Fibromyalgia (fi·bro·my·al·gi·a) is a condition that causes pain all over the body (also referred to as widespread pain), sleep problems, fatigue, and often emotional and mental distress.

People with fibromyalgia may be more sensitive to pain than people without fibromyalgia. This is called abnormal pain perception processing. Fibromyalgia affects about 4 million US adults, about 2% of the adult population.

The cause of fibromyalgia is not known, but it can be effectively treated and managed.

What are the signs and symptoms of fibromyalgia?

The most common symptoms of fibromyalgia are

  • Pain and stiffness all over the body.
  • Fatigue and tiredness.
  • Depression and anxiety.
  • Sleep problems.
  • Problems with thinking, memory, and concentration.
  • Headaches, including migraines.

Other symptoms may include:

  • Tingling or numbness in hands and feet.
  • Pain in the face or jaw, including disorders of the jaw know as temporomandibular joint syndrome (also known as TMJ).
  • Digestive problems, such as abdominal pain, bloating, constipation, and even irritable bowel syndrome (also known as IBS).

What are the risk factors for fibromyalgia?

Known risk factors include:

  • Age. Fibromyalgia can affect people of all ages, including children. However, most people are diagnosed during middle age and you are more ly to have fibromyalgia as you get older.
  • Lupus or Rheumatoid Arthritis. If you have lupus or rheumatoid arthritis (RA), you are more ly to develop fibromyalgia.

Some other factors have been weakly associated with onset of fibromyalgia, but more research is needed to see if they are real. These possible risk factors include:

  • Sex. Women are twice as ly to have fibromyalgia as men.  
  • Stressful or traumatic events, such as car accidents, post-traumatic stress disorder (PTSD).
  • Repetitive injuries. Injury from repetitive stress on a joint, such as frequent knee bending.
  • Illness (such as viral infections).
  • Family history.
  • Obesity.

How is fibromyalgia diagnosed?

Doctors usually diagnose fibromyalgia using the patient’s history, physical examination, X-rays, and blood work.

How is fibromyalgia treated?

Fibromyalgia can be effectively treated and managed with medication and self-management strategies. You can learn about self-management strategies in the section below titled How can I improve my quality of life?

Fibromyalgia should be treated by a doctor or team of healthcare professionals who specialize in the treatment of fibromyalgia and other types of arthritis, called rheumatologists. Doctors usually treat fibromyalgia with a combination of treatments, which may include:

  • Medications, including prescription drugs and over-the-counter pain relievers.
  • Aerobic exercise and muscle strengthening exercise.
  • Patient education classes, usually in primary care or community settings.
  • Stress management techniques such as meditation, yoga, and massage.
  • Good sleep habits to improve the quality of sleep.
  • Cognitive behavioral therapy (CBT) to treat underlying depression. CBT is a type of talk therapy meant to change the way people act or think.

In addition to medical treatment, people can manage their fibromyalgia with the self-management strategies described below, which are proven to reduce pain and disability, so they can pursue the activities important to them.

What are the complications of fibromyalgia?

Fibromyalgia can cause pain, disability, and lower quality of life. US adults with fibromyalgia may have complications such as:

  • More hospitalizations. If you have fibromyalgia you are twice as ly to be hospitalized as someone without fibromyalgia.
  • Lower quality of life. Women with fibromyalgia may experience a lower quality of life.
  • Higher rates of major depression. Adults with fibromyalgia are more than 3 times more ly to have major depression than adults without fibromyalgia. Screening and treatment for depression is extremely important.
  • Higher death rates from suicide and injuries. Death rates from suicide and injuries are higher among fibromyalgia patients, but overall mortality among adults with fibromyalgia is similar to the general population.
  • Higher rates of other rheumatic conditions. Fibromyalgia often co-occurs with other types of arthritis such as osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis.

How can I improve my quality of life?

  • Get physically active. Experts recommend that adults be moderately physically active for 150 minutes per week. Walk, swim, or bike 30 minutes a day for five days a week. These 30 minutes can be broken into three separate ten-minute sessions during the day. Regular physical activity can also reduce the risk of developing other chronic diseases such as heart disease and diabetes. Learn more about physical activity for arthritis. You can exercise on your own or participate in a CDC-recommended physical activity program.
  • Go to recommended physical activity programs. Those concerned about how to safely exercise can participate in physical activity programs that are proven effective for reducing pain and disability related to arthritis and improving mood and the ability to move. Classes take place at local Ys, parks, and community centers. These classes can help you feel better. Learn more about CDC-recommended physical activity programs.
  • Join a self-management education class, which helps people with arthritis or other conditions—including fibromyalgia—be more confident in how to control their symptoms, how to live well and understand how the condition affects their lives. Learn more about the CDC-recommended self-management education programs.

Learn more about fibromyalgia


Fibromyalgia Symptoms, Treatment, Tests, Causes, Diagnosis, Medication


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There are both medication and non-medication treatments for fibromyalgia. Medication treatments frequently help manage the pain and sleeplessness from which fibromyalgia patients suffer.

However, the non-medication treatments are really the basis of treatment for fibromyalgia. The non-medication treatments for fibromyalgia include education, exercise, and stress reduction.

Sleep disorders may require both medication and non-medication treatments.

Education about fibromyalgia is very important. Often patients have suffered with symptoms for years, and simply knowing why they have pain can be a relief, as many patients become anxious not knowing what is causing their symptoms.

Patients should also be educated about treatment approaches, good sleep hygiene, and the importance of treating conditions that may contribute to their symptoms.

For example, when a patient with rheumatoid arthritis has fibromyalgia as well, poor control of their rheumatoid arthritis may lead to worsening of fibromyalgia pain and sleeplessness.

An exercise program is crucial in the treatment of fibromyalgia and should include stretching, strengthening, and aerobic exercise.

Many patients with fibromyalgia find it difficult to institute a regular exercise program because they feel they are too tired to exercise and they may perceive that their pain and fatigue worsen when they begin to exercise.

However, numerous scientific studies have shown that exercise for fibromyalgia, especially aerobic exercise, can improve pain, physical function, and a sense of well-being. Starting slow and sticking with the exercise program is very important.

Low-impact aerobic activities such as swimming, water aerobics, walking, and biking are activities that patients with fibromyalgia find helpful. Many patients find it helpful to exercise in the morning. Some patients find yoga helpful for strengthening and stretching. An aerobic exercise program should also accompany this.

Stress reduction is important for the self-management of fibromyalgia symptoms. Many patients feel that their symptoms are triggered by stress. Stress reduction can be challenging.

There are many stressors in life; some can be changed and others cannot.

Stress reduction involves a combination of changing stressors that can be changed and learning to lessen the body's stress reaction to the stressors that cannot be changed.

Cognitive behavioral therapy is a form of psychological therapy whereby a therapist and patient work together, to establish healthy patterns of behavior by replacing negative thoughts with more productive thoughts and actions. This has been proven to work in fibromyalgia. This form of therapy can be done one on one in an office setting, or even over the Internet.

The non-medication therapies are the cornerstone of treatment for fibromyalgia. With them, many people improve and may not require medications. Moreover, without focusing on sleep hygiene, stress reduction and exercise, it is difficult to improve, even with medication.

When used with non-medication therapies, medication treatments can help improve sleep, pain, and function in fibromyalgia.

Administration of medications is most effective for pain relief when combined with ongoing non-medication treatments as discussed above.

Medications often used in the treatment of fibromyalgia include medications in the antidepressant class (medications originally developed to treat anxiety and depression) and anticonvulsants (medications originally developed to treat seizures).

  • Medications called “tricyclic antidepressants” have been used to treat fibromyalgia for many years. These medications include amitriptyline (Elavil), doxepin (Sinequan, Silenor), and desipramine (Norpramin). These medications are generally started in low doses and increased until adequate response is achieved. The advantage of these medications is that they are effective for sleep and pain, widely available, and less costly for most patients than some of the newer agents. Cyclobenzaprine (Flexeril) is a medication that is both a muscle relaxant and tricyclic antidepressant that can be used to help with sleep and pain in patients with fibromyalgia.
  • Medications in the antidepressant class that affect the serotonin and the norepinephrine neurotransmitters (SNRI antidepressants) are frequently used in the treatment of fibromyalgia. These medications include duloxetine (Cymbalta), milnacipran (Savella), and venlafaxine (Effexor). Norepinephrine is a neurotransmitter in the brain, and increasing the levels of norepinephrine with these medications decreases pain levels. Fluoxetine (Prozac) is an antidepressant that affects mainly serotonin at low doses but increases norepinephrine as well at higher doses. Higher doses of fluoxetine can be used to treat fibromyalgia pain.
  • Pregabalin (Lyrica) and gabapentin (Neurontin) are anticonvulsants (medications initially developed to treat seizures). There are many scientific studies showing that pregabalin and gabapentin can be effective for fibromyalgia pain.
  • Tramadol (Ultram) is an opioid pain reliever, which is helpful in some patients with fibromyalgia but should be used with caution as sometimes the use of opioids can worsen the pain cycle in fibromyalgia.
  • Memantine (Namenda) is a medication commonly used for dementia. Preliminary studies show that memantine may be helpful with pain and other symptoms of fibromyalgia, but further studies are needed to confirm this.
  • There have been small scientific studies of low-dose naltrexone (Revia, Vivitrol) in fibromyalgia. Naltrexone's main scientifically proven use is in treating narcotic addiction. In one small study, a very low dose of naltrexone was shown to benefit some patients with fibromyalgia. Further studies of low-dose naltrexone in fibromyalgia are needed to know if it really works.

A few notes on other treatments for fibromyalgia: Acupuncture can be helpful for some patients with fibromyalgia but is not usually recommended as one of the first-line treatments for fibromyalgia because the scientific studies on acupuncture for fibromyalgia patients have not shown definite benefit.

wise, trigger point injections help for some patients. Alternative medicines have not been proven to be helpful in fibromyalgia; in particular, scientific studies on guaifenesin (Mucinex) show that it does not work.

Of note, patients with vitamin D deficiency can have widespread arthralgia and myalgia, fibromyalgia, which improves with vitamin D supplementation.

While having a sufficient level of vitamin D is important to maintain bone health, a healthy immune system, and perhaps prevent certain types of cancer, vitamin D supplementation does not improve fibromyalgia symptoms in patients who have sufficient levels of vitamin D. Narcotic pain medications should be avoided in fibromyalgia because they may worsen the underlying problem.


What You Need to Know About Fibromyalgia


Fibromyalgia is a fairly common syndrome characterized by symptoms such as muscle pain, painful areas of the body called tender points, and fatigue.

See Getting the Sleep You Need With Fibromyalgia

The overall extent and nature of symptoms vary widely from person to person, and the symptoms may be chronic or they may come and go over time, sometimes making it challenging to get an accurate diagnosis.

See Suffering and Chronic Pain

arthritis, fibromyalgia is considered a rheumatic condition because impacts the muscles, joints, and bones. See How Arthritis Causes Joint Pain

The term fibromyalgia stems from the Latin “fibra,” for fibrous tissue, the Greek words “mys” for muscle, and “algia” for pain. Before the 1980s, the condition was called fibrositis.

Fibromyalgia does not harm organs and is almost never life-threatening, though it can significantly impact one's quality of life. The focus of treatment is to manage the pain and symptoms.

See Finding the Right Medical Treatment for Chronic Pain and Depression


Fibromyalgia shares some symptoms with arthritis, including chronic pain and fatigue. arthritis, it is considered a rheumatic condition because it has an impact on the muscles, joints, and bones. The condition is different from chronic pain and arthritis in important ways, however, such as:

  • Fibromyalgia does not damage joints or muscles, and inflammation does not play a significant role, though many of the tender points are near the joints.
  • There are no outward signs of inflammation in adults. Children may experience some brief swelling.
  • Fibromyalgia is not a degenerative condition. Patients’ symptoms may improve following diagnosis and treatment.

Rheumatologists often treat fibromyalgia, but many people also see internists, family practice physicians or other qualified health professionals to manage their condition.

See What Is a Rheumatologist?

Due to the range of symptoms associated with fibromyalgia, an interdisciplinary health care team is generally beneficial. In addition to the main treating physician, who is usually a rheumatologist, a physical therapist is usually part of this team, and a chiropractor, neurologist, pain specialist, physiatrist, and psychologist or psychiatrist may also be involved.

See Other Specialists for Arthritis Treatment

Coexisting Conditions

Many individuals with fibromyalgia have at least one other medical condition.

See Fibromyalgia or Not? 6 Conditions to Know

Other rheumatic conditions are especially common in those with fibromyalgia. An estimated 25% to 65% also have systemic lupus erythematosus, ankylosing spondylitis, or rheumatoid arthritis.

See Ankylosing Spondylitis Diagnosis

Symptoms of these coexisting conditions may overlap with those of fibromyalgia, leading to a delay in diagnosis. Further complicating a diagnosis is the fact that there is no single, widely accepted diagnostic test for fibromyalgia. Instead, diagnosis is based largely on the patient's symptoms and by using medical tests to rule out other conditions.

See Rheumatoid Arthritis (RA) Diagnosis


When an individual has fibromyalgia, the brain overreacts to pain signals, intensifying feelings of pain in different parts of the body. It is not known what sets off this reaction, though in some cases it appears to be tied to a stressful or traumatic event, illness, injury, or another disease. The condition runs in families, but a specific gene for fibromyalgia has not been found.

See Chronic Pain Can Lead to Depression

More Common in Women

It is estimated that about 2% to 4% of adults have fibromyalgia.1 About 80% to 90% of people with fibromyalgia are women,1 typically between the ages of 40 and 75, and the symptoms tend to be more severe in women.

In recent years, more men have been diagnosed than in the past, possibly as a result of shifts in the diagnostic criteria beginning in 2010.2,3 In children, the condition is most often diagnosed in adolescence and is known as juvenile-onset fibromyalgia.

See Symptoms and Causes of Juvenile Rheumatologic Diseases

Under-diagnosis is a major concern; it is believed that up to 75 percent of those with fibromyalgia have not been diagnosed.4


Fibromyalgia | FMS

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Fibromyalgia is chronic condition that causes pain all over the body, fatigue, and other symptoms. People with fibromyalgia may be more sensitive to pain than people who don't have it. This is called abnormal pain perception processing.

What causes fibromyalgia?

The exact cause of fibromyalgia is unknown. Researchers think that certain things might contribute to its cause:

  • Stressful or traumatic events, such as car accidents
  • Repetitive injuries
  • Illnesses such as viral infections

Sometimes, fibromyalgia can develop on its own. It can run in families, so genes may play a role in the cause.

Who is at risk for fibromyalgia?

Anyone can get fibromyalgia, but it is more common in

What are the treatments for fibromyalgia?

Not all health care providers are familiar with fibromyalgia and its treatment. You should see a doctor or team of health care providers who specialize in the treatment of fibromyalgia.

Fibromyalgia is treated with a combination of treatments, which may include medicines, lifestyle changes, talk therapy, and complementary therapies:

  • Medicines
    • Over-the-counter pain relievers
    • Prescription medicines that were specifically approved to treat fibromyalgia
    • Prescription pain medicines
    • Certain antidepressants, which may help with pain or sleep problems
  • Lifestyle changes
    • Getting enough sleep
    • Getting regular physical activity. If you have not already been active, start slowly and gradually increase how much activity you get. You may want to see a physical therapist, who can help you create a plan that is right for you.
    • Learning how to manage stress
    • Eating a healthy diet
    • Learning to pace yourself. If you do too much, it can make your symptoms worse. So you need to learn to balance being active with your need for rest.
  • Talk therapy, such as cognitive behavioral therapy (CBT), can help you learn strategies to deal with pain, stress, and negative thoughts. If you also have depression along with your fibromyalgia, talk therapy can help with that too.
  • Complementary therapies have helped some people with the symptoms of fibromyalgia. But researchers need to do more studies to show which ones are effective. You could consider trying them, but you should check with your health care provider first. These therapies include
    • Massage therapy
    • Movement therapies
    • Chiropractic therapy
    • Acupuncture
  • Fibromyalgia (National Institutes of Health)
  • Fibromyalgia (Medical Encyclopedia) Also in Spanish


Why Fibromyalgia Is So Puzzling


Fibromyalgia is a chronic disorder characterized by widespread pain that is often accompanied by fatigue, depression, sleep disturbance, cognitive impairment, and digestive and urinary symptoms.

It is a poorly understood disorder in which pain signals processed by the brain appear to be exaggerated, amplifying the sensation of pain in muscles and soft tissues. There are no tests to identify it, so fibromyalgia is diagnosed by excluding other possible causes.

Treatment may involve over-the-counter pain relievers, antidepressants, physical therapy, self-care, and medications specifically approved to treat fibromyalgia, such as Lyrica (pregabalin). 

What does fibromyalgia feel ? It's about more than just muscle aches and joint pain. It is persistent, widespread pain that can move through the body in waves, causing sensations described as throbbing, diffuse, intense, or stabbing. Even mild changes in temperature or pressure (including touch) may trigger discomfort.

While some people maintain fairly consistent levels of symptoms, others will go through periods of remission alternating with periods of activity (flares). Beyond pain, fibromyalgia is associated with an almost dizzying array of symptoms affecting multiple organ systems. They include:

  • Fatigue, usually chronic, affecting four five people with the disorder
  • Muscle and joint symptoms such as muscle spasms, muscle weakness, and jaw pain
  • Cognitive symptoms such as the loss of concentration, disorientation, and “brain fog”
  • Sleep disorders such as broken sleep, sleep starts, and insomnia
  • Neurosensory symptoms such as vertigo, migraine, or sensitivity to light, sound, or smells
  • Gastrointestinal symptoms such as diarrhea, constipation, bloating, or cramping
  • Urinary symptoms including bladder pain, pain during urination, or the frequent urge to urinate
  • Psychiatric symptoms such as depression, mood swings, hypervigilance, or panic attacks
  • Reproductive symptoms such as painful periods, pelvic pain, or early menopause

Temporary hair loss, heart palpitations, and the benign overgrowth of fatty tissue (lipomas) may also occur.

People with fibromyalgia tend to unusually high concentrations of two chemicals, known as substance P and glutamate, in their body. Substance P and glutamate are involved in the transmission and regulation of pain information. By having such elevated levels of substance P and glutamate, the pain messages to and from the brain may effectively be over-exaggerated.

Similarly, a number of smaller studies have shown that people with fibromyalgia tend to have decreased blood flow to the thalamus, the section of the brain that acts as the center of pain perception. It is strongly believed that this may also contribute to the heightened pain perception.

While fibromyalgia is today recognized as a syndrome by the medical community, there remains debate as to whether it is a purely somatic (physical) disorder. The symptoms of fibromyalgia are clearly influenced by depression, anxiety, sleep problems, and stresses that can either enhance the perception of pain or directly affect neurological function.

At this stage, we simply don't know. What we do know is that certain risk factors may increase the odds of getting fibromyalgia. Among them:

  • Women are nine times more ly to have fibromyalgia than men. It has been suggested that decreases in estrogen during menstruation and around the time of menopause. 
  • Age is also a factor. Despite being considered a disorder affecting post-menopausal women, fibromyalgia is most often diagnosed between the ages of 20 and 50, although symptoms usually develop several years prior. Children can also have fibromyalgia.
  • Stress appears to precipitate fibromyalgia symptoms. When accompanied by sleep problems, the perception of pain is further heightened as is the risk of fatigue and depression.
  • Genetics are also believed to be a factor. Research suggests that having a parent or sibling with fibromyalgia significantly increases your risk.

With no lab or imaging tests able to confirm the disorder, diagnosis of fibromyalgia requires first excluding other possible causes of your symptoms. It can be a painstaking process that should be overseen by a rheumatologist or, alternately, a neurologist or general practitioner experienced with fibromyalgia or other connective tissue issues.

In 2010, the American College of Rheumatology (ACR) updated their diagnostic criteria for fibromyalgia, taking into consideration the distribution of the pain, the duration of the pain, and your perception of the pain and other symptoms.

The ACR criteria include two score-based evaluations:

  • The first, called the widespread pain index (WPI), assigns one point for each of the 19 body parts in which you’ve experienced pain (for a maximum of 19 points).
  • The second, called the symptom severity (SS) scale, assigns 0 to 3 points—0 meaning no symptoms, 3 meaning serious symptoms—to each of four characteristic symptoms of the disorder (for a maximum of 12 points).

While these are physicians' tools, knowing more about them can give you a sense of what your doctor will factor into his diagnosis decision making.

Get our printable guide for your next doctor's appointment to help you ask the right questions.

To be diagnosed with fibromyalgia, you need to satisfy the following three conditions:

  1. You must have either a) WPI of 7 or more with an SS score of 5 or more, or b) a WPI of 3 to 6 and an SS score of 9 or more.
  2. You must have had these symptoms for at least three months.
  3. There must be no other medical explanation for your symptoms.

There is no single pill that can treat fibromyalgia or ensure the sustained remission of symptoms. A multi-faceted approach is needed, which may include over-the-counter (OTC) and prescription medications, physical therapy and counseling, lifestyle interventions, and complementary therapies.

Because no two cases of fibromyalgia are a, treatment can vary from one person to the next.

Medications are typically the backbone of therapy. The choice of drugs is largely dependent on the types and severity of your symptoms and how well you tolerate any side effects. Among them:

Sleep problems are typically treated with low-dose antidepressants, Elavil (amitriptyline), rather than sleeping pills. Muscle relaxers, Flexeril (cyclobenzaprine), can also do double-duty by alleviating muscle tension while helping a person sleep.

In addition to medications, your doctor may refer you to specialists who can help you overcome physical or emotional challenges, including physical therapists, occupational therapists, psychiatrists, or counselors.

Lifestyle Modifications and Complementary Treatments

Stress alleviation is among the primary facets of any fibromyalgia treatment plan. Relaxation techniques and mind-body therapies are obvious and helpful options.

But eating better, exercising, and avoiding things caffeine, alcohol, and smoking can also help elevate your mood.

In particular, physical activity triggers the release of serotonin, dopamine, and endorphins, what many dub “feel-good” chemicals.

Complementary approaches to treatment include:

  • Meditation, guided imagery, and deep breathing (pranayama) to alleviate stress
  • Yoga and Tai Chi, which incorporate controlled movements and the release of tension
  • Massage therapy, especially gentler forms Shiatsu or aromatherapy massage
  • Progressive muscle relaxation (PMR), which focuses the release of tension by body part
  • Biofeedback, which can teach you how to control the stress response
  • Medical marijuana, which can reduce pain, elevate mood, and help you sleep better
  • 5-HTP (5-hydroxytryptophan), a naturally-occurring amino acid that can be taken as a supplement, which may help raise serotonin levels

Despite increased public awareness, fibromyalgia remains a mystery to many peoples, some of whom may doubt its existence or suggest that it’s “all in your head.” It is not.

Don’t let other people’s misconceptions prevent you from seeking the care you need. Find support from friends and family, opening up about not only what you feel but how you feel.

Join a local support group or contact the National Fibromyalgia & Chronic Pain Association to find one near you.

Building a support system can provide you with the confidence and education to become an advocate for your own care.

If your doctor is unable to help or understand your concerns, find a rheumatologist in your area through the online locator offered by the American College of Rheumatology. Drug co-pay and patient assistance programs are also available to help defray the cost of treatment, if you are eligible.


Characteristic Symptoms of Fibromyalgia


Fibromyalgia symptoms typically intensify, or flare, periodically. These flares can be unpredictable; what was an invigorating walk one day could be excruciatingly painful the next.

Symptoms may also ease considerably or even disappear for days, months, or longer, only to re-appear again at a later date.

See How to Understand Chronic Pain vs. Acute Pain


The number and type of fibromyalgia symptoms vary with the individual, but chronic pain and stiffness, fatigue, sleep problems, and cognitive impairment are common.

Musculoskeletal pain
The body pain can range from a dull ache to a burning or shooting pain, and parts of the body may feel sore. Some individuals compare the body pain to that of the flu. The pain may be worsened by a variety of factors, such as physical activity, cold or damp weather, stress, or the time of day.

See Suffering and Chronic Pain

Tender points
A characteristic sign of fibromyalgia is the small, sensitive spots around the body known as tender points. Tender points are discreet areas of tenderness in the muscular and tendinous tissue in the body. Pain radiates out from these points, and some individuals have pain in all 19 tender points.

See Are My Painful Joints Caused By Rheumatoid Arthritis (RA) or Something Else?

These points are painful when minor pressure is applied, as when a doctor presses his or her finger on the area during a physical examination. The pain is felt in the body’s soft tissues, such as muscles and ligaments.

See Doctors Who Treat Fibromyalgia

Many patients report stiffness, which is generally widespread and diffuse. As is typical of other rheumatic diseases, the stiffness is usually worse in the morning and may improve as the day progresses. It is usually exacerbated the day after physical exertion or exercise.

See Is My Joint Pain Caused by Rheumatoid Arthritis (RA) or Another Autoimmune Disorder?

Patients sometimes report feeling exhausted or weighed down by fibromyalgia. It is common to experience short periods of energy (such as for 24 to 48 hours), only to rebound into feeling fatigued and tired again.

See Getting the Sleep You Need With Fibromyalgia

For some, fibromyalgia fatigue is more of a disability than the pain, as it can substantially impact quality of life. Fatigue can make it difficult to sustain or progress in a career, make social plans, and participate in life's milestones, such as family events. Lack of social interaction can in turn contribute to a feeling of isolation or depression.

See Chronic Fatigue Syndrome and Myofascial Pain Syndrome vs. Fibromyalgia

Non-restorative sleep
Most individuals with fibromyalgia have sleep problems and feel tired upon waking no matter how long they sleep. Pain is often one cause, but individuals with fibromyalgia are also more ly than average to have sleep-related problems such as restless legs syndrome and sleep apnea, which causes breathing to stop briefly while sleeping.

See Coping with Chronic Pain and Insomnia

These sleep disruptions may prevent an individual from getting the deep sleep that allows muscles to relax and tissues to rebuild. Some doctors think the lack of quality sleep may contribute to fibromyalgia’s mental sharpness and fatigue issues. Sleep deprivation has been shown to make pain worse even for those without chronic conditions.1

See Therapies for Treating Insomnia

Difficulty focusing
Difficulties with focusing, paying attention, and retaining new information are sometimes referred to as “brain fog” or “fibro fog.” Patients may also have trouble using the right words when they talk or have short-term memory loss. These cognitive issues tend to occur most when the individual is feeling tired, stressed, or anxious.

The lack of sharpness varies from person to person, and can last hours, weeks, or longer. For some people, the problem can be serious enough to affect job performance. Driving is unsafe if the impairment is severe.


Individuals with fibromyalgia are more ly than others to have coexisting medical issues including, but not limited to:

  • Ankylosing spondylitis
  • Anxiety
  • Bladder problems, including painful or frequent urination
  • Coping with Fatigue syndrome
  • Depression
  • Dizziness/balance problems
  • Dry mouth
  • Extra sensitivity to bright light, foods, and noise
  • Gynecological problems, including endometriosis, painful periods, and vulvodynia
  • Hypothyroidism (underactive thyroid gland)
  • Irritable bowel syndrome
  • Low back pain
  • Multiple chemical sensitivities
  • Muscle twitches and cramps (also called muscle spasms)
  • Myofascial pain syndrome
  • Numbness/tingling in hands and feet
  • Post-traumatic stress disorder
  • Restless legs syndrome
  • Rheumatoid arthritis
  • Sleep apnea
  • Systemic lupus erythematosus (lupus)
  • Painful or frequent urination
  • Temporomandibular joint (TMJ) disorders, including tinnitus (ringing in the ears)
  • Tension and migraine headaches
  • Temperature sensitivity

See Conditions Related to Inflammatory Arthritis

Some of these symptoms are particularly prevalent. In one study of 529 patients, 71% reported anxiety, and 56% reported symptoms of depression.2

See Conditions Related to Degenerative Arthritis

Reponses to an online survey by the National Fibromyalgia Association with more than 10,000 responses also pointed to a large number of overlapping conditions. More than 60% reported low back pain, and more than 40% listed one or more these symptoms:

  • Arthritic joint pain
  • Balance problems
  • Irritable bowel syndrome
  • Muscle spasms
  • Numbness
  • Recurrent headaches
  • Tingling3

Keeping a diary of activities, stressors, and environmental factors may help patients track what makes symptoms better or worse. Once these “triggers” are known, strategies to avoid or minimize them can be developed.

See How Mind-Body Techniques Help With Fibromyalgia

Modulating Factors

While the timing of some symptom flares is unpredictable, the following situations typically lead to an exacerbation of symptoms:

  • Cold, damp weather
  • Stress
  • Overexertion

See Exercise Helps Relieve Fibromyalgia Symptoms

The reverse is also true. Patients feel better with warm weather, hot baths, or even vacations from home or work. Non-steroidal anti-inflammatory medications (NSAIDs), such as ibuprofen and naproxen, usually do not alleviate symptoms.4,5

See More Holistic Life Changes for Pain and Depression


What is Fibromyalgia?


Fibromyalgia (fy-bro-my-AL-ja) is a common and complex chronic pain disorder that causes widespread pain and tenderness to touch that may occur body wide or migrate over the body.  Along with other symptoms, pain and tenderness wax and wane over time.  Fibromyalgia (FM) affects people physically, mentally and socially.

 Approximately 10 million Americans (2-4%) have FM with a ratio of about 8 to 2, women over men.  It occurs in people of all ages, including children. The literal translation of the word fibromyalgia is pain in the muscles, ligaments and tendons. But FM is much more than pain and presents with many other symptoms that vary from person to person.


Healthcare providers diagnose FM a combination of relevant symptoms, or how the person feels, including fatigue, tenderness, functionality, and overall well-being.  Lab tests may be needed to rule out or diagnose co-existing conditions (i.e., lupus, thyroid hormone resistance, rheumatoid arthritis).

Symptoms of fibromyalgia can vary in intensity.  Fatigue, sleep disturbances (sleep apnea and/or waking up unrefreshed), cognitive difficulties (memory problems or thinking clearly), and stiffness are the most prevalent symptoms reported.

  Additional common symptoms may include depression or anxiety, migraines, tension headaches, pelvic pain, irritable or overactive bladder, irritable bowel syndrome (IBS), TMJD (including tinnitus), and gastrointestinal reflux disease (GERD).

  Stress often worsens the related problems and symptoms.

  In a 2013 survey of people with fibromyalgia by Oregon Health and Sciences University and the National Fibromyalgia & Chronic Pain Association, symptoms were measured as well as the impact of fibromyalgia on daily living.  (To read survey results, please click here.) 

There is no cure for fibromyalgia.  Multi-disciplinary approaches for management and relief of symptoms are often recommended.  Medications, cognitive behavioral therapies, and gentle exercise are the most common combinations.

  In partnership with a healthcare provider, development of self-management strategies and long-term health goals may reduce the chronic symptoms and the frequency, duration, and intensity of periodic flares (rapid increase of symptoms).

  Cultural attitudes and stigmatization of people with chronic pain issues often cause people with fibromyalgia to become withdrawn from family and friends.  Isolation and feeling alone to manage fibromyalgia can contribute to depression.

Symptoms ->

HISTORY FM has existed for centuries, and our great grandmothers who experienced FM symptoms were probably diagnosed with rheumatism.  In 1904 Sir William Gowers gave a Lecture on Lumbago:  Its Lessons and Analogues, to physicians at the National Hospital for the Paralyzed and Epileptic in London, England.

  It was during this lecture that Dr. Gowers described “fibrositis” for the first time and the term began to be used as a descriptive word for the symptoms of soft tissue rheumatism.  The word fibrositis indicated that inflammation was present which contributed to the patient's pain experience.

As science advanced and more was learned about the disorder, it became evident that the kind of inflammation found in arthritic diseases is not present in FM.  It took until 1976 for the “itis”to be dropped and fibromyalgia syndrome adopted as the new title for this age old malady.

  Syndrome was added to fibromyalgia because the term offers a way to compile the different symptoms of fibromyalgia into one disorder, discernible by healthcare professionals.

In the late 1990's fibromyalgia syndrome (FMS) transitioned into just fibromyalgia (FM) because research began to uncover more scientific evidence of FM being a distinct entity.  Although FM has become a familiar medical term, it continues to baffle the professional community as well as the people it affects.

SCIENTIFIC PERSPECTIVE Fibromyalgia is a chronic pain state in which the nerve stimuli causing pain originates mainly in the tissues of the body.  Hence the increased pain on movement and the aggravation of fibromyalgia by strenuous exertion.

Pain is a universal experience that serves the vital function of triggering avoidance. A few unfortunate individuals have a congenital absence of pain sensation; they do not fare well due to repeated bodily insults that go unnoticed. Physicians see patients with an acquired deficiency in the pain sensation (e.g.

diabetic neuropathy or neurosyphilis) who develop a severe destructive arthritis–a result of repeated minor joint injuries that are overlooked. Thus pain sensation is a necessary part of being human. Pain sensation is a fact of life. Even the primitive amoeba takes avoiding action in the face of adverse events.

In such primitive life forms, pain avoidance is purely reflex action, as they do not have the complexity of a highly developed brain to feel pain in the sense that humans do: (1)The unconscious reflex avoidance reaction that is so rapid that it occurs before the actual awareness of the pain sensation (as in all life forms), (2) the actual experience of the pain sensation (that can only occur in highly complex organisms). This is an important point, as it implies that different parts of the brain are involved in these two consequences of the pain reaction.

Over the last few years a number of important research discoveries have started to clarify the enigma of chronic pain. Many of these new findings have a special relevance to the chronic pain of fibromyalgia. The cardinal symptom of FM is widespread body pain.

The cardinal finding is the presence of focal areas of hyperalgesia, the tender points. Tender points imply that the patient has a local area of reduced pain threshold, suggesting a peripheral pathology.

In general, tender points occur at muscle tendon junctions, a site where mechanical forces are most ly to cause micro-injuries. Many–but not all–FM patients have tender skin and an overall reduction in pain threshold.

These latter observations suggest that some FM patients have a generalized pain amplification state. There has been a recent plethora of experimental studies apposite to the pathophysiological basis of both the peripheral and central aspects of pain.

In his article “Fibromyalgia: A Clinical Review” published in the Journal of the American Medical Association (JAMA), April 16, 2014, Dr.

Dan Clauw, Director of the University of  Michigan’s Chronic Pain and Fatigue Research Center expands on current scientific thought regarding the type of pain experienced by people with fibromyalgia:
“Fibromyalgia can be thought of as a centralized pain state.

  Centralized pain is a lifelong disorder beginning in adolescence or young adulthood manifested by pain experienced in different body regions at different times.  Centralized refers to central nervous system origins of/or amplification of pain.  This term does not imply that peripheral nociceptive input  (i.e.

damage or inflammation of body regions) is not contributing to these individuals’ pain but rather that they feel more pain than would normally be expected the degree of nociceptive input.

  Understanding centralized pain is important for surgeons and proceduralists because patients with these disorders may request interventions to eliminate pain (e.g. hysterectomy, back surgery). Not surprisingly, this pain-prone phenotype, best exemplified by a patient with fibromyalgia, predicts failure to respond to opioids or operations performed to reduce pain.”

PATIENT PERSPECTIVE Symptom severity of FM ranges from slight to severe.  Fibromyalgia is life-altering.  If you ask any person with fibromyalgia what fibromyalgia is, their response would be pain; from the top of their head to the end of their toes.

  Pain that “waxes and wanes” from day to day and persists even with the use of scientifically accepted medical treatments.  The pain experience is described as deep muscular aching, shooting, throbbing, stabbing, pounding, along with many other descriptions, and at times it is unbearable.

  People with FM do not sleep well, waking up feeling they have been hit by a “Mack truck,” with morning stiffness or spasticity that makes it difficult to move.  Repetitive movement seems to accentuate the pain and forces many people with FM to severely limit their activities, including exercise routines.

  This lack of exercise results in people becoming physically unfit, causing their FM symptoms to become more severe.  The other major complaint is fatigue so severe that people have a difficult time performing everyday tasks, enjoying hobbies, staying employed or taking part in their children's activities.

  People may feel as though their arms and legs are weighed down by cement, and their bodies may feel so drained of energy that every task is a major effort.

The progression of fibromyalgia research has provided new knowledge about centralized pain that is already helping to open doors to better, more effective treatment for people with fibromyalgia.