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, headaches, depression, and anxiety.
People with fibromyalgia may also have tenderness in the joints, muscles, tendons, and other soft tissues.
Fibromyositis; FM; Fibrositis
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
- Hypothyroidism (underactive thyroid)
- Lyme disease
- Sleep disorders
Pain is the main symptom of fibromyalgia.
The areas where pain occurs are called tender points. These points are found in the soft tissue on the back of the head, neck, shoulders, chest, lower back, hips, elbows, and knees. The pain then spreads out from these areas. The qualities of the pain are:
- It 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 of the 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)
- 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
- Thinking or memory problems
It is not necessary 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 may also occur in people who have other forms of arthritis, such as:
- Rheumatoid arthritis
- Systemic lupus erythematosus
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 health care 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
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.
Your provider may refer you to a pain clinic if your condition is severe.
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
Call your provider if you have symptoms of fibromyalgia.
There is no known prevention.
Bennett RM. Fibromyalgia, chronic fatigue syndrome, and myofascial pain. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 274.
Bernardy K, Klose P, Busch AJ, Choy EH, Hauser W. Cognitive behavioural therapies for fibromyalgia. Cochrane Database Syst Rev. 2013;(9):CD009796. PMID: 24018611 www.ncbi.nlm.nih.gov/pubmed/24018611.
Clauw DJ. Fibromyalgia: a clinical review. JAMA. 2014;311(15):1547-1555. PMID: 24737367 www.ncbi.nlm.nih.gov/pubmed/24737367.
Clauw DJ. Fibromyalgia and related syndromes. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2015:chap 80.
Crofford LJ. Fibromyalgia. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. Kelley and Firestein's Textbook of Rheumatology. 10th ed. Philadelphia, PA: Elsevier; 2017:chap 52.
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 www.ncbi.nlm.nih.gov/pubmed/26982602.
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. www.hindawi.com/journals/ecam/2015/610615/.
Marvisi M, Balzarini L, Mancini C, Ramponi S, Marvisi C. Fibromyalgia is frequent in obstructive sleep apnea and responds to CPAP therapy. Eur J Intern Med. 2015;26(9):e49-e50. PMID: 26129987 www.ncbi.nlm.nih.gov/pubmed/26129987.
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 www.ncbi.nlm.nih.gov/pubmed/28545798.