Fibromyalgia: what is it, symptoms, testing, treatment

It’s not uncommon for researchers to disagree about the criteria or best treatments for a medical condition. What’s unusual is when researchers disagree over whether a particular condition even exists. 

As new research has accumulated in the last 30 years, most researchers do now accept that fibromyalgia is a true medical illness. However, many questions still remain about what causes fibromyalgia and what therapies will help those living with fibromyalgia pain (Häuser, 2018).

Fibromyalgia is considered a chronic but treatable illness. Here’s a look at what we do know about its symptoms, causes, and treatments.

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Fibromyalgia (FM) is a complex medical condition characterized by chronic, widespread musculoskeletal pain. Researchers now consider it to be a type of neurosensory disorder. This means that a person’s brain processes pain signals differently than someone without fibromyalgia (Bhargava, 2020).

FM was initially called fibrositis by researchers in France and England in the mid-19th century. Fibromyalgia syndrome is now recognized as an independent disorder by rheumatologists (medical providers who study and treat autoimmune conditions and arthritis) (Goldenberg, 2020).  

FM is the most common cause of generalized musculoskeletal pain in women between 20 and 55 years. Approximately 2–3% of the general population is affected by fibromyalgia. While it can occur in men and children, women are more commonly diagnosed with it, and the risk of developing it increases with age (Goldenberg, 2020).  

Fibromyalgia symptoms typically start in the early to middle teenage years, usually between nine and twenty years of age. Researchers think FM is rare in children under nine. There are almost no known cases in children under four years old (Kimura, 2021).

The hallmark symptom of fibromyalgia is chronic pain, but those affected can also experience many other physical, mental, and cognitive symptoms.

Pain

Fibromyalgia pain can affect just about any part of the body and usually involves multiple areas. It is often described as muscle pain, but joints can become painful as well. Despite the pain, there is typically no evidence of inflammation in the body's soft tissues (Bhargava, 2020).

Fatigue

Extreme tiredness is also a common symptom of FM. This can occur right after waking up in the morning, mid-afternoon, or after even minor activities. Confusingly, being inactive for long periods can increase the symptoms of pain and fatigue. People with fibromyalgia have to work to find the right balance of activity and inactivity (Bhargava, 2020).

Brain fog 

Some people with FM often report feeling like they are “looking at life through a haze.” Brain fog, also known as “fibro fog,” is a decreased ability to concentrate, memory trouble, and inability to multitask—symptoms many people with fibromyalgia experience. Some people report that brain fog impacts their lives even more than other FM symptoms (Kravitz, 2015).

Digestive problems

Irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD) are common in people with fibromyalgia. The connection between these illnesses and fibromyalgia isn’t totally clear, but people with fibromyalgia experience these digestive problems more often than the general public (Bhargava, 2020).

Sleep problems

Sleep disturbances are common with fibromyalgia. Affected people frequently complain about sleeping lightly and waking up multiple times in the early morning. It's common for people with fibromyalgia to sleep 8–10 hours at night and still feel unrefreshed in the morning (Bhargava, 2020).

Medical researchers don’t know the exact cause of fibromyalgia. Likely, it doesn’t come from a single event but is triggered by multiple physical and emotional stressors such as (Bhargava, 2020; U.S. National Library of Medicine, 2021):

• Stressful or traumatic events

• Repetitive injuries

• Viral infections

• Other serious medical problems

Fibromyalgia also appears to run in families, meaning genetics might play a part in who is affected. Certain populations are more likely to be diagnosed with FM than others. These include (U.S. National Library of Medicine, 2021):

• Women

• People in middle-age

• People with autoimmune conditions such as rheumatoid arthritis, lupus, or ankylosing spondylitis

• People with a family member diagnosed with FM

Getting a diagnosis of fibromyalgia can sometimes be difficult. It often involves multiple visits to several different healthcare providers before a final diagnosis of fibromyalgia is reached. Part of the problem is there is no specific test for fibromyalgia (U.S. National Library of Medicine, 2021).

Another factor is that the main symptoms in FM (pain, fatigue, brain fog) are also prevalent in other health conditions. Your healthcare provider will need to rule out these other potential causes before diagnosing you with fibromyalgia (U.S. National Library of Medicine, 2021).

The work-up for your symptoms may include a detailed medical history, a physical exam, x-rays, and blood tests to rule out any other conditions (U.S. National Library of Medicine, 2021).

Fibromyalgia diagnosis criteria

With fibromyalgia, there are usually no abnormalities found with lab testing or imaging. Healthcare providers will then look at the American College of Rheumatology classification criteria for fibromyalgia (Bhargava, 2020).

The original criteria required a specified minimum number of fibromyalgia trigger points or painful points on the body. However, there were limitations to these criteria, and they likely failed to identify many people who actually did have FM. So experts revised the requirements in 2016. 

The current diagnostic criteria for fibromyalgia require that the following three conditions be met (Bhargava, 2020):

1. Widespread pain index (WPI) score is 7, and symptom severity (SS) scale score is 5, or WPI equals 3 to 6, and SS scale score of 9

2. Symptoms have been present at a similar level for at least three months

3. No other disorder would otherwise explain the pain

The WPI measures how many areas a person has had pain in during the last week, with each area counting as a point in the score. The SS scale measures how much the other FM symptoms (fatigue, poor sleep, etc.) have affected the person in the previous week, with a higher number meaning symptoms are more severe (Bhargava, 2020).

There is currently no known cure for fibromyalgia, but there are treatments available to manage it and improve the quality of life for those affected. Treatment of fibromyalgia usually involves a combination of therapies. These can include medications for pain relief, lifestyle changes, psychotherapy, and complementary therapies.

Medication

Medications can help manage the pain flare-ups associated with fibromyalgia. Studies haven’t shown that any particular medication works significantly better than others that are used. Medicines that are commonly used include over-the-counter pain relievers, the antidepressant medications duloxetine (Cymbalta) and milnacipran (Savella), and the anticonvulsant pregabalin (Lyrica). Opioid pain medications are not generally recommended (Maffei, 2020).

Exercise

Exercise therapy has been shown to improve pain levels and quality of life for people with FM. Some types of exercise that have shown promising results for fibromyalgia include yoga, aquatic exercise, belly dancing, Zumba, and Tai chi. Exercise is generally tolerated by many individuals with FM and has actually been found to improve the ability to do daily activities (Maffei, 2020).

Therapy

Cognitive-behavioral therapy (CBT) can help those living with FM to learn strategies to deal with pain and stress and reframe negative thoughts about the illness. It can also help those with anxiety and depression, two conditions commonly occurring with FM (U.S. National Library of Medicine, 2021).

Complementary therapies

Many people also use alternative and complementary therapies to treat fibromyalgia. More research is still needed to tell how effective each of these treatments is, but they are still commonly sought out by those living with FM. These include (Maffei, 2020):

• Acupuncture

• Thermal therapies such as body warming and cryotherapy

• Hyperbaric oxygen therapy (HBOT) 

• Low-level laser therapy

• Massage

• Probiotics

If you are experiencing symptoms that might be connected to fibromyalgia, talk to your healthcare provider. They can rule out any other medical conditions that might be causing your problems. If it is fibromyalgia, your healthcare provider can help you develop a treatment plan to manage your fibromyalgia symptoms.

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

July 27, 2021

Written by

Ellyn Vohnoutka, BSN, RN

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.