I wish I could provide a clear answer for this question but no one really knows what is going on physiologically in people with fibromyalgia. We know it affects the nervous and endocrine systems – I’d say that’s about all that is known with a degree of certainty.
Cortical areas implicated in fibromyalgia include the insula, amygdala, ventromedial prefrontal cortex (VMPFC), and anterior cingulate cortex (ACC) (). They are frequently referred to in aggregate as limbic/paralimbic cortex; they activate in response to many emotions or when affective processing is required. These regions are involved in the processing of thermal and nociceptive information, perhaps influencing their affective quality. At least some components of these networks appear dysfunctional in fibromyalgia.
Some of the medications used to treat fibromyalgia can make hot flashes better (gabapentin) or worse (milnacipran, although milnacipran brought about mild improvement in hot flashes in men treated for prostate cancer). If we understood what the medications are doing, it might shed some light on this aspect of the pathophysiology of fibromyalgia.
This article originally appeared on Quora.