Definition

Fibromyalgia is a condition in which a person has long-term pain that is spread throughout the body. The pain is most often linked to fatigue, sleep problems, difficulty concentrating, headaches, depression, and anxiety.

People with fibromyalgia may also have tenderness in the joints, muscles, tendons, and other soft tissues.

Alternative Names

Fibromyositis; FM; Fibrositis

Causes

The cause is not known. Researchers think that fibromyalgia is due to a problem with how the central nervous system processes pain. Possible causes or triggers of fibromyalgia include:

• Physical or emotional trauma.
• Abnormal pain response: Areas in the brain that control pain may react differently in people with fibromyalgia.
• Sleep disturbances.
• Infection, such as a virus, although none has been identified.

Fibromyalgia is more common in females as compared to males. Women ages 20 to 50 are most affected.

The following conditions may be seen with fibromyalgia or have similar symptoms:

• Long-term (chronic) neck or back pain
• Long-term (chronic) fatigue syndrome
• Depression
• Hypothyroidism (underactive thyroid)
• Lyme disease
• Sleep disorders

Symptoms

Widespread pain is the main symptom of fibromyalgia. Fibromyalgia appears to belong in a range of chronic widespread pain, which may be present in 10% to 15% of the general population. Fibromyalgia falls on the far end of that pain severity and chronicity scale and occurs in 1% to 5% of the general population.

The central feature of fibromyalgia is chronic pain in multiple sites. These sites are the head, each arm, the chest, the abdomen, each leg, the upper back and spine, and the lower back and spine (including the buttocks).

The pain may be mild to severe.

• It may feel like a deep ache, or a stabbing, burning pain.
• It may feel like it is coming from the joints, although the joints are not affected.

People with fibromyalgia tend to wake up with body pain and stiffness. For some people, pain improves during the day and gets worse at night. Some people have pain all day long.

Pain may get worse with:

• Physical activity
• Cold or damp weather
• Anxiety and stress

Most people with fibromyalgia have fatigue, depressed mood, and sleep problems. Many people say that they cannot get to sleep or stay asleep, and they feel tired when they wake up.

Other symptoms of fibromyalgia may include:

• Irritable bowel syndrome (IBS) or gastroesophageal reflux (GERD)
• Memory and concentration problems
• Numbness and tingling in hands and feet
• Reduced ability to exercise
• Tension or migraine headaches

Exams and Tests

To be diagnosed with fibromyalgia, you must have had at least 3 months of widespread pain with one or more of the following:

• Ongoing problems with sleep
• Fatigue
• Thinking or memory problems

It is not necessary for the health care provider to find tender points during the exam to make a diagnosis.

Results from the physical exam, blood and urine tests, and imaging tests are normal. These tests may be done to rule out other conditions with similar symptoms. Studies of breathing during sleeping may be done to find out if you have a condition called sleep apnea.

Fibromyalgia is common in every rheumatic disease and complicates diagnoses and therapy. These disorders include:

• Rheumatoid arthritis
• Osteoarthritis
• Spondyloarthritis
• Systemic lupus erythematosus

Treatment

The goals of treatment are to help relieve pain and other symptoms, and to help the person cope with the symptoms.

The first type of treatment may involve:

• Physical therapy
• Exercise and fitness program
• Stress-relief methods, including light massage and relaxation techniques

If these treatments do not work, your provider may also prescribe an antidepressant or muscle relaxant. Sometimes, combinations of medicines are helpful.

• The goal of these medicines is to improve your sleep and help you better tolerate pain.
• Medicine should be used along with exercise and behavior therapy.
• Duloxetine (Cymbalta), pregabalin (Lyrica), and milnacipran (Savella) are medicines that are approved specifically for treating fibromyalgia.

Other medicines are also used to treat the condition, such as:

• Anti-seizure drugs, such as gabapentin
• Other antidepressants, such as amitriptyline
• Muscle relaxants, such as cyclobenzaprine
• Pain relievers, such as tramadol

If you have sleep apnea, a device called continuous positive airway pressure (CPAP) may be prescribed.

Cognitive-behavioral therapy is an important part of treatment. This therapy helps you learn how to:

• Deal with negative thoughts
• Keep a diary of pain and symptoms
• Recognize what makes your symptoms worse
• Seek out enjoyable activities
• Set limits

Complementary and alternative treatments may also be helpful. These may include:

• Tai chi
• Yoga
• Acupuncture

Support groups may also help.

Things you can do to help take care of yourself include:

• Eat a well-balanced diet.
• Avoid caffeine.
• Practice a good sleep routine to improve quality of sleep.
• Exercise regularly. Start with low-level exercise.

There is no evidence that opioids are effective in the treatment of fibromyalgia, and studies have suggested possible adverse effects.

Referral to a clinic with interest and expertise in fibromyalgia is encouraged.

Outlook (Prognosis)

Fibromyalgia is a long-term disorder. Sometimes, the symptoms improve. Other times, the pain may get worse and continue for months or years.

When to Contact a Medical Professional

Contact your provider if you have symptoms of fibromyalgia.

Prevention

There is no known prevention.

References

Arnold LM, Clauw DJ. Challenges of implementing fibromyalgia treatment guidelines in current clinical practice. Postgrad Med. 2017;129(7):709-714. PMID: 28562155 pubmed.ncbi.nlm.nih.gov/28562155/.

Borg-Stein J, Brassil ME, Borgstrom HE. Fibromyalgia. In: Frontera, WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 102.

Crofford LJ. Fibromyalgia. In: Firestein GS, Budd RC, Gabriel SE, Koretzky GA, McInnes IB, O'Dell JR, eds. Firestein & Kelley's Textbook of Rheumatology. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 55.

Clauw DJ. Fibromyalgia and related syndromes. In: Hochberg MC, Gravallese EM, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 91.

Gilron I, Chaparro LE, Tu D, et al. Combination of pregabalin with duloxetine for fibromyalgia: a randomized controlled trial. Pain. 2016;157(7):1532-1540. PMID: 26982602 pubmed.ncbi.nlm.nih.gov/26982602/.

Goldenberg DL. Diagnosing fibromyalgia as a disease, an illness, a state, or a trait? Arthritis Care Res (Hoboken). 2019;71(3):334-336. PMID: 30724034 pubmed.ncbi.nlm.nih.gov/30724034/.

Lauche R, Cramer H, Häuser W, Dobos G, Langhorst J. A systematic overview of reviews for complementary and alternative therapies in the treatment of the fibromyalgia syndrome. Evid-Based Complement Alternat Med. 2015; 2015:610615. doi:10.1155/2015/610615. PMID: 26246841 pubmed.ncbi.nlm.nih.gov/26246841/.

López-Solà M, Woo CW, Pujol J, et al. Towards a neurophysiological signature for fibromyalgia. Pain. 2017;158(1):34-47. PMID: 27583567 pubmed.ncbi.nlm.nih.gov/27583567/.

Wu YL, Chang LY, Lee HC, Fang SC, Tsai PS. Sleep disturbances in fibromyalgia: a meta-analysis of case-control studies. J Psychosom Res. 2017;96:89-97. PMID: 28545798 pubmed.ncbi.nlm.nih.gov/28545798/.

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