In general, patients with fibromyalgia and other chronic pain syndromes experience generalized aching, extreme fatigue and insomnia. However, the etiologies of fibromyalgia and chronic pain are unclear. Fibromyalgia seems to be associated with genetic predisposition and environmental factors. The disturbance of neurotransmitters and hormones play an important role in developing fibromyalgia and chronic pain. Depression, sleep disturbance, and obesity are also commonly associated with pain disorders. Like the famous question, “What comes first, the chicken or the egg?” The relationship between chronic pain, depression, and obesity is complex and interrelated.

Extended pain can cause a person to become depressed. People with a chronic condition such as osteoarthritis, rheumatoid arthritis, chronic back pain, or fibromyalgia, can become depressed because of increasing pain severity, interference with daily activity, and poor response to treatment and stress. Depression, which produces feelings of gloom, agitation, loss of energy, and worthlessness as well as changes in appetite and sleeping habits, can predispose a patient to develop chronic pain and obesity.

Chronic pain and depression frequently go hand-in-hand and lead to significant disability. Neurotransmitters, chemical substances produced and regulated within the brain, keep everyday pain sensations in sync. When these neurotransmitters become unbalanced as a result of depression, the brain becomes incapable of processing the transmitted pain signals properly, causing the signals to be exaggerated or even distorted. The prognosis of combined depression and chronic pain is poor compared to individuals with depression or pain alone.

Similarly, due to lack of exercise and seeking comforting food as a result of pain, it is not uncommon to see chronic pain patients who are overweight or obese. Multiple epidemiological studies show that fibromyalgia patients are highly likely to be obese (40%) or overweight (30%) when compared to healthier patients. Excess weight is known to aggravate fibromyalgia symptoms: the more severe the obesity, the more severe the fibromyalgia symptoms. Those who have a BMI of 35 or higher experience the worst symptoms and physical functioning. Several mechanisms have been proposed to explain “the hidden link” between fibromyalgia and obesity. A plausible explanation for the close relationship is the possibility that excess body fat triggers metabolic changes that produce inflammation and pain. Notwithstanding, obesity is also commonly associated with depression. Obesity can cause poor self-image, low self-esteem, and social isolation, all known contributors to depression.

Chronic pain, depression and obesity create an almost unbreakable, vicious cycle. Without treating depression and obesity, it is difficult to manage chronic pain successfully. The combination of anti-depressants with relaxation training, positive attitude, healthier diet, and regular exercise, is the best treatment to strategically break this cycle and effectively control pain, depression, and obesity.