Fibromyalgia

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is fibromyalgia?

Fibromyalgia is a complex health condition characterized by chronic widespread muscle pain, fatigue, sleep disorders, memory problems, and tenderness at certain points on the body. It is a leading cause of musculoskeletal pain in the United States. The cause of fibromyalgia is not completely understood, but it has been suggested that people with fibromyalgia process pain differently from other people.

Fibromyalgia is a common disorder affecting approximately 4 million people in the United States alone. It is more common in women than men. Fibromyalgia is typically diagnosed during middle age.

Symptoms of fibromyalgia may appear directly following an emotionally or physically traumatic event, or they may slowly increase in severity without obvious cause. Not everyone who has fibromyalgia will have all the characteristics of the disorder, and some symptoms may lie in remission for a time. Fortunately, several medications are available for managing symptoms, including pain relievers and antidepressants.

While its cause is not understood, some cases of fibromyalgia have been related to injuries, illnesses, certain chronic diseases, and traumatic events. A genetic component for fibromyalgia has also been suggested.

In some cases, left untreated, the pain of fibromyalgia can lead to a serious emotional condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have such serious symptoms as suicidal thoughts or severe depression with thoughts of harming oneself or others.

Seek prompt medical care if you are being treated for fibromyalgia but mild symptoms recur or are persistent.

Who gets fibromyalgia?

In the United States, 2 to 4% of the population—about 4 to 12 million people—have fibromyalgia. Anyone can develop it, but there are certain trends:

  • Fibromyalgia is 2 to 7 times more common in women than men.
  • Fibromyalgia develops most commonly in middle age. However, it can also begin during the teenage years or later in life.
  • People with a mother, father or sibling with fibromyalgia are eight times more likely to develop the condition.
  • Fibromyalgia does not appear to affect one race or ethnic background more than another.

What are the symptoms of fibromyalgia?

Fibromyalgia is often associated with persistent muscle pain, particularly in areas that have been noted as trigger points or localized points of pain. Emotional symptoms may also be caused by fibromyalgia due to stress, lack of sleep, and chronic pain. Fibromyalgia may be strongly associated with other conditions, such as endometriosis (presence of uterine lining tissue outside the uterus), irritable bowel syndrome (IBS; digestive discomfort that does not cause intestinal damage or serious disease), and sleep disturbances.

Physical symptoms of fibromyalgia

You may experience physical symptoms of fibromyalgia daily or only occasionally. Any of these physical symptoms can range from mild to severe:

  • Decreased tolerance for exercise
  • Fatigue (often worse mid-afternoon)
  • Muscle pain that can be severe
  • Paresthesias (tingling, burning, crawling sensations)
  • Sleep disturbances
  • Stiffness when waking
  • Tenderness, concentrated at certain areas known as tender points

Emotional symptoms of fibromyalgia

You may experience fibromyalgia emotional symptoms daily or only occasionally. Any of these emotional symptoms can be severe:

  • Depression
  • Difficulty thinking clearly
  • Difficulty with memory

Symptoms that might indicate a serious condition

In some cases, left untreated, the pain of fibromyalgia can lead to a serious emotional condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these serious symptoms including:

  • Being a danger to oneself or others, including threatening, irrational or suicidal behavior
  • Suicidal thoughts

What causes fibromyalgia?

The cause of fibromyalgia is not known, but most studies indicate it is related to how the nervous system processes pain. It has been suggested that people with fibromyalgia process pain signals differently, and a genetic tendency has also been suggested.

Some of the genes studied in fibromyalgia research are involved in making and breaking down neurotransmitters in the brain. Neurotransmitters are natural chemicals that pass signals between nerve cells. This includes pain signals. The underlying problem in fibromyalgia may stem from abnormal pain processing in the brain. As such, some experts describe fibromyalgia as a central pain amplification disorder—the brain’s ‘pain sensation’ volume is set abnormally high. In other words, people with fibromyalgia are more sensitive to pain; they respond to a pain stimulus to a greater degree than people without fibromyalgia.

Fibromyalgia is not an autoimmune or inflammatory disease. However, people who have a musculoskeletal autoimmune disease, like rheumatoid arthritis, have a greater risk of developing fibromyalgia.

Factors that may trigger the condition include:

  • Emotional or physical stress, such as a car accident, abuse, child neglect, or exposure to war or other type of traumatic event
  • Obesity

What are the risk factors for fibromyalgia?

Several factors are associated with fibromyalgia. Not all people with risk factors will get fibromyalgia. Risk factors include:

  • Age. Most people are diagnosed with fibromyalgia during middle age but it can also affect children. 

  • Family history of fibromyalgia
  • Sleep problems. Lack of restorative sleep is associated with increased inflammation and decreased pain tolerance.
  • Obesity. Overweight and obese women have a greater risk of developing fibromyalgia.

People with other rheumatic diseases have a high risk of developing fibromyalgia. These conditions include:

  • Rheumatoid arthritis (chronic autoimmune disease characterized by joint inflammation)
  • Systemic lupus erythematosus (disorder in which the body attacks its own healthy cells and tissues)

You can reduce your risk of developing fibromyalgia by working with your doctor to manage any health problems that affect your bones, joints or muscles.

What are some conditions related to fibromyalgia?

Conditions with symptoms and characteristics similar to or overlapping with fibromyalgia include:

  • Chronic fatigue syndrome—a condition characterized by extreme fatigue, sleep problems, and intolerance to exertion
  • Chronic pain—a state of persistent pain for weeks, months or years due to an injury, long-term disease, or a condition like fibromyalgia
  • Regional pain syndrome—a chronic disorder oftentimes triggered by direct damage to the nervous system
  • Interstitial cystitis—a chronic, painful inflammation of the bladder with no known cause
  • Temporomandibular disorder—also known as TMJ syndrome or simply TMJ, this painful disorder involves the jaw joint and surrounding muscles

When should you see a doctor for fibromyalgia?

If you are experiencing fibromyalgia symptoms—widespread pain, fatigue, memory problems, and emotional problems—that have lasted more than three months, it’s time to see a doctor to determine the cause of your symptoms. While there is no medical cure for fibromyalgia, many treatments can ease symptoms and improve your quality of life.

People with fibromyalgia may at first be misdiagnosed with other common conditions, such as arthritis, chronic fatigue syndrome, depression, or some other type of pain-related condition. If you suspect fibromyalgia, it’s important to find a doctor with experience diagnosing and treating patients with fibromyalgia.

Although fibromyalgia is not a joint disease, it can cause arthritis-like joint pain and fatigue. For this reason, many people see a rheumatologist for diagnosis. A rheumatologist specializes in arthritis, autoimmune diseases, and pain disorders.

Pain specialists, family medicine doctors, internists, and neurologists can treat people with fibromyalgia too. You can also contact the National Fibromyalgia Association and see if they can suggest someone in your area.

How do doctors diagnose fibromyalgia?

A patient’s symptoms and medical history are the basis of a fibromyalgia diagnosis. Previously, a patient had to have a certain number of tender points for a fibromyalgia diagnosis. This is no longer necessary, but healthcare providers may still consider the number of pain points in the diagnosis.

Healthcare providers may diagnose fibromyalgia in patients with the following signs and symptoms:

  • Widespread pain in certain areas. There are up to 19 points on the body that may feel tender in a fibromyalgia patient. The neck, shoulders, chest, lower back, thighs, and arms are commonly affected, as well as joints.
  • Fatigue
  • Not feeling refreshed after sleep
  • Thinking and memory problems
  • Symptoms lasting at least three months

There is no specific test for fibromyalgia, but blood tests and imaging tests (X-ray or MRI) can help rule out conditions with symptoms similar to fibromyalgia. Blood tests may include:

  • Anti-nuclear antibody (ANA) test to check for lupus or other autoimmune disorder
  • Complete blood count (CBC) to look for anemia and white or red blood cell abnormalities
  • Comprehensive metabolic panel (CMP) to check levels of electrolytes, calcium, glucose, and proteins, as well as liver and kidney function
  • Creatine kinase (CK) test to look for conditions that cause muscle weakness or pain
  • Red blood cell (erythrocyte) sedimentation rate (ESR) to check for inflammation in the body
  • Thyroid function test to check for hypothyroidism, which can cause symptoms similar to fibromyalgia

How do you treat fibromyalgia?

There is no cure for fibromyalgia; the goal of treatment is to improve the patient’s symptoms and functional abilities. The U.S. Food and Drug Administration has approved drugs specifically for treating fibromyalgia symptoms. However, it is equally important to treat any underlying conditions that can make fibromyalgia worse. Examples include depression, anxiety, or a sleep disorder.

Common and evidence-based fibromyalgia treatments include:

  • Medications to control pain, manage mood disorders, and improve sleep
  • Physical activity, particularly aerobic exercise
  • Self-help strategies, including good sleep hygiene, mindfulness, stress management, and a healthy diet
  • Physical therapy to improve strength and flexibility, restore function, and reduce or manage pain
  • Complementary and alternative therapies, such as acupuncture or chiropractic
  • Counseling, including talk therapy

Medications used to treat fibromyalgia

Medications used to treat fibromyalgia include:

  • Analgesics, such as aspirin or acetaminophen (Tylenol)
  • Antidepressants, such as duloxetine (Cymbalta), fluoxetine (Prozac), or milnacipran (Savella)
  • Antiseizure medications, such as gabapentin (Neurontin) and pregabalin (Lyrica)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin)
  • Pain relievers, such as Tramadol (Ultram)
  • Sleep medicines, including low-dose tricyclic antidepressants

Your healthcare professional can develop a treatment plan tailored to your needs. It is important to follow your treatment plan for fibromyalgia precisely to help minimize your symptoms and decrease the chance of your symptoms recurring over time. It is equally important to notify your healthcare professional if symptoms worsen or new symptoms develop.

What you can do to improve your fibromyalgia

Your treatment plan for fibromyalgia may also involve lifestyle changes, such as regular physical activity and a healthy diet. Maintaining a healthy weight can help reduce stress on your muscles and joints and thereby lessen the severity of symptoms.

In addition to taking your medications as prescribed, you can reduce the severity of your symptoms by:

  • Eating a healthy diet
  • Getting plenty of sleep (improve sleep hygiene regimen)
  • Getting regular physical activity
  • Maintaining a healthy weight

Complementary and alternative treatments

Some complementary treatments may help with fibromyalgia. These treatments, sometimes referred to as alternative therapies, are used in conjunction with traditional medical treatments. Complementary treatments are not meant to substitute for traditional medical care.

Complementary and alternative treatments may include:

  • Chiropractic care
  • Massage therapy
  • Nutritional dietary supplements, herbal remedies, tea beverages, and similar products
  • Heat therapy and hydrotherapy
  • Yoga

Be sure to notify your doctor if you are consuming nutritional supplements or homeopathic (nonprescription) remedies as they may interact with the prescribed medical therapy.

What are diet and nutrition tips for fibromyalgia?

While no particular diet or dietary tips will ease all fibromyalgia symptoms, many experts agree that people with fibromyalgia should follow a healthy, nutritious diet and drink plenty of water. A healthy diet can help you meet your daily nutritional requirements and boost energy. Proper nutrition is one component of a healthy lifestyle—along with regular exercise, quality sleep, and stress management—which can help manage fibromyalgia symptoms.

Healthy diet tips for fibromyalgia include:

  • Eat a healthy, well-balanced diet. Focus on fresh fruits, vegetables, and whole grains and avoid processed foods.
  • Limit red meat; choose lean poultry, fish, and plant-based proteins instead.
  • Include healthy fats, such as those found in avocado, chia seeds, olive oil, and fatty fish like salmon.
  • Take vitamin and mineral supplements to get the average daily requirement of vitamins and minerals.
  • Avoid alcohol and caffeine.
  • Avoid food additives, including the artificial sweetener aspartame and the flavor enhancers monosodium glutamate (MSG) and nitrates; all of which are thought to make fibromyalgia pain and symptoms worse.
  • Cut back on sugar which may reduce yeast infections that are common for people with fibromyalgia. 

Ask your healthcare provider for guidance before making significant changes to your diet.

How does fibromyalgia affect quality of life?

Measuring health-related quality of life is a standard way to find out how an illness impacts people with the condition. It can help guide effective treatments and disease management. Quality of life includes physical, mental and social well-being. The health-related quality of life for people with fibromyalgia is lower than with other chronic conditions. This is based on responses to multiple self-reporting and clinical questionnaires.

Factors contributing to lower quality of life in adults with fibromyalgia include:

  • Disability, which seems to depend on the extent of psychological problems the patient experiences
  • Co-existing rheumatic and musculoskeletal conditions, including rheumatoid arthritis, lupus, and ankylosing spondylitis
  • Co-existing mental health conditions, including depression and anxiety
  • Higher healthcare costs from disease treatment, doctor visits, and hospital stays. One-third of fibromyalgia patients spend $100 to $1,000 per month on office visits alone.

Studies show greater self-efficacy is related to better physical ability and quality of life. Self-efficacy is belief in one’s ability to reach a goal or overcome a challenge. Physical activity, eating right, and healthy coping strategies are signs of good self-efficacy.

What are the potential complications of fibromyalgia?

You can help minimize your risk of serious complications by following the treatment plan you and your healthcare professional design specifically for you. Complications of fibromyalgia include:

  • Chronic pain
  • Decreased quality of life
  • Depression
  • Higher rates of suicide
  • Inability to participate normally in activities

Does fibromyalgia shorten life expectancy?

Fibromyalgia is not a life-threatening condition. It also does not cause physical damage to the body; although the complications of fibromyalgia can. Fibromyalgia is associated with significant sleep problems and mental health conditions like depression. Severe depression can be life-threatening because of the risk of suicide. The rate of suicide deaths is greater in people with fibromyalgia. It is critical for fibromyalgia patients to seek treatment for a mood disorder in addition to physical symptoms.

Fibromyalgia patients can enjoy a more normal life and a better outlook. The key is consistent and comprehensive treatment in a supportive, low-stress environment.

Fibromyalgia awareness

The fact that people with fibromyalgia do not look like they have an illness has hampered its acceptance as a medical condition. With more research and medicines approved specifically for fibromyalgia, the outlook is rapidly changing. Music performer Lady Gaga’s 2017 disclosure of her fibromyalgia has helped lead the way to greater recognition.

May 12 is Fibromyalgia Awareness Day. Learn more about fibromyalgia at the National Fibromyalgia Association and American College of Rheumatology.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jun 27
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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