Fibromyalgia: Symptoms, Causes, Diagnosis and Treatment

Fibromyalgia is a long-term condition that causes widespread pain and tenderness throughout the body. It commonly also causes fatigue, sleep difficulties and problems with concentration or memory.

The condition can significantly affect everyday activities, work, relationships and quality of life.

Fibromyalgia does not simply mean painful joints or muscles, and it is not the same as arthritis.

Researchers do not yet fully understand what causes it. Current evidence suggests that people with fibromyalgia have changes in the way the nervous system processes pain and other sensory signals, resulting in increased sensitivity.

There is currently no cure for fibromyalgia, but symptoms can often be managed through a combination of physical activity, self-management strategies, psychological or behavioural therapies and, when appropriate, medication.

What Is Fibromyalgia?

Fibromyalgia is a chronic pain disorder characterized primarily by widespread pain and increased sensitivity to pain.

The pain can occur in many parts of the body, including the:

• arms,
• legs,
• neck,
• shoulders,
• chest,
• abdomen,
• back,
• hips,
• and buttocks.

People describe the pain in different ways. It may feel:

• aching,
• burning,
• throbbing,
• tender,
• or unusually sensitive to touch.

Symptoms vary considerably from one person to another and may become better or worse at different times.

Is Fibromyalgia a Joint Disease?

No.

The old version of this article described fibromyalgia as a disease involving chronic “joint pain, tenderness and stiffness of the tendons, joints and muscles.”

That description is misleading.

Fibromyalgia can certainly make someone feel pain around muscles and joints, but it does not cause the type of joint inflammation and structural joint damage seen with inflammatory arthritis.

A person can, however, have fibromyalgia and another condition such as rheumatoid arthritis or osteoarthritis at the same time.

Is Fibromyalgia the Same as Fibrositis?

The term fibrositis was historically used for fibromyalgia because researchers once believed inflammation of fibrous tissue was responsible for the condition.

Modern understanding has changed substantially.

Fibromyalgia is now the accepted term, and the condition is not considered primarily an inflammatory disease of muscles or connective tissue.

What Are the Main Symptoms of Fibromyalgia?

The three particularly important symptoms are:

• widespread pain,
• fatigue,
• and sleep problems.

However, fibromyalgia can cause many additional symptoms.

Widespread Pain

Chronic widespread pain is the defining feature of fibromyalgia.

The pain typically affects several areas of the body rather than one isolated joint or muscle.

It may:

• fluctuate from day to day,
• become more intense during a flare,
• change location,
• or vary according to activity, sleep and other factors.

For diagnosis, healthcare professionals generally look for a persistent pattern of widespread pain rather than a few days of soreness.

Fatigue

Fatigue can be one of the most disabling aspects of fibromyalgia.

A person may feel extremely tired even after spending many hours in bed.

This is not simply ordinary tiredness after a busy day.

Fatigue can affect:

• work,
• exercise,
• concentration,
• social activities,
• and normal household responsibilities.

Sleep Problems

Many people with fibromyalgia have difficulty getting restorative sleep.

They may:

• have difficulty falling asleep,
• wake repeatedly,
• sleep for many hours but still wake exhausted,
• or have another sleep disorder.

Conditions such as sleep apnea and restless legs syndrome can sometimes occur alongside fibromyalgia and may require separate treatment.

What Is Fibro Fog?

Many people with fibromyalgia experience difficulties with thinking, concentration and memory.

This is commonly called “fibro fog.”

It may involve:

• difficulty concentrating,
• forgetfulness,
• losing track of conversations,
• trouble finding words,
• slower thinking,
• or difficulty completing mentally demanding tasks.

Fatigue and poor sleep can make these cognitive problems more noticeable.

Other Possible Symptoms

Fibromyalgia may also be associated with:

• muscle or joint stiffness,
• tenderness to touch,
• headaches or migraine,
• numbness or tingling in the hands or feet,
• digestive symptoms such as bloating or constipation,
• irritable bowel syndrome,
• increased sensitivity to temperature,
• increased sensitivity to light,
• increased sensitivity to noise,
• anxiety,
• and depression.

Not everyone experiences all these symptoms.

Can Fibromyalgia Affect the Digestive System?

Some people with fibromyalgia experience digestive problems.

These may include:

• abdominal discomfort,
• bloating,
• constipation,
• diarrhoea,
• or irritable bowel syndrome.

However, persistent or severe digestive symptoms should not automatically be attributed to fibromyalgia.

Other gastrointestinal conditions may need investigation.

Does Fibromyalgia Affect the Internal Organs?

Fibromyalgia itself does not cause the type of progressive damage to joints, muscles or internal organs seen in some inflammatory or autoimmune diseases.

However, this does not mean the condition is harmless or insignificant.

Chronic pain, fatigue, poor sleep and cognitive problems can have a major effect on:

• physical function,
• mental wellbeing,
• employment,
• relationships,
• and quality of life.

Symptoms should therefore be taken seriously.

Who Can Develop Fibromyalgia?

Anyone can develop fibromyalgia.

It occurs in:

• women,
• men,
• adults of different ages,
• and sometimes children and adolescents.

It occurs across racial and ethnic groups.

Fibromyalgia is more commonly diagnosed in women, but it should not be described simply as a “female disease.”

The old article's claim that fibromyalgia affects “over 78% women over the world” and mainly women aged 34–56 is too rigid and should not be retained.

Fibromyalgia often begins during middle age, although it can occur at other ages, and the likelihood increases with age.

What Causes Fibromyalgia?

The exact cause is not fully understood.

Research suggests that people with fibromyalgia have increased sensitivity to pain.

Changes have been identified in neural pathways involved in transmitting and processing pain signals.

This means the brain and nervous system may respond differently to signals that would normally produce less pain—or no pain—in someone without fibromyalgia.

Fibromyalgia is therefore more complex than simply having painful muscles.

Is Fibromyalgia an Autoimmune Disease?

Fibromyalgia is not currently classified as an autoimmune disease.

This distinguishes it from conditions such as:

• rheumatoid arthritis,
• lupus,
• and some other rheumatic diseases.

However, fibromyalgia can occur in someone who also has an autoimmune disease.

Having both conditions does not mean they are the same disease.

Genetics and Family History

Fibromyalgia tends to occur in families.

Researchers believe genetic factors probably influence susceptibility.

Having a close relative with fibromyalgia may therefore increase a person's likelihood of developing it.

However, there is no single known “fibromyalgia gene,” and people without a family history can also develop the condition.

Possible Triggers

For some people, symptoms begin or become more noticeable following a significant event.

Reported triggers can include:

• physical injury,
• surgery,
• infection,
• or significant emotional stress.

For other people, symptoms develop gradually without an obvious trigger.

A trigger should not necessarily be interpreted as the sole cause of fibromyalgia.

Can Stress Cause Fibromyalgia?

Stress and fibromyalgia have a complicated relationship.

Significant emotional stress may be associated with the onset or worsening of symptoms in some people, but fibromyalgia should not simply be dismissed as a disease “caused by stress.”

Living with chronic pain can itself create considerable stress.

Stress-management strategies can therefore be useful as part of a broader treatment plan.

Can Fibromyalgia Occur With Lupus or Arthritis?

Yes.

People with fibromyalgia can also have other medical conditions.

Fibromyalgia is seen more frequently in people with certain rheumatic or chronic-pain conditions, including:

• rheumatoid arthritis,
• systemic lupus erythematosus,
• osteoarthritis,
• ankylosing spondylitis,
• and chronic back pain.

This is clinically important because symptoms from different conditions can overlap.

How Is Fibromyalgia Diagnosed?

There is no single blood test, X-ray or scan that confirms fibromyalgia.

Diagnosis is based primarily on:

• symptoms,
• medical history,
• physical examination,
• the distribution of pain,
• duration of symptoms,
• fatigue,
• sleep difficulties,
• and other associated symptoms.

Healthcare professionals may order tests when necessary to rule out other explanations.

How Long Does the Pain Need to Be Present?

Modern diagnostic approaches generally consider widespread pain lasting at least three months.

The pattern of pain is more important than identifying one particular tender point.

A healthcare professional may assess whether pain occurs across several regions of the body.

Are the Old Fibromyalgia Tender Points Still Required?

No.

Older diagnostic approaches placed considerable emphasis on 18 specific tender points on the body.

These points were pressed during examination to see how many caused pain.

Modern diagnostic criteria no longer require a particular number of tender points.

Assessment now considers widespread pain alongside symptoms such as:

• fatigue,
• waking unrefreshed,
• and cognitive difficulties.

This has made diagnosis less dependent on one physical-examination technique.

Why Can Diagnosis Take Time?

Fibromyalgia symptoms overlap with many other medical conditions.

For example, widespread pain or fatigue can also occur with:

• rheumatoid arthritis,
• lupus,
• thyroid disorders,
• anemia,
• sleep disorders,
• myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS),
• and other conditions.

A healthcare professional may therefore need to consider alternative explanations.

Are Blood Tests Needed?

There is no blood test specifically for fibromyalgia.

However, blood tests may sometimes be ordered to look for other conditions that could explain the symptoms.

Testing should be based on the person's:

• symptoms,
• medical history,
• examination,
• and clinical circumstances.

Extensive repeated testing is not automatically necessary once an appropriate diagnosis has been established.

Can Fibromyalgia Be Prevented?

There is currently no established method guaranteed to prevent fibromyalgia.

The old article said fibromyalgia could be prevented through massage, keeping affected areas warm, resting and following a “fibromyalgia diet.”

Those approaches have not been shown to prevent someone from developing the condition.

This distinction is important:

managing fibromyalgia symptoms is not the same as preventing fibromyalgia.

Can Fibromyalgia Be Cured?

At present, there is no established cure.

Treatment instead aims to:

• reduce pain,
• improve sleep,
• reduce fatigue,
• improve physical function,
• support emotional wellbeing,
• and help people maintain everyday activities.

Many people benefit from using several strategies together.

Exercise and Fibromyalgia

Regular physical activity is one of the most important non-drug treatments for fibromyalgia.

Exercise may seem difficult when someone already has pain and fatigue.

The key is usually to begin at a manageable level and increase activity gradually.

Low-impact activities may include:

• walking,
• swimming,
• cycling,
• water-based exercise,
• gentle strengthening,
• yoga,
• and tai chi.

A physiotherapist or appropriately qualified exercise professional can help develop an individualized programme when needed.

Can Exercise Initially Make Symptoms Worse?

It can.

Some people experience increased discomfort when they first begin exercising.

This does not necessarily mean exercise is damaging the body.

Starting with too much activity too quickly may worsen symptoms.

A gradual approach is generally preferable.

The goal is to build a sustainable level of activity rather than pushing through severe pain.

Pacing Your Activities

People with fibromyalgia may experience a cycle in which they do a large amount of activity on a good day and then become exhausted or experience increased symptoms afterward.

Pacing involves balancing:

• activity,
• exercise,
• work,
• household responsibilities,
• and rest.

The aim is not complete inactivity.

Remaining active at a manageable and consistent level is generally more helpful than alternating between overexertion and prolonged inactivity.

Sleep Management

Improving sleep is an important part of fibromyalgia management.

Helpful habits may include:

• keeping consistent sleep and wake times,
• making the bedroom dark, quiet and comfortable,
• limiting caffeine later in the day,
• avoiding nicotine,
• developing a relaxing bedtime routine,
• and discussing persistent sleep problems with a healthcare professional.

Sleep disorders such as sleep apnea should be treated when present.

Cognitive Behavioural Therapy

Cognitive behavioural therapy (CBT) can help some people manage the effects of fibromyalgia.

CBT does not mean the pain is imaginary.

It can teach practical skills for:

• coping with chronic pain,
• managing stress,
• changing unhelpful responses to symptoms,
• improving confidence,
• and maintaining everyday activities.

Psychological and behavioural treatments are often most useful as part of a wider management plan.

Medicines for Fibromyalgia

Medication may be appropriate for some people.

Different countries approve different medicines for fibromyalgia, so treatment should be individualized.

Medicines sometimes used include certain:

• antidepressants,
• and medicines originally developed for epilepsy that can modify pain signalling.

Examples used in some countries or circumstances include:

• duloxetine,
• milnacipran,
• pregabalin,
• gabapentin,
• and low-dose amitriptyline.

Not every medicine is approved specifically for fibromyalgia in every country.

The appropriate choice depends on:

• symptoms,
• other medical conditions,
• possible side effects,
• interactions with other medicines,
• and local prescribing guidance.

Why Are Antidepressants Used?

Some antidepressant medicines influence brain chemicals involved in pain processing and sleep.

They may therefore help fibromyalgia symptoms even when a person does not have depression.

Their use does not mean a healthcare professional believes the pain is psychological or imaginary.

Are Anti-Inflammatory Painkillers Effective?

Fibromyalgia is not primarily an inflammatory condition.

For this reason, anti-inflammatory medicines generally do not target the underlying mechanism of fibromyalgia.

They may still be useful when someone has another painful inflammatory condition at the same time.

Pain medication should be discussed with a healthcare professional, particularly when used frequently or long-term.

What About Opioid Painkillers?

Long-term opioid treatment is generally not recommended as a routine treatment for fibromyalgia.

Opioids can cause:

• dependence,
• tolerance,
• sedation,
• constipation,
• and other significant side effects.

In some circumstances, long-term opioid use may also make pain more difficult to manage.

Medication decisions should be individualized by an appropriately qualified healthcare professional.

Can Massage Help?

Massage may help some people temporarily with:

• relaxation,
• muscle discomfort,
• stress,
• or stiffness.

However, massage is not a proven way to prevent fibromyalgia.

Some people with fibromyalgia are also unusually sensitive to touch, so deep or aggressive massage may actually be uncomfortable.

If massage is used, the pressure should be adjusted according to individual comfort.

Does Keeping the Body Warm Treat Fibromyalgia?

Warm baths, showers or heat may temporarily ease stiffness or discomfort for some people.

However, keeping painful areas warm is not a cure or preventive treatment.

Temperature sensitivity is also common in fibromyalgia, and individuals may respond differently to heat or cold.

Is There a Special Fibromyalgia Diet?

There is currently no universally accepted “fibromyalgia diet” proven to cure the condition.

A nutritious balanced eating pattern can support general health.

This may include:

• vegetables,
• fruits,
• whole grains,
• appropriate sources of protein,
• nuts and seeds,
• and other nutrient-rich foods.

People with other medical conditions may require specific dietary advice.

Be cautious about websites or products claiming that a particular diet, detox or supplement can cure fibromyalgia.

Supplements and Herbal Remedies

Some supplements are promoted for fibromyalgia, but evidence for many is limited or inconsistent.

“Natural” does not automatically mean safe.

Supplements can:

• cause side effects,
• interact with prescription medicines,
• or contain ingredients that differ from what the label claims.

Discuss supplements with an appropriate healthcare professional, especially if you take prescription medication.

Living With Fibromyalgia

Living with a chronic condition can be challenging.

A practical long-term approach may include:

• understanding the condition,
• setting realistic goals,
• maintaining regular physical activity,
• improving sleep,
• pacing activities,
• managing stress,
• following an individualized treatment plan,
• and seeking social or psychological support when needed.

The aim is not necessarily to eliminate every symptom before living normally.

Treatment often focuses on improving function and quality of life even when some symptoms remain.

When Should You Seek Medical Advice?

Consider speaking with a healthcare professional if you have:

• widespread pain lasting several weeks or months,
• persistent unexplained fatigue,
• ongoing sleep problems,
• significant stiffness,
• difficulty concentrating,
• pain that is affecting work or daily activities,
• or symptoms that are worsening or unexplained.

Unlike the old article, there is no useful rule that fibromyalgia should be suspected simply because symptoms persist for “a few days.”

Fibromyalgia is a chronic condition, and diagnosis requires appropriate assessment.

When Should You Seek Urgent Medical Care?

Fibromyalgia does not normally cause sudden medical emergencies.

Do not automatically blame new or severe symptoms on fibromyalgia.

Seek urgent medical attention for symptoms such as:

• sudden chest pain,
• severe difficulty breathing,
• sudden weakness or paralysis,
• sudden confusion,
• loss of consciousness,
• a new severe neurological problem,
• or other rapidly developing or potentially life-threatening symptoms.

A person with fibromyalgia can still develop unrelated medical conditions requiring urgent treatment.

The Bottom Line

Fibromyalgia is a long-term disorder involving widespread pain and increased sensitivity to pain, often accompanied by fatigue, sleep problems and cognitive difficulties known as fibro fog.

It can affect anyone, although it is diagnosed more often in women.

Fibromyalgia does not cause the same structural joint or organ damage associated with some inflammatory and autoimmune diseases, but its symptoms can significantly affect daily life and wellbeing.

There is:

• no single diagnostic blood test,
• no established cure,
• and no proven way to prevent fibromyalgia completely.

Treatment is usually individualized and may combine:

• gradual regular exercise,
• physical therapy,
• activity pacing,
• improved sleep habits,
• CBT or other psychological support,
• stress management,
• and appropriate medication.

People experiencing persistent widespread pain and fatigue should seek proper medical assessment rather than relying on self-diagnosis or supposed fibromyalgia cures.

Medical Disclaimer

This article provides general health information for an international audience and is not a substitute for diagnosis or individualized treatment from a qualified healthcare professional. Fibromyalgia symptoms overlap with many other medical conditions, and medicines used to manage fibromyalgia vary between countries. Do not start, stop or change prescription medicines based solely on information in this article.

Sources and Further Reading

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) — Fibromyalgia

https://www.niams.nih.gov/health-topics/fibromyalgia

NIAMS — Fibromyalgia: Diagnosis, Treatment, and Steps to Take

https://www.niams.nih.gov/health-topics/fibromyalgia/diagnosis-treatment-and-steps-to-take

Mayo Clinic — Fibromyalgia: Symptoms and Causes

https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780

Mayo Clinic — Fibromyalgia: Diagnosis and Treatment

https://www.mayoclinic.org/diseases-conditions/fibromyalgia/diagnosis-treatment/drc-20354785