance (phasic alpha sleep activity characteristic FM, increase cyclic alternating pattern of sleep) Neurohormonal perturbation (hyperactivity of stress response, altered HPA axis linked to childhood trauma, physical abuse, abnormal GH levels) Autonomic nervous system dysfunction (low Dopa, serotonin, adrenaline)