What Is Fibromyalgia? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Fibromyalgia is a chronic (long-term) disorder defined by pain and tenderness throughout your body, as well as fatigue.

People with fibromyalgia tend to have a heightened sense of pain. This feeling is sometimes described as a constant muscle ache. (1)

Fibromyalgia isn’t a progressive disease, which means that it won’t steadily worsen over time.

There’s no cure for fibromyalgia, but treatments are available that may help relieve symptoms and improve your quality of life. (2)

Fibromyalgia is known for causing widespread pain and tenderness throughout the body, as well as fatigue. It can also cause:

• Difficulty sleeping
• Problems with memory or concentration (“fibro fog”)
• Dizziness
• Numbness and tingling in the hands and feet
• Sensitivity to bright lights or loud noises
• Headaches
• Digestive issues
• Dry eyes or mouth

Because the symptoms of fibromyalgia overlap with those of many other conditions, diagnosing fibromyalgia can be difficult. In fact, it’s not uncommon to see several doctors and have many medical tests to rule out other conditions before getting a diagnosis of fibromyalgia. (3)

RELATED: Learn More About the Signs and Symptoms of Fibromyalgia

Researchers don’t know exactly what causes fibromyalgia, but it seems to occur when the body’s central and peripheral nervous systems don’t process pain properly.

While pain in fibromyalgia may feel like it’s coming from a specific area of your body, it’s actually originating in your brain, specifically from the nervous system.

Even though it’s often grouped with rheumatic diseases like arthritis and lupus, fibromyalgia isn’t considered to be a disease of inflammation, or a joint or muscle disorder.

It’s also not an autoimmune disorder — a condition in which the body’s immune system mistakenly attacks healthy tissues.

Symptoms of fibromyalgia often begin after physical or emotional trauma, such as an illness, surgery, infection, stressful life event, or injury.

Some experts believe these events may trigger the onset of the disorder, but it’s unclear exactly how this connection could be explained.

Repeated stimulation may cause the brains of people with fibromyalgia to change — leading to an increase in chemicals known as neurotransmitters that signal pain. (4)

The actual pain receptors in the brain may also undergo changes, developing a kind of “memory” that leads them to overreact to pain signals.

To complicate matters, fibromyalgia can also occur seemingly spontaneously, in the absence of trauma.

Genetics may also play a role. Fibromyalgia is often seen in families, and having a relative with the disorder puts you at increased risk for it.

But genes alone aren’t responsible for fibromyalgia. (2)

Historically, fibromyalgia was diagnosed by having a doctor check 18 specific points on the body to see how many of them were painful when pressed firmly. This was called a “tender point” exam.

However, doctors are moving away from the tender point exam in the diagnosis of fibromyalgia. Now, if you experience widespread pain — over a large area of your body — for more than three months, with no other possible cause, you’ll likely be diagnosed with the condition. (5)

At present, there are no tests that can be used to definitively diagnose fibromyalgia. However, your doctor may recommend a blood test to rule out other conditions.

For example, a complete blood count (CBC) can rule out conditions such as anemia, which can cause weakness and fatigue. This test and others like it will not confirm a fibromyalgia diagnosis, but they will effectively eliminate other possible causes for your symptoms.

Prognosis of Fibromyalgia

Fibromyalgia in and of itself doesn’t shorten life expectancy, according to a study published in 2018. (6) Nor does it damage muscles or organs or directly cause death. (7)

However, risks for anxiety and depression are higher among people with fibromyalgia, which may also increase risk for suicide.

In addition, people with the condition are also more likely to have diabetes, heart disease, and high blood pressure, among other health problems, which may lead to poorer overall health and quality of life.

Although currently available treatments can help to manage the symptoms of fibromyalgia, there’s no cure for the condition.

Many people with fibromyalgia live with widespread pain and debilitating fatigue for many years. As a result, the condition is a leading cause of disability and presents many challenges for people as they try to go about their day-to-day activities.

Symptoms have also been known to worsen over time in some people with fibromyalgia, so taking steps to maintain overall health — including exercise, a healthy diet, and reducing stress — are particularly important for those with the condition.

A variety of types of medical specialists treat fibromyalgia. Some family practice doctors or internists (internal medicine specialists) can recognize and manage the condition.

Other types of doctors who commonly treat fibromyalgia include:

• Pain management doctors, who treat all forms of pain, including that caused by fibromyalgia
• Rheumatologists, internists who specialize in treating arthritis and diseases of the joints, muscles, and soft tissues
• Neurologists, who treat diseases of the brain and nervous system

Before making an appointment with any of these specialists, ask whether they treat fibromyalgia. Not all pain management specialists, rheumatologists, or neurologists are knowledgeable about fibromyalgia.

Fibromyalgia is often best treated with a combination of approaches.

For some people, certain types of prescription medication can help reduce symptoms. For others, drugs have little effect, and for everyone, drugs have side effects that must be balanced with potential benefits.

Medication Options

No one medication works for all of the symptoms of fibromyalgia. (5)

However, some prescription drugs can help reduce the pain of the condition and improve sleep, which can help with fatigue. But these medication options are for patients who do not see successful outcomes after stress reduction, cognitive behavioral therapy (CBT), exercise, and other nonmedication options.

To date, three prescription medications have been approved by the U.S. Food and Drug Administration (FDA) specifically to treat fibromyalgia:

• duloxetine (Cymbalta)
• pregabalin (Lyrica)
• milnacipran (Savella)

Each of these drugs works differently, so talk to your doctor about which one may be right for your symptoms.

Before starting you on a prescription medication, however, your doctor may recommend over-the-counter (OTC) pain relievers, such as:

• acetaminophen (Tylenol)
• ibuprofen (Advil)
• naproxen (Aleve)

If these drugs don’t reduce your pain symptoms, your doctor may recommend a prescription pain reliever. However, opioid-based pain relievers aren’t recommended for people with fibromyalgia, as they can lead to dependence and may even worsen your pain over time.

In addition, certain types of antidepressants have been found to work on fibromyalgia pain and reduce fatigue. Other antidepressants can help you sleep better.

Your doctor may also suggest muscle relaxants or even anti-epileptic drugs (AEDs) to relieve pain.

Alternative and Complementary Therapies

Exercise According to the American College of Rheumatology, physical exercise is the most effective treatment for fibromyalgia. Gentle stretching and aerobic exercise can relieve pain and prevent deconditioning or getting weaker from lack of exercise. It can also improve sleep. (2)

Engaging in exercise may be the last thing on your mind when you hurt all over from fibromyalgia, but in fact, not exercising can make your pain worse. The best approach to being physically active when you have fibromyalgia is to start low and go slow. In other words, start with a few minutes of activity, and gradually increase the amount of time you’re active over several weeks or months to build your strength and endurance.

It’s better to do a little less than you’re capable of than to push too hard and trigger a fibromyalgia flare. Additionally, if you’re having a flare, reduce the time and intensity of your exercise sessions, but don’t be completely inactive.

Generally, working with a physical or occupational therapist can be helpful in getting started with an exercise regimen.

Specifically, a physical therapist can teach you exercises designed to improve your strength, flexibility, and stamina. Water-based exercises might be particularly beneficial for people with fibromyalgia. (5)

In addition, an occupational therapist may help you make adjustments to your home or workplace that will cause less stress on your body.

Some patients cannot tolerate these exercise programs, but an alternative form of exercise that incorporates mind-body work is tai chi. One study from 2018 showed that tai chi appeared to be as effective or better than aerobic exercise for managing fibromyalgia. The longer the duration, the greater the benefits.

Stress Reduction Some other lifestyle approaches that may improve fibromyalgia symptoms include stress reduction, not smoking, following a healthy diet, losing weight if you’re overweight, and establishing good sleep habits.

One possible way to reduce stress is to undergo counseling. Talking with a therapist can help strengthen your belief in your abilities and teach you strategies for dealing with stressful situations.

Cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) — types of talk therapy that help individuals reframe their thoughts and change behaviors — can help address brain fog by helping you develop targeted coping strategies and mitigate stress by teaching you to use skills like relaxation, acceptance, mindfulness, and identifying how to best use your energy.

They can reduce fatigue by helping you identify your stressors and your limiting beliefs.

Mindfulness In addition, mindfulness meditation has been shown to reduce stress, depression, anxiety, and the impact of symptoms of fibromyalgia. Improvements in sleep, pain, and fatigue have also been observed.

Mindfulness is a contemplative practice emphasizing moment-to-moment awareness as a means of working through stressful events. You can learn and practice mindfulness in courses offered online or in your local community, and by using any of a variety of apps, such as Calm, Headspace, Buddhify, or 10 Percent Happier.

Healthy Diet Like everyone, people with fibromyalgia should eat foods that support their body. This means a diet high in fruits, vegetables, whole grains, low-fat dairy, healthy oils, legumes, and low-fat protein like fish and chicken (unless you have food sensitivities to any of these).

It also means cutting out foods that you know are bad for you — like junk, processed, fatty, sugary foods, and soda.

For some people, making dietary changes can ease their fibromyalgia symptoms, particularly when their meals contain good sources of vitamin D (such as cold-water fish or fortified milk or orange juice), include foods high in magnesium (such as dried beans and leafy greens), and are rich in antioxidants from deeply colored fruits and vegetables.

In general, you should discuss nutritional approaches with a registered dietitian nutritionist or your doctor. However, research suggests that carbohydrates, and particularly sugars, may contribute to brain fog in fibromyalgia because people with the condition don’t metabolize carbohydrates and sugars normally.

Beyond that, some research suggests that avoiding dietary excitotoxins — chemicals that excite the neurons in the brain — can provide additional symptom improvement. The most common excitotoxins in the Western diet are food additives used to enhance or sweeten the flavor of foods. Monosodium glutamate is an example of such an additive. (8)

Supplements Some vitamin and herbal supplements may also help with fibromyalgia symptoms, although research evidence to date is limited. For example, both vitamin D and magnesium levels have been found to be low in people with the condition.

Vitamin D appears to have some effects on nerve and muscle function, and some studies have suggested that low levels of vitamin D may be associated with the chronic pain of fibromyalgia. Taking a vitamin D supplement is a relatively safe intervention and could be started after a discussion with your physician and possibly a measurement of your vitamin D levels. (9)

S-adenosylmethionine (SAMe) is a substance that occurs naturally throughout the body and is involved in many of the body’s processes, including pain. Research has shown that this OTC dietary supplement, taken as a tablet, can help treat depression and the chronic pain associated with osteoarthritis, and some studies show that taking SAMe may offer fibromyalgia pain relief and help with fatigue and stiffness. (10)

Finally, melatonin is a natural hormone found in the body, thought to be involved in promoting sleep. In pill form it’s often used as a sleep aid, but has also been used for depression, chronic fatigue, and fibromyalgia. (11)

Talk to your doctor before trying any of these supplements, as they can affect how well your prescription medications work and have side effects.

Acupuncture Acupuncture is one of the oldest forms of treatment for chronic pain and is based on ancient Chinese medical practices. There have been several studies on the usefulness of acupuncture as a natural remedy for fibromyalgia symptoms. Although this treatment seems to offer some functional improvement in people with fibromyalgia, the results are not long-lasting. (12)

Massage Other types of alternative and complementary approaches that can be used in fibromyalgia include massage therapy. In general, massage therapy seems to help with many types of muscle pain, including fibromyalgia, and it’s safe.

Reiki The Japanese technique Reiki has been used for pain control, relaxation, and stress relief. It’s thought to work with a system of energy that flows through the body.

Biofeedback Biofeedback is an alternative therapy that uses the mind-body connection to help you learn to control your chronic pain with the power of your mind. It’s helpful for many painful conditions when it’s used along with other therapies.

RELATED: Learn More About Treatment for Fibromyalgia: Medication, Alternative and Complementary Therapies, and More

Prevention of Fibromyalgia

There’s no proven way to prevent fibromyalgia. (13)

However, in general, maintaining a healthy diet, exercising regularly, and getting enough rest are good rules to follow if you want to prevent any chronic medical condition, including fibromyalgia.

If you have fibromyalgia, being informed is the best way to get good treatment and understand what lifestyle measures will help with symptoms. And, sticking to your doctor-prescribed treatment plan is the best way to keep symptoms in check. (13)

The constant pain, fatigue, and lack of sleep associated with fibromyalgia can interfere with your daily life.

Many people are unable to function at work or at home and become frustrated because this condition is often misunderstood.

Specific complications of fibromyalgia may include:

Mental Fog Some people with fibromyalgia experience lasting memory and cognitive problems that interfere with their ability to concentrate. This is often known as “fibro fog.”

Hospitalization People with fibromyalgia are about twice as likely as others to be hospitalized for any reason. (14)

Depression People with fibromyalgia are more than 3 times as likely as others to have major depression, which makes mental health screening extremely important. (14)

Death From Suicide or Injury The risk of death from these causes is higher than in the general population, though the overall risk of death isn’t any higher in people with fibromyalgia. (14)

Fibromyalgia is one of the most common chronic pain disorders, although estimates of the number of Americans it affects vary. About 10 million adults in the United States have fibromyalgia, according to the National Fibromyalgia Association (NFA), while the Centers for Disease Control and Prevention puts the number at four million U.S. adults, or about 2 percent of the adult population. (14,15)

Although fibromyalgia can occur in anyone, it’s more common in women. Between 75 and 90 percent of people diagnosed with the disorder are women, the NFA estimates.

The disorder affects people of all races and ethnicities. Most people with fibromyalgia are diagnosed between ages 20 and 50, with symptoms typically showing up months or even years beforehand. Even children can have fibromyalgia.

But the incidence of the condition rises with age, so that by age 80, 8 percent of people meet the criteria for fibromyalgia, says the NFA.

Few studies have examined how common fibromyalgia is among people in different racial and ethnic groups, including among Black, Indigenous, and People of Color (BIPOC) populations.

However, a study published in September 2015 that attempted to determine the prevalence of fibromyalgia in the U.S. population generally based on symptoms reported in the 2012 U.S. National Health Interview Survey (NHIS) — not based on physician diagnosis of fibromyalgia — did list some of the demographic characteristics of the survey respondents with fibromyalgia. (16)

The researchers identified fibromyalgia in 1.75 percent of participants overall. With respect to race and ethnicity, they found no significant differences among Hispanic Americans, non-Hispanic Black Americans, and non-Hispanic white Americans, but Asian Americans had a significantly lower fibromyalgia prevalence than these groups, and “all other races” — meaning the participant identified as being of more than one race or identified as American Indian, Alaska Native, Native Hawaiian, or Other Pacific Islander — had a significantly greater prevalence.

Interestingly, 73 percent of the people identified as having fibromyalgia in this study had not received a clinical diagnosis of fibromyalgia.

Having certain other medical conditions may raise the risk for fibromyalgia.

In many cases, it isn’t clear whether these conditions might trigger the onset of fibromyalgia, or whether they are instead an effect of fibromyalgia — or whether both conditions are due to some other underlying cause.

Per the NFA, people with fibromyalgia often also have: (17)

• ADHD
• Allergies
• Neck or back pain, including disk disease
• Chronic fatigue syndrome
• Endocrine disorders, such as thyroid problems
• Esophageal motility disorders (problems with swallowing)
• Painful menstrual periods
• Breathing issues, such as hyperventilation
• Sjögren’s syndrome, an autoimmune disorder that causes dry eyes and mouth
• Lupus
• Lyme disease
• Heart valve problems
• Enthesopathies (detachment of a tendon or ligament)
• Irritable bowel syndrome (IBS)
• Tension headaches or migraine
• Temporomandibular joint (TMJ) syndrome, a condition that causes jaw pain
• A mood disorder, such as anxiety or depression
• Restless legs syndrome, a limb movement disorder characterized by unpleasant sensations in the legs
• Endometriosis, a condition in which tissue grows outside a woman’s uterus
• A rheumatic disease, such as osteoarthritis, rheumatoid arthritis, lupus, or ankylosing spondylitis
• Vestibular disorders, such as vestibular neuritis or Ménière’s disease
• Sleep disorders, such as obstructive sleep apnea or chronic insomnia

In addition, although rheumatoid arthritis (RA) and fibromyalgia are two distinct disorders, people with RA are more likely to also develop fibromyalgia. (18) When the two conditions occur together, pain from one can trigger or exacerbate pain from the other.

Among the key differences between RA and fibromyalgia are that RA is an autoimmune disease while fibromyalgia is not, and RA causes inflammation in and around the joints while fibromyalgia does not attack the joints. The pain of fibromyalgia tends to be widespread, seemingly coming from many points of the body at once.

Each condition is treated differently. However, staying physically active can be helpful in both.

Similarly, people with psoriatic arthritis, a systemic autoimmune disease and an inflammatory form of arthritis, also seem to be at greater risk for developing fibromyalgia. While there are different types of psoriatic arthritis, ultimately, they all cause joint pain, stiffness, and loss of function.

Doctors suspect co-occurring fibromyalgia when a person with psoriatic arthritis experiences persistent pain and fatigue, possibly accompanied by other symptoms of fibromyalgia, such as fibro fog, sleep problems, and irritable or overactive bladder.

One hazard of not recognizing fibromyalgia in a person with an autoimmune disease such as rheumatoid arthritis, psoriatic arthritis, or lupus is that a doctor might increase a drug dosage or change drug treatments for the psoriatic arthritis unnecessarily, possibly compromising that person’s treatment. Another hazard is that the fibromyalgia goes untreated.

Favorite Sources of Information and Connection

American Chronic Pain Association

You know you’re in pain. Now what can you do about it? The American Chronic Pain Association provides support and education in pain management skills to people with chronic, painful conditions, their families, and their healthcare providers. It also provides tools to track fibromyalgia symptoms and communicate how you’re feeling to others.

American College of Rheumatology

When you need authoritative information on fibromyalgia, the patient area of this professional organization website can help, with the basics on diagnosis, treatment, and healthy living with fibromyalgia.

Favorite Support Groups and Group Locators

Living With Fibro

Whether you want to ask about a potential treatment or just vent about how you’re feeling, this online support group provides a forum to discuss a range of topics and concerns.

Best Ways to Find Clinical Trials for Fibromyalgia

ClinicalTrials.gov

Interested in research? This website provides a searchable database of clinical trials nationwide, including those related to fibromyalgia.

CenterWatch

For participating in research studies, this may be your best bet. It provides information about clinical trials that are currently enrolling patients and will also notify you of new trials that match your interests.

Additional reporting by Brian P. Dunleavy.