Fibromyalgia

Definition

Fibromyalgia is a condition in which a person has long-term pain that is spread throughout their body. The pain is most often accompanied by 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 of fibromyalgia is not known. Researchers think that it is due to a problem with how the central nervous system processes pain signals from nerves. Possible causes or triggers of fibromyalgia include:

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

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

Symptoms

Widespread pain is the main symptom of fibromyalgia. Fibromyalgia appears to be on one end of 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.

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:

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

Other symptoms in people with fibromyalgia may include:

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:

It is not necessary for the health care provider to find tender points during a physical exam to make a diagnosis and results of the exam may be normal.

Results from blood and urine tests, and imaging tests are normal. These tests may be done to check for 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 may complicate diagnoses and therapy. These disorders include:

Treatment

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

The first type of treatment may involve:

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

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

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:

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

Support groups may also help.

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

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 special expertise in diagnosing and treating fibromyalgia may be helpful.

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

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.

Clauw DJ. Fibromyalgia. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 253.

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.

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/.

Minhas D, Clauw DJ. Fibromyalgia and related syndromes. In: Hochberg MC, Gravallese EM, Silman AJ, Hejjde D, Weinblatt ME, Weisman MH, eds. Rheumatology. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 88.


Review Date: 1/25/2023
Reviewed By: Neil J. Gonter, MD, Assistant Professor of Medicine, Columbia University, NY and private practice specializing in Rheumatology at Rheumatology Associates of North Jersey, Teaneck, NJ. Review provided by VeriMed Healthcare Network. Internal review and update on 01/25/2024 by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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