Autonomic Dysfunction in Fibromyalgia

Published: July 13, 2012

In this study, 90 women were asked to fill out a detailed questionnaire looking for symptoms of autonomic dysfunction. 30 of the women had fibromyalgia, 30 had rheumatoid arthritis, and 30 were healthy. The questionnaire used is called the "COMPASS scale."

The autonomic nervous system is the part of our brain that controls blood pressure, sweating, and bowel function (called "peristalsis"). Other functions, such as sleep, may also be controlled by this part of the brain. In this study, the large majority of fibromyalgia patients had a very high autonomic problem score relative to healthy women or those with rheumatoid arthritis. This study suggests that autonomic dysfunction, especially as it relates to overdrive of our adrenaline or sympathetic nervous system, is an integral part of the fibromyalgia.

As discussed in our writings over the last several decades, autonomic dysfunction is a routine part of CFS and fibromyalgia. The autonomic nervous system is controlled by the hypothalamic "circuit breaker" that is malfunctioning in these illnesses (because of the energy crisis), so this study comes as no surprise. There are two key parts of the autonomic nervous system, however. The first is called the "sympathetic nervous system," which is adrenaline driven. The latter is called the "parasympathetic nervous system," which leaves us sleepy and aids digestion. Research is suggesting that the sympathetic/adrenaline nervous system is the part that appears to be on overdrive in fibromyalgia. This then exhausts, leaving you exhausted.

Our experience has shown that addressing fibromyalgia with the "SHINE Protocol" supports recovery of the autonomic nervous system. Especially important is nutritional support with a good multivitamin powder and adrenal support. Increasing salt and water intake is also very helpful.

Autonomic Dysfunction in Fibromyalgia Assessed by the Composite Autonomic Symptoms Scale (COMPASS)

Carla Solano, MD, Aline Martinez, MD, Lizbeth Becerril, MD, Angelica Vargas, MD, Javier Figueroa, MD, Carmen Navarro, MD, Cesar Ramos-Remus, MD, and Manuel Martinez-Lavin, MD


It has been suggested that autonomic nervous system dysfunction may explain all of fibromyalgia (FM) multisystem features. Such proposal is based mostly on the results of diverse heart rate variability analyses. The Composite Autonomic Symptom Scale (COMPASS) is a different validated method to recognize dysautonomia.


The main objective of our study was to investigate symptoms of autonomic dysfunction in FM patients by means of COMPASS. A secondary objective was to define whether there is a correlation between COMPASS and Fibromyalgia Impact Questionnaire (FIQ) scores in FM patients.


Design, analytical cross-sectional study. Our study population included 3 different groups of women: 30 patients with FM, 30 patients with rheumatoid arthritis, and 30 women who considered themselves healthy. All participants filled out COMPASS and FIQ questionnaires.


FM patients had significantly higher values in all COMPASS domains. COMPASS total score (54.6 _ 20.9; mean _ standard deviation) clearly differentiated FM patients from the other 2 groups (21.6 _ 16.5 and 9.5 _ 10.2, respectively). P _ 0.0001. The majority of FM patients gave affirmative answers to questions related to orthostatic, digestive, sleep, sudomotor, or mucosal dysfunction. There was a significant correlation between COMPASS and FIQ scores (Spearman r _ 0.5, P _ 0.005).


Patients with FM have multiple nonpain symptoms related to different expressions of autonomic dysfunction. There is a correlation between a questionnaire that measures FM severity (FIQ) and an autonomic dysfunction questionnaire (COMPASS). Such correlation suggests that autonomic dysfunction is inherent to FM.


J Clin Rheumatol 2009;15

Jacob Teitelbaum, MD

is one of the world's leading integrative medical authorities on fibromyalgia and chronic fatigue. He is the lead author of eight research studies on their effective treatments, and has published numerous health & wellness books, including the bestseller on fibromyalgia From Fatigued to Fantastic! and The Fatigue and Fibromyalgia Solution. His newest book (June 10, 2024) is You Can Heal From Long COVID. Dr. Teitelbaum is one of the most frequently quoted fibromyalgia experts in the world and appears often as a guest on news and talk shows nationwide including Good Morning America, The Dr. Oz Show, Oprah & Friends, CNN, and Fox News Health.

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