Fibromyalgia: Symptoms, Causes & Treatment Options

What Is Fibromyalgia?

Fibromyalgia is a chronic pain syndrome characterized by widespread musculoskeletal pain lasting more than three months, accompanied by fatigue, sleep disturbances, and cognitive difficulties. It affects 2-4% of the population globally, with women being 2-3 times more likely to develop the condition than men.

Fibromyalgia, sometimes called fibromyalgia syndrome (FMS), is a chronic condition that causes pain and tenderness throughout the body. The name comes from Latin and Greek roots: "fibro" meaning fibrous tissues, "myo" meaning muscles, and "algia" meaning pain. However, despite its name, fibromyalgia is now understood to be a disorder of pain processing in the central nervous system rather than a disease of the muscles themselves.

The condition was first recognized as a distinct medical entity in the 1970s, and the American College of Rheumatology established the first diagnostic criteria in 1990. Since then, our understanding has evolved significantly. Research has shown that people with fibromyalgia have alterations in how their brain and spinal cord process pain signals, a phenomenon called central sensitization. This means that normal sensations that wouldn't typically cause pain—such as gentle pressure or slight temperature changes—can be perceived as painful.

Fibromyalgia is classified by the World Health Organization in the International Classification of Diseases (ICD-10 code M79.7 and ICD-11 code MG30.01). It is recognized as a legitimate medical condition by major medical organizations worldwide, including the American College of Rheumatology, European League Against Rheumatism (EULAR), and the National Institutes of Health.

It is important to understand that fibromyalgia is not a progressive disease—it does not get worse over time or cause damage to muscles, joints, or internal organs. Unlike inflammatory conditions such as rheumatoid arthritis, fibromyalgia does not cause joint destruction or deformity. While symptoms can fluctuate and may be severe at times, many people find that with appropriate management, they can lead active and fulfilling lives.

What Are the Symptoms of Fibromyalgia?

The main symptoms of fibromyalgia include chronic widespread pain throughout the body, severe fatigue that doesn't improve with rest, sleep disturbances, cognitive difficulties often called "fibro fog," morning stiffness, and heightened sensitivity to pain. Symptoms must be present for at least three months to meet diagnostic criteria.

Fibromyalgia presents with a constellation of symptoms that extend far beyond just pain. While widespread musculoskeletal pain is the hallmark feature, the condition affects multiple body systems and can significantly impact daily functioning. Understanding the full range of symptoms helps both patients and healthcare providers recognize the condition and develop appropriate management strategies.

The pain in fibromyalgia is typically described as a constant, dull ache that affects muscles throughout the body. Unlike pain from an injury that localizes to one area, fibromyalgia pain is widespread—meaning it occurs on both sides of the body and both above and below the waist. The pain intensity often fluctuates, with "flares" of increased symptoms that may be triggered by stress, weather changes, poor sleep, or overexertion.

Beyond pain, fibromyalgia causes a distinctive pattern of fatigue that differs from ordinary tiredness. People often describe waking up feeling exhausted despite sleeping for many hours. This fatigue can be as disabling as the pain itself, making it difficult to complete daily activities, maintain employment, or participate in social activities.

Chronic Widespread Pain

The defining feature of fibromyalgia is widespread pain that has been present for at least three months. This pain typically affects multiple areas of the body simultaneously. Common pain locations include the neck, shoulders, upper back, lower back, hips, arms, and legs. Many people describe the sensation as a deep, persistent ache in the muscles, though some experience burning, stabbing, or throbbing sensations.

The pain in fibromyalgia has several distinguishing characteristics. First, it tends to migrate—meaning it may be worse in different areas on different days. Second, it is often accompanied by increased sensitivity, where even light touch or gentle pressure causes discomfort. Third, the pain is typically worse in the morning and may improve somewhat as the day progresses, only to worsen again in the evening.

Fatigue and Sleep Problems

Fatigue in fibromyalgia goes beyond normal tiredness. People often describe it as exhaustion that doesn't improve with rest. Even after a full night's sleep, individuals may wake feeling unrefreshed—a phenomenon sometimes called "non-restorative sleep." This fatigue can be so severe that it interferes with work, relationships, and daily activities.

Sleep disturbances are nearly universal in fibromyalgia. Research using sleep studies has shown that people with fibromyalgia often have disrupted deep sleep (slow-wave sleep), which is the most restorative phase of the sleep cycle. Common sleep problems include difficulty falling asleep, frequent nighttime awakenings, restless legs syndrome, and sleep apnea. The relationship between sleep and fibromyalgia is bidirectional—poor sleep worsens pain, and pain disrupts sleep, creating a difficult cycle to break.

Cognitive Difficulties (Fibro Fog)

Many people with fibromyalgia experience cognitive symptoms collectively referred to as "fibro fog" or "brain fog." These difficulties can include problems with concentration, memory lapses, difficulty finding words, mental confusion, and slowed thinking. Research has confirmed that these cognitive changes are real and measurable, not just subjective complaints.

Fibro fog can be particularly frustrating because it affects work performance, daily decision-making, and social interactions. People may forget appointments, struggle to follow conversations, or have difficulty completing tasks that were previously easy. These cognitive symptoms often worsen during pain flares and may improve when pain and sleep are better controlled.

Other Common Symptoms

Fibromyalgia is associated with numerous other symptoms that can vary from person to person:

• Morning stiffness: Many people feel particularly stiff when waking up, with symptoms often lasting 30 minutes to several hours
• Headaches: Tension-type headaches and migraines are more common in people with fibromyalgia
• Irritable bowel symptoms: Including abdominal pain, bloating, constipation, and diarrhea
• Tingling and numbness: Especially in the hands and feet
• Temperature sensitivity: Being unusually sensitive to cold or heat
• Anxiety and depression: Common co-occurring conditions that may worsen fibromyalgia symptoms
• Urinary symptoms: Including increased frequency and urgency
• Dry eyes and mouth: Similar to symptoms seen in Sjögren's syndrome

What Causes Fibromyalgia?

The exact cause of fibromyalgia is not fully understood, but research indicates it involves abnormal pain processing in the central nervous system (central sensitization). Contributing factors include genetic predisposition, physical or emotional trauma, infections, chronic stress, and sleep disturbances. Multiple factors likely combine to trigger the condition.

Understanding what causes fibromyalgia has been one of the most challenging aspects of the condition. Unlike diseases caused by a specific virus, bacteria, or genetic mutation, fibromyalgia appears to result from a complex interaction of multiple factors. Current research points to alterations in how the central nervous system—the brain and spinal cord—processes pain signals.

The leading theory is that fibromyalgia involves central sensitization, a state where the central nervous system becomes hypersensitive to pain signals. In this condition, neurons in the brain and spinal cord become overactive, amplifying pain signals and lowering the threshold at which sensations are perceived as painful. Brain imaging studies have confirmed these differences, showing altered activity in pain-processing regions in people with fibromyalgia.

Research has identified several neurotransmitter abnormalities in fibromyalgia. Levels of substance P (which transmits pain signals) tend to be elevated, while levels of serotonin and norepinephrine (which help dampen pain signals) tend to be lower. These imbalances help explain why certain medications that affect these neurotransmitters can be effective treatments.

Genetic Factors

Fibromyalgia tends to run in families, suggesting a genetic component. First-degree relatives of people with fibromyalgia have an eight-fold higher risk of developing the condition. Research has identified several genes that may increase susceptibility, particularly genes involved in serotonin and dopamine signaling, stress response, and pain processing. However, no single gene causes fibromyalgia—rather, multiple genes likely contribute small amounts of risk.

Triggering Events

Many people with fibromyalgia can identify an event that seemed to trigger or worsen their symptoms. These triggers can include physical trauma (such as car accidents or surgery), infections (including viral illnesses), significant psychological stress, or other medical conditions. However, some people develop fibromyalgia without any identifiable trigger, and the same events that trigger fibromyalgia in one person may not affect another.

The Role of Sleep, Stress, and Pain

Sleep disturbances, chronic stress, and pain create interconnected feedback loops in fibromyalgia. Poor sleep increases pain sensitivity, while pain disrupts sleep. Similarly, stress activates the body's stress response system, which can worsen pain and disrupt sleep. This creates a self-reinforcing cycle that can be difficult to break without addressing multiple factors simultaneously.

How Is Fibromyalgia Diagnosed?

Fibromyalgia is diagnosed clinically based on the ACR 2016 criteria, which require widespread pain lasting at least 3 months along with fatigue, sleep problems, and cognitive symptoms. There is no specific blood test or imaging study that can diagnose fibromyalgia. Blood tests may be performed to rule out other conditions with similar symptoms.

Diagnosing fibromyalgia can be challenging because there is no single test that definitively confirms the condition. Unlike many diseases that can be diagnosed with a blood test, imaging study, or biopsy, fibromyalgia is diagnosed based on clinical criteria—meaning doctors must evaluate symptoms, medical history, and examination findings to make the diagnosis.

The current gold standard for diagnosis is the American College of Rheumatology (ACR) 2016 revised criteria. These criteria were developed to provide a standardized way to diagnose fibromyalgia while accounting for the full range of symptoms beyond just pain. The criteria assess widespread pain, the presence and severity of additional symptoms, and exclude other conditions that could explain the symptoms.

The diagnostic process typically involves several components: a detailed medical history, physical examination, assessment using standardized questionnaires, and laboratory tests to rule out other conditions.

Clinical Assessment

Your doctor will ask detailed questions about your symptoms, including where you experience pain, how long you've had symptoms, and what makes them better or worse. They will also ask about sleep quality, fatigue levels, cognitive symptoms, and other associated complaints. A physical examination will assess for tenderness at multiple points throughout the body and look for signs of other conditions.

Standardized questionnaires are often used to assess symptom severity. The Widespread Pain Index (WPI) evaluates how many areas of the body are affected by pain, while the Symptom Severity Scale (SSS) measures the severity of fatigue, cognitive symptoms, and waking unrefreshed. Together, these provide a more objective way to assess the condition.

Laboratory Tests

While there is no specific test for fibromyalgia, blood tests are important to rule out other conditions that can cause similar symptoms. Common tests include:

• Complete blood count (CBC): To check for anemia and other blood cell abnormalities
• Thyroid function tests: Hypothyroidism can cause fatigue, pain, and cognitive difficulties similar to fibromyalgia
• Inflammatory markers (ESR, CRP): Usually normal in fibromyalgia but elevated in inflammatory conditions like rheumatoid arthritis
• Vitamin D level: Deficiency can cause muscle pain and fatigue
• Rheumatoid factor and anti-CCP antibodies: To rule out rheumatoid arthritis
• Antinuclear antibody (ANA): May be checked if lupus is suspected

In fibromyalgia, these tests typically return normal results, which helps distinguish it from inflammatory or autoimmune conditions. X-rays and other imaging studies are also usually normal and are primarily done to rule out other conditions.

Conditions That May Mimic Fibromyalgia

Several other conditions can cause symptoms similar to fibromyalgia and must be considered during diagnosis:

• Rheumatoid arthritis: Causes joint pain and fatigue but also causes joint swelling and elevated inflammatory markers
• Hypothyroidism: Can cause fatigue, pain, and cognitive symptoms but is detected by thyroid blood tests
• Polymyalgia rheumatica: Causes muscle pain and stiffness, primarily in older adults, with elevated inflammatory markers
• Systemic lupus erythematosus: An autoimmune disease with fatigue and joint pain but also skin rashes and positive ANA test
• Vitamin D deficiency: Can cause diffuse muscle pain and weakness
• Sleep apnea: Causes non-restorative sleep and daytime fatigue

How Is Fibromyalgia Treated?

The most effective treatment for fibromyalgia combines multiple approaches: regular physical exercise (especially aerobic exercise), cognitive behavioral therapy (CBT), good sleep habits, and medications when needed. Exercise has the strongest evidence and is considered the cornerstone of treatment. Medications that may help include duloxetine, pregabalin, and low-dose amitriptyline.

Treating fibromyalgia effectively requires a comprehensive, multimodal approach that addresses the multiple dimensions of the condition. No single treatment works for everyone, and most people benefit from combining several strategies. The goals of treatment are to reduce pain, improve function, enhance quality of life, and help people return to normal activities as much as possible.

According to the 2017 European League Against Rheumatism (EULAR) guidelines, treatment should follow a graduated approach, starting with non-pharmacological therapies. Exercise is recommended as the first-line treatment because it has the strongest evidence base and the best benefit-to-risk ratio. Medications are typically added when non-pharmacological approaches alone are insufficient.

It's important to set realistic expectations for treatment. While fibromyalgia cannot currently be cured, symptoms can be significantly reduced with proper management. Many people experience substantial improvements in their quality of life, though this often requires patience and persistence in finding the right combination of treatments.

Exercise and Physical Activity

Exercise is the most evidence-supported treatment for fibromyalgia. Numerous high-quality studies have shown that regular physical activity reduces pain, improves function, and enhances overall well-being. Exercise works through multiple mechanisms: it releases endorphins (natural pain-relieving chemicals), improves sleep, reduces stress, and helps maintain muscle strength and flexibility.

The most studied and recommended forms of exercise include:

• Aerobic exercise: Activities like walking, swimming, cycling, or dancing that raise your heart rate. Studies show 30-40 minutes of moderate aerobic exercise, 2-3 times per week, can significantly reduce symptoms.
• Water-based exercise: Pool activities and aqua aerobics are particularly beneficial because the buoyancy of water reduces stress on joints and muscles while providing resistance for strengthening.
• Strength training: Gentle resistance exercises help maintain muscle strength, which is important for daily function and preventing further deconditioning.
• Stretching and flexibility: Yoga, tai chi, and stretching exercises improve flexibility and may help with morning stiffness.

The key to successful exercise in fibromyalgia is starting slowly and progressing gradually. Many people with fibromyalgia have become deconditioned due to inactivity, and doing too much too soon can trigger a flare. Begin with just 5-10 minutes of gentle activity and gradually increase duration and intensity over weeks to months. Working with a physiotherapist can be helpful in developing an appropriate exercise program.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy is a psychological treatment that has strong evidence for helping with fibromyalgia. CBT works by helping people identify and change negative thought patterns and behaviors that can worsen symptoms and disability. It does not suggest that fibromyalgia is "all in your head"—rather, it recognizes that how we think about and respond to chronic pain influences how we experience it.

CBT for fibromyalgia typically addresses:

• Pain catastrophizing: The tendency to magnify the threat of pain and feel helpless about it
• Activity pacing: Learning to balance activity and rest to avoid boom-bust cycles
• Sleep hygiene: Developing habits that promote better sleep
• Stress management: Techniques for reducing the impact of stress on symptoms
• Relaxation training: Methods like progressive muscle relaxation and deep breathing

Multiple studies have shown that CBT can reduce pain, improve function, and enhance quality of life in fibromyalgia. Benefits may be long-lasting, with improvements persisting even after treatment ends.

Medications

Several medications have been shown to help with fibromyalgia symptoms. While no medication can cure fibromyalgia, they can reduce pain and improve function when used as part of a comprehensive treatment plan. The main categories include:

SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors): Duloxetine and milnacipran are approved for fibromyalgia in many countries. They work by increasing levels of serotonin and norepinephrine, which help dampen pain signals. They may also help with fatigue and mood symptoms. Common side effects include nausea, dry mouth, and constipation.

Pregabalin and Gabapentin: These anticonvulsant medications help reduce pain by calming overactive nerve signals. Pregabalin is approved for fibromyalgia and may also help with sleep. Side effects can include dizziness, drowsiness, and weight gain. Due to potential for dependence, these should be prescribed by a specialist.

Tricyclic Antidepressants: Low-dose amitriptyline is commonly used for fibromyalgia, particularly for improving sleep and reducing pain. It is usually taken at bedtime because of its sedating effects. Side effects may include dry mouth, constipation, and morning drowsiness.

Medications to Avoid or Use Cautiously:

• Opioids: Generally not recommended for fibromyalgia as they are not effective for central sensitization pain and carry significant risks
• NSAIDs: Anti-inflammatory drugs like ibuprofen are usually not helpful because fibromyalgia does not involve inflammation
• Tramadol: May provide modest benefit in some cases but should be used cautiously due to dependence risk

What Can I Do to Manage Fibromyalgia?

Self-management is crucial for fibromyalgia. Key strategies include staying physically active with gentle exercise, maintaining good sleep habits, managing stress through relaxation techniques, applying heat for muscle pain, pacing activities to avoid overdoing it, and learning as much as possible about the condition to feel empowered in your care.

Living well with fibromyalgia requires active participation in your own care. While healthcare providers play an important role, the day-to-day management of fibromyalgia depends largely on the choices and habits you develop. Understanding the condition and learning effective self-management strategies can make a significant difference in symptoms and quality of life.

One of the most important things to understand is that fibromyalgia, while painful and limiting, is not dangerous. It does not damage your muscles, joints, or organs. This means that the pain you experience, while real and sometimes severe, is not a sign of harm occurring to your body. Understanding this can help reduce fear of movement and enable you to stay active despite some discomfort.

Stay Physically Active

Perhaps the most important self-care strategy is maintaining regular physical activity. It may seem counterintuitive to exercise when you're in pain, but movement is one of the most effective ways to reduce fibromyalgia symptoms over time. The key is finding the right type and amount of activity for you.

Start with activities you enjoy, whether that's walking, swimming, gentle yoga, or gardening. Begin with short periods—even 5-10 minutes—and gradually increase as your body adapts. Consistency is more important than intensity; regular moderate activity is better than occasional intense exercise followed by days of rest.

Expect some increase in symptoms when you first start exercising—this is normal muscle response to new activity, not a sign of harm. If you persist with gentle, regular exercise, most people find their symptoms improve over several weeks to months.

Prioritize Good Sleep

Sleep problems and fibromyalgia are closely linked, and improving sleep often leads to improvement in other symptoms. Good sleep hygiene practices include:

• Going to bed and waking at consistent times, even on weekends
• Creating a calm, comfortable sleep environment (cool, dark, quiet)
• Avoiding caffeine after noon and limiting alcohol
• Avoiding screens (phone, TV, computer) for at least an hour before bed
• Developing a relaxing bedtime routine
• Avoiding long daytime naps, which can interfere with nighttime sleep

Manage Stress

Stress can trigger and worsen fibromyalgia symptoms. Learning effective stress management techniques is an important part of self-care. Techniques that may help include:

• Deep breathing exercises: Slow, deep breaths activate the body's relaxation response
• Progressive muscle relaxation: Systematically tensing and relaxing muscle groups
• Mindfulness meditation: Focusing attention on the present moment without judgment
• Gentle yoga or tai chi: Combine physical movement with relaxation

Apply Heat

Heat can temporarily relieve muscle pain and stiffness. Options include warm baths or showers, heating pads, hot water bottles, or heated blankets. Heat promotes relaxation and increases blood flow to muscles. Some people find alternating heat and cold helpful, though cold is generally less well-tolerated in fibromyalgia.

Pace Your Activities

Many people with fibromyalgia fall into a "boom-bust" pattern—doing too much on good days, then crashing and being unable to do anything for days afterward. Learning to pace activities can help break this cycle. This means:

• Breaking large tasks into smaller, manageable chunks
• Taking regular rest breaks before you feel exhausted
• Resisting the urge to "make up for lost time" on good days
• Planning activities and spreading them throughout the week

What Is It Like Living with Fibromyalgia?

Living with fibromyalgia presents ongoing challenges but is manageable with the right approach. Many people learn to balance activity with rest, maintain meaningful relationships and work, and find that symptoms fluctuate over time. Support from healthcare providers, family, and patient communities can make a significant difference.

Living with a chronic condition like fibromyalgia requires adaptation and resilience. The unpredictable nature of symptoms—with good days and bad days—can be particularly challenging. However, many people with fibromyalgia find ways to live fulfilling lives, maintain relationships, and even continue working, though often with modifications.

It is important to focus on what you can do rather than what you cannot. While fibromyalgia may require you to make some adjustments, it does not have to define your entire life. Setting realistic goals, celebrating small victories, and maintaining connections with activities and people you enjoy are all important for well-being.

Impact on Mental Health

Chronic pain and fatigue can take a toll on mental health. Depression and anxiety are more common in people with fibromyalgia than in the general population. These are not signs of weakness—they are common responses to living with chronic illness and are also related to the same neurotransmitter changes involved in fibromyalgia itself.

If you experience persistent sadness, loss of interest in activities, excessive worry, or thoughts of harming yourself, it is important to seek help. Mental health treatment—whether therapy, medication, or both—can improve both psychological symptoms and pain.

Work and Daily Life

Many people with fibromyalgia are able to continue working, though some may need workplace accommodations such as flexible hours, ergonomic equipment, or the ability to take short rest breaks. Open communication with employers about your needs can help. Occupational therapists can provide advice on adapting work environments and daily tasks to reduce strain.

Relationships and Family

Fibromyalgia affects not only the person with the condition but also their family and friends. The invisible nature of fibromyalgia—where you may look fine but feel terrible—can lead to misunderstanding. Open communication about your symptoms and limitations, while also acknowledging the impact on family members, helps maintain healthy relationships.

For partners and family members, it can be challenging to know how to help. Encouraging activity while respecting limitations, offering emotional support, and learning about the condition can all be beneficial. Family therapy or couples counseling may help improve communication and coping.

Pregnancy and Fibromyalgia

Women with fibromyalgia can become pregnant and have healthy babies. Some women find their symptoms improve during pregnancy, while others find them unchanged or worse. It is important to discuss medication use with your doctor before becoming pregnant, as some fibromyalgia medications should be avoided during pregnancy.

Planning for the postpartum period is also important, as sleep deprivation and the physical demands of caring for a newborn can be challenging with fibromyalgia. Having support systems in place before the baby arrives can help.

What Is the Long-Term Outlook for Fibromyalgia?

Fibromyalgia is a chronic condition, meaning symptoms typically persist over time. However, it is not progressive and does not cause organ damage or shorten life expectancy. Many people experience significant improvement with appropriate treatment, and some may achieve long periods of minimal symptoms.

The long-term outlook for fibromyalgia varies considerably between individuals. For most people, fibromyalgia is a chronic condition with fluctuating symptoms—periods of relative wellness interspersed with flares of more severe symptoms. However, with appropriate management, many people achieve significant improvements in their quality of life.

Unlike some chronic conditions, fibromyalgia does not get progressively worse over time. It does not cause joint destruction like rheumatoid arthritis, does not damage internal organs, and does not shorten life expectancy. This is important reassurance for people newly diagnosed with the condition.

Research on long-term outcomes shows mixed results. Some studies show that about 50% of people experience moderate improvement over several years, while others may have persistent symptoms. Factors associated with better outcomes include:

• Maintaining regular physical activity
• Having good social support
• Developing effective coping strategies
• Active participation in treatment decisions
• Addressing co-occurring conditions like depression and sleep disorders

It is worth noting that our understanding of fibromyalgia continues to evolve, and new treatments are being researched. Advances in understanding the neurobiology of chronic pain may lead to more targeted therapies in the future.