- Is It Hereditary?
- Risk Factors
- Diagnostic Tests
- More Info
Facts you should know about fibromyalgia
- Fibromyalgia is a pain syndrome characterized by chronic pain, fatigue, and tenderness to touch.
- Fibromyalgia syndrome is the most common medical cause of chronic, widespread pain in the United States.
- Fibromyalgia affects 2%-4% of people, mostly women.
- Defining fibromyalgia symptoms and signs include
- chronic pain, which may be in the muscles, joints, and/or bones,
- sleep problems, and
- tenderness throughout the body to light touch.
- Those with fibromyalgia may also experience
- depression and/or anxiety,
- cognitive difficulties, such as forgetfulness and lack of concentration (fibro fog),
- abdominal pain,
- dry eyes,
- chest wall pain,
- dry mouth,
- bladder symptoms,
- pelvic pain,
- heart palpitations,
- numbness and tingling,
- chemical sensitivities and multiple allergies, and
- weight gain.
- Exercise and getting enough sleep are very important in the management of fibromyalgia. Taking medications can help relieve the pain.
- The fact is there is no test to detect fibromyalgia. When a health care professional suspects fibromyalgia, sometimes tests are necessary to exclude other medical conditions.
What is fibromyalgia?
Fibromyalgia syndrome is a chronic pain condition (not a type of arthritis) that affects 4% of people in the United States. The pain syndrome commonly affects the muscles and ligaments and usually has been present for years when a health care professional diagnoses the condition. Fibromyalgia was formerly known as fibrositis.
What causes fibromyalgia?
Fibromyalgia syndrome has been shown to be genetic. The disorder frequently becomes evident after stressful events. The stressful events may be emotional (such as a traumatic life event), physical (such as a motor vehicle accident), or medical (such as certain infections). The chronic pain of rheumatoid arthritis, systemic lupus erythematosus, and other health conditions and autoimmune diseases can trigger the development of fibromyalgia.
The manner in which the brain and spinal cord process pain sensations is abnormal in fibromyalgia. The threshold at which stimuli cause pain or discomfort has been proven to be lower in fibromyalgia. The pain felt is more intense because the pain is amplified by abnormalities in the central nervous system and in pain processing. Because of this, things that are not normally painful may be painful for someone with fibromyalgia. In addition, fibromyalgia causes the pain from any given cause to be worse. For example, a patient with fibromyalgia may find a massage painful instead of pleasant. In addition, back pain that someone without fibromyalgia experiences as moderate may be experienced as severe by someone with fibromyalgia, because the pain is amplified by abnormalities in pain processing by the central nervous system.
IMAGESSee a medical illustration of fibromyalgia trigger points plus our entire medical gallery of human anatomy and physiology See Images
Is fibromyalgia hereditary?
Increasing evidence supports a strong genetic component to fibromyalgia. Siblings, parents, and children of people with fibromyalgia are eight times more likely to have the disorder than those who have no relatives with the health condition. Several genes that have been suspected to play a role in fibromyalgia syndrome. Studies in twins suggest that half the risk of fibromyalgia and related disorders is genetic and half is environmental.
What are risk factors for fibromyalgia?
Because it is in part hereditary, a family history of fibromyalgia syndrome is a risk factor for the development of fibromyalgia. Other risk factors include autoimmune diseases such as rheumatoid arthritis, lupus, and ankylosing spondylitis, as people with these diseases are more likely to have fibromyalgia than the general population. These patients are referred to as having "secondary fibromyalgia" because the autoimmune disease may trigger fibromyalgia.
Other emotional and physical stressors such as physical trauma (especially involving the spine and trunk), emotional stress, and certain infections (hepatitis C, Epstein-Barr virus, parvovirus, and Lyme disease but not the common cold) are associated with the development of fibromyalgia in some.
- Attachment Theory: What It Is, Stages & the Different Attachment Styles
- Gentle Parenting: What It Is, Techniques & Discipline
- U.S. Nursing Homes Fail to Report Many Serious Falls, Bedsores: Study
- The Younger You Get Diabetes, the Higher Your Risk for Dementia Later
- FDA Grants Full Approval to Paxlovid to Treat COVID-19
- More Health News »
What are fibromyalgia symptoms and signs? What are fibromyalgia tender points?
The defining feature of fibromyalgia syndrome is chronic widespread pain and tenderness. This means pain in multiple areas of the body, most commonly in muscles, tendons, and joints. Joint stiffness and irritable bowel syndrome (IBS) are common, as well. The pain is generally above and below the waist, on the left side of the body, and on the right side of the body but can be localized, often in the neck and shoulders or low back, initially. The pain is chronic, which means it is present for more than three months. People commonly feel as if they "hurt all over" with flu-like symptoms, or are about to develop a cold or the flu. It is common for some days to be worse than others are, and many patients report "flare-ups" where their pain and other symptoms are worse for several days in a row or longer.
Fatigue is the other universal symptom of fibromyalgia. It is most noticeable upon awakening, but it may also be marked in the mid-afternoon. It is very common to wake up in the morning not feeling refreshed, even after sleeping through the night. Patients commonly feel they sleep "lightly" and may have multiple nighttime awakenings with difficulty returning to sleep.
While widespread pain, fatigue, and sleep problems are the defining symptoms of the syndrome, fibromyalgia is associated with many other symptoms. Disordered thinking (cognitive disturbances) is often referred to as "fibro fog." Patients describe difficulty with attention and completing tasks, as well as a general sense of being in a fog.
Depression and anxiety co-occur in 30%-50% of patients at the time of diagnosis with fibromyalgia. Headaches are present in more than half of patients. Patients also may have a variety of poorly understood additional symptoms, including abdominal pain, diarrhea, constipation, nausea, dry eyes, dry mouth, chest wall pain, pelvic pain, and bladder symptoms, heart palpitations, numbness, and tingling (pins and needles), multiple allergies and chemical sensitivities, weight gain, and others.
Fibromyalgia tender points
The physical examination is remarkable for tenderness, particularly in specific anatomic locations, such as the back of the neck where the neck muscles connect to the skull. There are 18 such locations, which are referred to as fibromyalgia tender points. In the past, studies required patients to have 11 out of a possible 18 fibromyalgia tender points in order to be included in a scientific study on fibromyalgia, but this definition of fibromyalgia has changed in the past few years.
How do health care professionals test for and diagnose fibromyalgia?
Health care professionals diagnose fibromyalgia based on the patient's symptoms, primarily widespread pain. Chronic widespread pain in the muscles and joints, in combination with fatigue and poor sleep, leads to the consideration of fibromyalgia. A health care professional will perform a thorough history and physical exam to exclude other illnesses presenting with similar symptoms.
There is no widely accepted blood test or X-ray test for fibromyalgia at this time. Any testing is done to exclude other conditions. Tests for inflammation are generally normal in isolated fibromyalgia.
Usually, multiple soft-tissue areas ("fibromyalgia tender points") are tender to palpation. However, not all patients are tender at the tender points. In general, females are more likely to be tender at the classic fibromyalgia tender points than males.
The American College of Rheumatology developed new guidelines and diagnostic criteria to help diagnose patients with fibromyalgia. The new guidelines no longer require a certain number of tender points to be present to be confident that a patient has fibromyalgia. The new guidelines use pain and other symptoms of fibromyalgia to aid diagnosis. Patient questionnaires to assist in the diagnosis of fibromyalgia can be found online.
Which specialties of doctors treat fibromyalgia?
Rheumatologists, internists, family medicine doctors, pain-management doctors, physical medicine and rehabilitation doctors, and primary care providers all treat fibromyalgia. Health care practitioners other than physicians are also frequently involved in the treatment of fibromyalgia, including clinical psychologists, physical therapists, nurse practitioners, and physician assistants.
Subscribe to MedicineNet's General Health Newsletter
What is the treatment for fibromyalgia?
There are both medication and non-medication treatments for fibromyalgia. Medication treatments frequently help manage the pain and sleeplessness from which fibromyalgia patients suffer. However, the non-medication treatments are really the basis of treatment for fibromyalgia. The non-medication treatments for fibromyalgia include education, exercise, and stress reduction. Sleep disorders may require both medication and non-medication treatments.
Education about fibromyalgia is very important. Often patients have suffered from symptoms for years, and simply knowing why they have pain can be a relief, as many patients become anxious not knowing what is causing their symptoms. Patients should also be educated about treatment approaches, good sleep hygiene, and the importance of treating conditions that may contribute to their symptoms. For example, when a patient with rheumatoid arthritis has fibromyalgia as well, poor control of their rheumatoid arthritis may lead to worsening of fibromyalgia pain and sleeplessness.
An exercise program is crucial in the treatment of fibromyalgia and should include stretching, strengthening, and aerobic exercise. Many patients with fibromyalgia find it difficult to institute a regular exercise program because they feel they are too tired to exercise and they may perceive that their pain and fatigue worsen when they begin to exercise. However, numerous scientific studies have shown that exercise for fibromyalgia, especially aerobic exercise, can improve pain, physical function, and a sense of well-being. Starting slow and sticking with the exercise program is very important. Low-impact aerobic activities such as swimming, water aerobics, walking, and biking are activities that patients with fibromyalgia find helpful. Many patients find it helpful to exercise in the morning. Some patients find yoga helpful for strengthening and stretching. An anaerobic exercise program should also accompany this.
Stress reduction is important for the self-management of fibromyalgia symptoms. Many patients feel that their symptoms are triggered by stress. Stress reduction can be challenging. There are many stressors in life; some can be changed and others cannot. Stress reduction involves a combination of changing stressors that can be changed and learning to lessen the body's stress reaction to the stressors that cannot be changed.
Cognitive-behavioral therapy is a form of psychological therapy whereby a therapist and patient work together, to establish healthy patterns of behavior by replacing negative thoughts with more productive thoughts and actions. This has been proven to work in fibromyalgia. This form of therapy can be done one on one in an office setting, or even over the Internet.
Non-medication therapies are the cornerstone of treatment for fibromyalgia. With them, many people improve and may not require medications. Moreover, without focusing on sleep hygiene, stress reduction, and exercise, it is difficult to improve, even with medication.
When used with non-medication therapies, medication treatments can help improve sleep, pain, and function in fibromyalgia. Administration of medications is most effective for pain relief when combined with ongoing non-medication treatments as discussed above. Medications often used in the treatment of fibromyalgia include medications in the antidepressant class (medications originally developed to treat anxiety and depression) and anticonvulsants (medications originally developed to treat seizures).
- Medications called "tricyclic antidepressants" have been used to treat fibromyalgia for many years. These medications include amitriptyline (Elavil), doxepin (Sinequan, Silenor), and desipramine (Norpramin). These medications are generally started in low doses and increased until an adequate response is achieved. The advantage of these medications is that they are effective for sleep and pain, widely available, and less costly for most patients than some of the newer agents. Cyclobenzaprine (Flexeril) is a medication that is both a muscle relaxant and tricyclic antidepressant that can be used to help with sleep and pain in patients with fibromyalgia.
- Medications in the antidepressant class that affect the serotonin and the norepinephrine neurotransmitters (SNRI antidepressants) are frequently used in the treatment of fibromyalgia. These medications include duloxetine (Cymbalta), milnacipran (Savella), and venlafaxine (Effexor). Norepinephrine is a neurotransmitter in the brain, and increasing the levels of norepinephrine with these medications decreases pain levels. Fluoxetine (Prozac) is an antidepressant that affects mainly serotonin at low doses but increases norepinephrine as well at higher doses. Higher doses of fluoxetine can be used to treat fibromyalgia pain.
- Pregabalin (Lyrica) and gabapentin (Neurontin) are anticonvulsants (medications initially developed to treat seizures). There are many scientific studies showing that pregabalin and gabapentin can be effective for fibromyalgia pain.
- Tramadol (Ultram) is an opioid pain reliever, which is helpful in some patients with fibromyalgia but should be used with caution as sometimes the use of opioids can worsen the pain cycle in fibromyalgia.
- Memantine (Namenda) is a medication commonly used for dementia. Preliminary studies show that memantine may be helpful with pain and other symptoms of fibromyalgia, but further studies are needed to confirm this.
- There have been small scientific studies of low-dose naltrexone (Revia, Vivitrol) in fibromyalgia. Naltrexone's main scientifically proven use is in treating narcotic addiction. In one small study, a very low dose of naltrexone was shown to benefit some patients with fibromyalgia. Further studies of low-dose naltrexone in fibromyalgia are needed to know if it really works.
A few notes on other treatments for fibromyalgia: Acupuncture can be helpful for some patients with fibromyalgia but is not usually recommended as one of the first-line treatments for fibromyalgia because the scientific studies on acupuncture for fibromyalgia patients have not shown definite benefit. Likewise, trigger point injections help some patients. Alternative medicines have not been proven to be helpful in fibromyalgia; in particular, scientific studies on guaifenesin (Mucinex) show that it does not work. Of note, patients with vitamin D deficiency can have widespread arthralgia and myalgia, like fibromyalgia, which improves with vitamin D supplementation. While having a sufficient level of vitamin D is important to maintain bone health, a healthy immune system, and perhaps prevent certain types of cancer, vitamin D supplementation does not improve fibromyalgia symptoms in patients who have sufficient levels of vitamin D. Narcotic pain medications should be avoided in fibromyalgia because they may worsen the underlying problem.
Health Solutions From Our Sponsors
Are there any home remedies for fibromyalgia?
The non-medication treatments for fibromyalgia are the cornerstone of the treatment of the syndrome. These include
- lifestyle changes like education,
- stress reduction,
- improving sleep, and
What is the prognosis of fibromyalgia?
The overall mortality is not increased in patients with fibromyalgia, and it is not an organ-threatening disease. However, many patients with fibromyalgia continue to suffer from long-term widespread pain. Once the diagnosis is confirmed, many fibromyalgia patients find their overall sense of well-being and their pain improves to pain levels that are more moderate with the treatments discussed above. There are some patients who experience a dramatic reduction in pain with changes in their life to reduce stress. However, these patients are always at risk for worsening their symptoms in the future and should maintain efforts for a healthy lifestyle, including sleep hygiene, ongoing exercise, and stress management. Fibromyalgia patients have a higher rate of disability than the general population, but seeking permanent disability status is generally discouraged because it frequently leads to worsening of symptoms.
Is it possible to prevent fibromyalgia?
Fibromyalgia is a syndrome with a genetic predisposition. It can be triggered by certain events, but the exact events leading to the onset of fibromyalgia are unknown. Because of this, there is no known way to prevent fibromyalgia.
However, leading a healthy lifestyle, including getting enough sleep, eating healthy foods, and exercising, is the best way to stay healthy.
Are there support groups for fibromyalgia?
Yes, there are support groups for fibromyalgia. Local support groups and further information can be found through the Arthritis Foundation (http://www.arthritis.org), National Fibromyalgia Association (http://www.fmaware.org), or the National Fibromyalgia Partnership, Inc. (http://www.fmpartnership.org).
What is the latest research on fibromyalgia?
There is ongoing medical research on fibromyalgia on many fronts. There is active research on the genes responsible for fibromyalgia, new medications, and new non-medication therapies to help the pain. One recent study found that non-restorative sleep -- when one wakes up feeling tired after a full night of sleep -- is strongly tied to developing widespread pain. Medical researchers have linked anxiety to developing widespread pain.
Health Solutions From Our Sponsors
Crofford, L. 2013. "Fibromyalgia." (2013) American College of Rheumatology. Mar. 6, 2014. <http://www.rheumatology.org/Practice/Clinical/Patients/Diseases_And_Conditions/Fibromyalgia/>.
Goldenberg, D.L. "Initial Treatment of Fibromyalgia in Adults." UpToDate.com. July 2019. <https://www.uptodate.com/contents/initial-treatment-of-fibromyalgia-in-adults>.?
Sarzi-Puttini P., et al. "Treatment strategy in fibromyalgia syndrome: Where are we now?" Semin Arthritis Rheum 37.6 June 2008: 353-365.
Sosa-Reina, M.D., et al. "Effectiveness of Therapeutic Exercise in Fibromyalgia Syndrome: A Systematic Review and Meta-Analysis of Randomized Clinical Trials." Biomed Res Int 2017 (2017): 235646.
"What Is Fibromyalgia?" Arthritis Foundation. < https://www.arthritis.org/about-arthritis/types/fibromyalgia/what-is-fibromyalgia.php>.
Wolfe, F., D.J. Clauw, M.A. Fitzcharles, D.L. Goldenberg, W. Hauser, R.L. Katz, P.J. Mease, A.S. Russell, I.J. Russell, and B. Walitt. "2016 Revisions to the 2010/2011 Fibromyalgia Diagnostic Criteria." Semin Arthritis Rheum 46.3 Dec. 2016: 319-329.
Yang, Tse-Yen, et al. "Risk for Irritable Bowel Syndrome in Fibromyalgia Patients: A National Database Study." Medicine 96.14 April 2017: e6657.
Top Fibromyalgia Facts Related Articles
Antinuclear Antibody TestAntinuclear antibodies (ANAs), unusual antibodies that can bind to certain structures within the nucleus of the cells, are found in patients whose immune system may be predisposed to cause inflammation against their own body tissues. ANAs are indicative of the potential presence of an autoimmune illness.
Body Pain: What Does It Mean When Your Whole Body Aches?Body aches are a symptom of the flu, arthritis, autoimmune disease, infections like Lyme disease, and other conditions. Body pain and muscle aches may accompany fever, headache, and other symptoms. Body aches are a general symptom of many potential underlying conditions. Only a doctor can diagnose and treat the cause.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis.
Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Chronic Fatigue QuizExhausted all the time? Maybe it's not all in the mind. Take the Chronic Fatigue Syndrome (CFS) Quiz to learn more about tricky condition.
Chronic Pain Syndrome: Treatment and Management for CPSDo you suffer from excruciating pain? What is chronic pain syndrome (CPS)? See causes, symptoms and treatment options, including medications. Learn about pain management tips such as strength training, biofeedback, and yoga, as well as forms of chronic pain such as lower back pain, arthritis, and migraines.
Complete Blood Count (CBC)A complete blood count (CBC) is a calculation of the cellular makeup of blood. A CBC measures the concentration of white blood cells, red blood cells, platelets in the blood, and aids in diagnosing conditions and disease such as malignancy, anemia, or blood clotting problems.
Fibromyalgia Treatments and Tips to Ease PainWhat is fibromyalgia? Learn about fibromyalgia symptoms such as trigger points (also called tender points), learn what causes fibromyalgia, and get treatment options for the condition like stress relief techniques, exercise tips, diet ideas, and other strategies that don't require medication.
Cortisone InjectionCortisone injections are used to treat small areas of inflammation or widespread inflammation throughout the body. There is minimal pain from these injections, and relief from the pain of inflammation occurs rapidly.
Learn to Spot Depression: Symptoms, Warning Signs, MedicationKnow when you or someone else is depressed. Get information on depression symptoms, signs, tests, and treatments for many types of depression chronic depression and postpartum depression.
Depression QuizMany people do not recognize the symptoms and warning signs of depression and depressive disorders in children and adults. With proper diagnosis, treatments and medications are available. Take this quiz to learn more about recovery from depression.
Fibromyalgia PictureA syndrome characterized by chronic pain, stiffness, and tenderness of muscles, tendons, and joints without detectable inflammation. See a picture of Fibromyalgia and learn more about the health topic.
Fibromyalgia QuizFibromyalgia could be the reason for your constant, deep bodily pain. Learn more about this painful condition with the Fibromyalgia Quiz.
Irritable Bowel Syndrome (IBS)Irritable bowel syndrome or IBS is a GI disorder with symptoms of constipation, abdominal pain, bloating, and gas. IBS treatment includes medications, dietary changes, and lifestyle changes.
Liver Blood TestsAn initial step in detecting liver damage is a simple blood test to determine the presence of certain liver enzymes in the blood. Under normal circumstances, these enzymes reside within the cells of the liver. But when the liver is injured, these enzymes are spilled into the blood stream, and can lead to diseases like fatty liver, type 2 diabetes, obesity, and hepatitis. Several medications also can increase liver enzyme test results.
Low FODMAP Diet for IBS
FODMAPs are foods that contain sugar alcohols and short chain carbohydrates. The gut can't digest them very well. There are "low" FODMAP foods and "high" FODMAP foods. Foods high in FODMAPs lay in the gut and ferment, which causes symptoms of:
- Excessive gas
- Abdominal pain
Some people with digestive diseases and disorders, for example, IBS, microscopic colitis, IBD (Crohn's disease and ulcerative colitis), and other functional bowel disorders often are placed on a low FODMAP diet to decrease the amount of high FODMAPs foods in the diet, which create uncomfortable symptoms.
Rheumatoid Arthritis (RA)Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body.
Rheumatoid Factor (RF)Rheumatoid factor is often measured in blood tests for the diagnosis of rheumatoid arthritis. However, rheumatoid factor can also be present in individuals with other conditions such as lupus, infectious hepatitis, syphilis, mononucleosis, tuberculosis, liver disease, and sarcoidosis.
Why Is My Whole Body Aching?Learn the reasons you have whole body aches and what you can do to relieve your whole body aching symptoms. Learn what medical treatments can help ease your body aches and speed up your recovery.