Dopamine – The Missing Link
Your brain uses a network of freeways (the basal ganglia) to interpret incoming signals and formulate appropriate responses. This communication highway strongly relies on dopamine to fine-tune the process but this transmitter is greatly reduced in people with fibromyalgia. And low brain dopamine contributes to many symptoms, including pain, fatigue, fibrofog, loss of motivation, and lack of pleasure.
Conventional treatments prescribed for fibromyalgia work by raising serotonin, norepinephrine and GABA, but not dopamine. As a result, you are left holding a bag full of unresolved symptoms. However, certain medications and therapy alternatives that raise dopamine can lighten your symptom load.
Fibro Research Findings
Structures deep within the basal ganglia pour out dopamine when healthy people are subjected to a painful stimulus. It’s a natural response to reduce the impact of the discomfort. However, a brain imaging study shows this dopamine response is blunted in fibromyalgia patients and helps explain why your pain processing system is crippled.1
Looking at important brain centers that are affected by the depletion of dopamine, the hippocampus is the hardest hit.2 This area is most noted for its role in memory and cognition. But other centers involved in pain regulation, like your thalamus and insula, are also seriously impacted.
Overall, the available levels of dopamine are reduced by 30 percent in the brains of people with fibromyalgia.3 And the low levels aren’t a fluke. Research studies in fibromyalgia patients show that decreased dopamine correlates with the reduced pain thresholds (the lower the dopamine, the greater the patient’s pain).
Aside from being known as the feel-good chemical that relieves pain and enhances cognitive processes, dopamine powers your brain’s reward system. It increases vitality, reduces fatigue, and lifts mood. In addition, it drives motivation so you can achieve your desired goals and feel a sense of gratification. Sadly, though, the most often prescribed treatments for your symptoms do not alter dopamine.
Although two brain imaging studies confirm that dopamine is depleted in fibromyalgia, one doesn’t need to measure this chemical to assess its impact on you. Researchers can also look at the function of brain centers that heavily rely on this transmitter.
Take for example, the prefrontal cortex (PFC). It’s essential for reward, motivation, and pleasure, but it doesn’t respond when fibromyalgia patients are promised a reward.4 The resulting loss of motivation, desire and sense of malaise are real, yet these symptoms are often misinterpreted.
It’s NOT Depression
Almost every fibromyalgia research study assesses patients for symptoms of depression. It’s standard protocol and it feeds the misconception that most patients are depressed. If only you could take an antidepressant to get rid of your fibromyalgia, you would gladly do so. But chances are, this simplistic view of your disease has led to treatment disappointments.
Questionnaires used to measure depression ask you about fatigue, reduced joy or pleasure in life, and lack of motivation. When your brain is low in dopamine, you are bound to respond “yes” to these inquires, but it doesn’t mean you are depressed. Your emotional emptiness could be due to anhedonia, the loss of pleasure from activities that used to be rewarding. This condition occurs in fibromyalgia because the reward/motivation system doesn’t work properly.5
Anhedonia and depression produce overlapping symptoms, such as lack of interest in activities that once gave you joy. However, the two conditions involve different brain chemicals. Anhedonia is linked to low dopamine while depression is strongly tied to serotonin imbalances. And although there is a questionnaire that picks up anhedonia, it is seldom used … not even in research on fibromyalgia.
Understandably, your reduced motivation and inability to feel pleasure can lead to sadness and compound depression. But if treatment for depression doesn’t resolve your emotional numbness, you might benefit from a dopamine-raising medication.
Boosting Dopamine
None of the FDA-approved drugs for fibromyalgia work to increase brain dopamine. But there are a class of drugs, called NMDA receptor antagonists, that can stimulate dopamine transmissions. In turn, they can provide pain relief, ease fibrofog, and reduce the symptoms of anhedonia. Your best option in this class is a prescription drug called memantine.
Two separate trials using 20 mg/day of memantine in fibromyalgia patients shows it improves pain, cognition, and overall disease severity.6,7 Symptoms of depression also improved (but anhedonia was not measured). Memantine cuts fibromyalgia symptoms in half in one out of six patients … but the odds of a 30 percent improvement could be as high as one out of three or four patients.
Memantine has been on the market for more than 20 years and it’s inexpensive ($12/month through a prescription savings plan such as the GoodRx). It can be used long term and has minimal side effects (mostly dizziness and headaches).
If you have tried several antidepressants but you still feel empty, talk to your doctor about bupropion. It treats anhedonia by working on norepinephrine and dopamine to stimulate the brain’s reward and motivation pathways.
Self-help therapies can also boost dopamine. For example, listening to music reduces pain perception in fibromyalgia and improves brain function in centers that rely heavily on dopamine (such as the insula and the thalamus).8 And naturally, aerobic exercise activates dopamine too and you might try combining it with your favorite music.
Transcranial magnetic stimulation (TMS) of the brain’s reward centers is another treatment approach that is being studied in fibromyalgia patients. In fact, an AFSA-funded study is investigating the potential of stimulating the prefrontal cortex to alleviate your key symptoms.
Digging Deeper
Your brain neurons responsible for producing and transmitting dopamine signals are not as active as they should be. But unlike Parkinson’s disease, in which many dopamine releasing neurons are destroyed, there is no evidence of nerve degeneration in fibromyalgia. So, what could be causing your dopamine malfunction?
One theory, borrowed from Parkinson’s research, points to glial cell activation.9 These cells nourish and help regulate neuron function, but these processes are adversely impaired when glial cells are in an activated state. As it turns out, the glial cells are activated throughout the brain in fibromyalgia patients (see the next article). However, the dopamine-glial cell link in fibromyalgia needs to be explored.
There are two approaches to quite your brain’s glial cells (low-dose naltrexone and a supplement called PEA). But treatment strategies that stimulate the dopamine-producing neurons in your brain are your best bet for improving dopamine function.
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Naltrexone | PEA | TMS | Dopamine Reward System | Why So Many Symptoms?
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References for Dopamine in Fibromyalgia
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- Wood PB, et al. Eur J Neurosci 25(12):3576-3582, 2007. Abstract
- Wood PB, et al. J Pain 10(6):609-618, 2009. Free Report
- Albrecht DS, et al. Brain Imaging Behav 10(3):829-839, 2016. Free Report
- Park SH, Baker AK, Martucci KT. Sci Rep 25(1):14560, 2025. Free Report
- Kim M, et al NeuroImage 211:116656, 2020. Free Report
- Olivan-Blazquez b, et al. PAIN 155(12):2517-2525, 2014. Abstract
- Fayed N, et al. Neuroradiol J 32(6):408-419, 2019. Free Report
- Prando-Naude V, et al. Sci Rep 9(1):15486, 2019. Free Report
- Wang T, et al. Cells 12(19):2336, 2023. Free Report