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Fibromyalgia

Fibromyalgia

Topic Overview

What is fibromyalgia?

Fibromyalgia is widespread pain in the muscles and soft tissues above and below the waist and on both sides of the body. People with fibromyalgia feel pain, tenderness, or both even when there is no injury or inflammation.

Fibromyalgia can cause long-lasting (chronic) pain. It has no cure. But with treatment, most people with fibromyalgia are able to work and do their regular activities. When it is not controlled, you may not have any energy. Or you may feel depressed or have trouble sleeping. But there are many things you can do to help manage your symptoms.

What causes fibromyalgia?

No one knows for sure what causes fibromyalgia. But experts have some ideas, such as:

  • Nerve cells may be too sensitive.
  • Chemicals in the brain (neurotransmitters) may be out of balance.
  • The deep phase of sleep may be disrupted and affect the amount of hormones that your body releases.

What are the symptoms?

The main symptoms of fibromyalgia are:

  • Deep or burning pain in your trunk, neck, low back, hips, and shoulders.
  • Tender points (or trigger points) on the body that hurt when pressed.

People with fibromyalgia may have other problems, such as:

Symptoms tend to come and go. You may have times when you hurt more, followed by times when symptoms happen less often, hurt less, or are absent (remissions). Some people find that their symptoms are worse in cold and damp weather, during times of stress, or when they try to do too much.

How is fibromyalgia diagnosed?

Doctors diagnose fibromyalgia based on:

  • How much of your body is affected by pain. If you have pain above and below your waist and on both the left and right sides of your body, it is considered widespread. The more widespread your pain, the more likely it is that you have fibromyalgia.
  • How bad your pain and other symptoms are. People who have fibromyalgia usually have pain. They usually also have fatigue, trouble sleeping, and trouble thinking. The more severe these symptoms are, the more likely it is that you have fibromyalgia.

Fibromyalgia is sometimes diagnosed or described using pain and tenderness at 18 specific spots on the body, or tender points. You may also hear these called trigger points.

Before the diagnosis, your doctor will make sure that you don't have other conditions that cause pain. These include rheumatoid arthritis, polymyalgia rheumatica, lupus, and other autoimmune diseases.

How is it treated?

Treatment is focused on managing pain, fatigue, depression, and other symptoms. You may be able to control your symptoms by:

  • Getting regular exercise. This is one of the best ways to manage the pain.
  • Taking medicine, if your symptoms bother you.
  • Going to counseling. This can help you cope with long-term (chronic) pain.
  • Taking care of yourself. Good self-care includes finding better ways to handle stress, having good sleep habits, and talking to your doctor if you have symptoms of depression.

Some people with fibromyalgia also find complementary therapies helpful. These include tai chi, acupuncture, massage, behavioral therapy, and relaxation techniques.

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Cause

Fibromyalgia is a syndrome—a set of symptoms that occur together. Experts have ideas about what may cause it, but there is not enough evidence to support any one idea. Some ideas include:

  • Nerve cells may be too sensitive.
  • Chemicals in the brain (neurotransmitters) may be out of balance.
  • The deep phase of sleep may be disrupted and affect the amount of hormones that your body releases.

Many people connect the beginning of their symptoms to a certain event, such as the flu, an injury or surgery, or emotional trauma and stress. An event of this type combined with other things, such as increased sensitivity to pain and sleep problems, may lead to fibromyalgia in some people.

Symptoms

The symptoms of fibromyalgia vary from person to person. Symptoms can last from days to months or years.

The most common symptoms are:

  • Widespread deep or burning pain above and below your waist and on the right and left sides of your body. Pain is more common in the trunk, neck, low back, hips, and shoulders. It usually gets worse gradually and can interfere with even simple daily activities.
  • Tender points (or trigger points) on the body that hurt when pressed.

Other symptoms that can occur along with pain include:

  • Fatigue that interferes with work and daily activities.
  • Sleep problems, such as trouble falling asleep or staying asleep, or waking up feeling tired.
  • Morning stiffness lasting less than an hour.
  • Headaches.
  • Constipation or diarrhea related to irritable bowel syndrome.
  • Memory problems and trouble concentrating.
  • Anxiety or depression.

People with fibromyalgia have times when their symptoms get worse and other times when they have milder or no symptoms. Flare-ups of fatigue and muscle and joint aches are common, especially following physical or emotional stress. Many people with fibromyalgia say that cold or damp weather, poor sleep, fatigue, stress, or being too active makes their pain worse.

What Happens

For most people, fibromyalgia seems to involve a cycle of muscle pain, increased sensitivity to pain, and inactivity that may be made worse by sleep problems and fatigue.

  • Increasing pain causes a person to be less physically active.
  • Muscles that aren't exercised regularly are more likely to be irritated during activity. And it may be that people with fibromyalgia are more sensitive to pain or have muscles that are more easily irritated.
  • The irritated muscles are painful. Some doctors think that the muscles of people with fibromyalgia stay sore because they don't repair themselves as well as they should.
  • Muscle pain, sometimes occurring with disrupted sleep and daytime fatigue, leads to less and less activity.

Although fibromyalgia is a long-lasting (chronic) condition with no cure, it can be controlled. It doesn't damage the muscles, joints, or internal organs. Most people adjust to their symptoms and are able to keep working and doing their daily activities. For more information about managing fibromyalgia, see the Treatment Overview.

What Increases Your Risk

Certain things may make you more likely to have fibromyalgia. Things that increase your risk (risk factors) include:

  • Being female.
  • Having certain health problems, such as rheumatoid arthritis, lupus, mononucleosis, or depression.
  • Having been through a traumatic event (such as a car accident).
  • Having a family history of fibromyalgia.

When should you call your doctor?

If not diagnosed

Call your doctor if you have had the following symptoms for more than 6 weeks without an obvious cause. They may be signs of fibromyalgia, especially if they have developed gradually.

  • Widespread muscle tenderness and pain, particularly on both sides of the body and both above and below the waist
  • Disturbed sleep (tossing, turning, waking up frequently during the night) and waking up feeling tired and unrested
  • Muscle and joint stiffness that doesn't get better when you move around

If diagnosed

If you have fibromyalgia, call your doctor if you have:

  • Symptoms of depression, such as a loss of interest in things you usually enjoy or changes in eating and sleeping habits. These can often be treated if you tell your doctor about them.
  • New symptoms or existing symptoms get worse. Your doctor may need to reassess your treatment, such as adjust your medicines or prescribe different ones.

Who to see

Health professionals who may be able to help you with fibromyalgia include:

You may need to see a specialist who has experience with fibromyalgia. These include:

Pain management programs can be helpful too. These typically include a team of doctors, counselors, physical therapists, nurses, and pharmacists who can help you develop a strategy for pain management. Your personal program may include medicines, complementary therapies, diet, exercise, and counseling.

Exams and Tests

There are no specific tests that can confirm a diagnosis of fibromyalgia. You will likely have lab tests to make sure that you don't have another condition causing your symptoms. Your doctor will also ask questions about your medical history and do a physical exam.

Doctors use a set of criteria to diagnose fibromyalgia. These include:

  • Widespread pain. Pain is considered to be widespread if it is above and below your waist and on the right and left sides of your body.
  • Other symptoms such as fatigue, trouble sleeping or feeling unrefreshed in the morning, and trouble thinking. If these symptoms are severe, widespread pain may not be as important in the diagnosis.
  • Symptoms that have lasted for at least 3 months.
  • No other medical explanation for why you feel this way (for example, another health condition or disease).

Fibromyalgia is sometimes diagnosed or described using pain and tenderness at 18 specific spots on the body, or tender points. You may also hear these called trigger points.

A person may not meet these criteria but may still have fibromyalgia. That is why diagnosis can be so difficult.

Treatment Overview

There are many steps you can take to manage your symptoms. Treatment is focused on managing pain, fatigue, depression, and other symptoms common in fibromyalgia. The goal is to break the cycle of increased sensitivity to pain and decreased physical activity.

The treatment you need or want may be based on:

  • How bad your symptoms are.
  • Whether the condition is disrupting your daily life.
  • What kinds of changes in your life you are willing and able to make.

Exercise

Getting consistent exercise, especially cardiovascular exercise, is one of the best ways to manage fibromyalgia. Pool exercise is a good example.

It's important to build up your exercise program slowly so you don't get sore muscles that cause you to want to stop exercising. Working with a physical therapist familiar with fibromyalgia may be helpful.

For more information, see Exercise and Fibromyalgia.

Medicines

Medicines are part of the long-term treatment of fibromyalgia. Medicines can help you sleep better, relax your muscles, or relieve muscle and joint pain. Your doctor may suggest prescription medicines, such as antidepressants, muscle relaxants, and anticonvulsants. Or he or she may suggest nonprescription pain relievers.

Not all people with fibromyalgia will need, want, or benefit from medicines. You might need to try one medicine before finding one that works best for you. You may also find that a medicine that has been helping your symptoms seems to not work as well over time.

Counseling

Cognitive-behavioral therapy and other forms of counseling, including relaxation therapy and biofeedback, have been shown to help people who have fibromyalgia.footnote 1

Counseling has been shown to help with the pain of fibromyalgia. It can also help with sleep problems and fatigue. And it can help improve your mood.footnote 1

Taking care of yourself over time

Taking care of yourself is a vital part of managing fibromyalgia. For example you can:

  • Identify sleep problems, if you have them. Then learn about ways to get more restful sleep.
  • Relieve pain and stiffness with medicines and heat.
  • Identify "triggers" that seem to make your symptoms worse. Then you can learn to avoid or manage them. Triggers may be a change in the weather, certain activities, stress, or a lack of sleep.
  • Talk to your doctor if you have signs of depression or anxiety.

With help, you will be able to start working on most of these goals at home. You may have a team of health professionals to help you. To learn more, see Home Treatment.

Because the symptoms of fibromyalgia can come and go, you may find it hard to judge whether a particular treatment is really working. Different people may respond differently to each type of treatment. Many people with fibromyalgia have other joint or muscle diseases (such as rheumatoid arthritis or lupus) that need to be treated too.

Finding a treatment can take time. You may have to try several different treatments to find an approach that works for you.

Prevention

Fibromyalgia can't be prevented or cured. But treating symptoms may help reduce how long a flare-up lasts.

For more information, see the Treatment Overview.

Home Treatment

Home treatment is the most important part of treating fibromyalgia. There are many things you can do over time to treat your symptoms:

  • Exercise regularly. Of all the treatments for fibromyalgia, cardiovascular (aerobic) exercise may have the most benefit in reducing pain and other symptoms and in improving your overall condition. Work with a physical therapist or other professional who has expertise with fibromyalgia to build an exercise program that works for you. And then stay with it.
  • Try to avoid or limit your exposure to "triggers" or "stressors" that make your symptoms worse. Common triggers include cold or damp weather, poor sleep, fatigue, physical or emotional stress, and being too active.
  • Improve sleep. Sleep disturbances seem to both cause and result from some of the other symptoms of fibromyalgia, such as pain. Learn good sleep habits. And try to get enough sleep each night.
  • Relieve pain. Heat therapy, massage, gentle exercise, and short-term use of nonprescription pain relievers may be helpful.
  • Reduce stress. Finding healthy ways to cope with stress may help reduce your pain.
  • Learn about fibromyalgia. The more you know about fibromyalgia, the more control you will have over your symptoms. People who feel more in control also tend to be more active and report less pain and other symptoms.
  • Learn ways to manage your memory problems. Feeling as though you are not thinking clearly—sometimes called "fibro fog"—increases stress and can make memory problems worse. Simple things like writing yourself notes can help you feel more in control.
  • Have a good-health attitude, along with these other healthy habits. It's hard to stay positive when you don't feel well. But a good attitude helps you focus less on your challenges and feel more healthy.

The best results occur when you take an active, committed role in your own treatment. You may need to adjust your lifestyle to fit home treatment, especially regular exercise, into your daily routine. It may take time to find an approach that works for you. Try to be patient. And keep in mind that consistent home treatment usually can help relieve or control symptoms of fibromyalgia.

Medications

Medicines are part of the long-term treatment of fibromyalgia. They may help break the cycle of pain and sleep problems when symptoms flare up. Not all people with fibromyalgia will need, want, or benefit from medicines. People with more severe pain, sleep problems, or depression that disturbs their daily life may find medicines helpful.

Fibromyalgia symptoms in different people respond to different medicines. Your doctor may try more than one medicine before finding one that works best for you. You may also find that a medicine that has been helping your symptoms seems to become less effective over time. Talk with your doctor if you are not getting relief. He or she may try a different medicine or make suggestions for helping find new ways to modify your activity, sleep, and stress.

Medicine choices

Certain types of medicines may be used to improve sleep, relieve pain and fatigue, and, in some cases, treat depression. These improvements in symptoms may allow you to feel better and to be more active. Medicines used for fibromyalgia include:

  • Cyclobenzaprine (Amrix).
  • Antidepressants, such as fluoxetine (Prozac), milnacipran (Savella), bupropion (Wellbutrin), and amitriptyline.
  • Anticonvulsants (seizure medicines), such as pregabalin (Lyrica).

Often medicines may be combined (such as fluoxetine and amitriptyline) for the most effective treatment of symptoms of pain and sleep disruptions.

Prescription pain medicines, such as tramadol (Ultram), are sometimes used. And they are sometimes combined with acetaminophen.

Nonprescription pain relievers, such as acetaminophen (for example, Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDS, such as ibuprofen or aspirin) usually aren't very helpful in treating day-to-day symptoms of fibromyalgia. But they may be useful in reducing severe pain caused by a flare-up of symptoms. Check with your doctor if you need to keep taking these medicines, because they may harm your stomach, kidneys, or in rare cases, your liver. Your doctor may want to monitor you if you take acetaminophen or NSAIDs daily.

Other Treatment

Counseling

The pain and other symptoms of fibromyalgia can get worse during stressful times. The good news is that there are a lot of things you can do to lower your stress. For example, research shows that you can change how you think. And how you think affects how you feel.

Here are some techniques you can try on your own or with help from a therapist or counselor trained in muscle relaxation, meditation, biofeedback, or cognitive-behavioral therapy:

Complementary therapy

Complementary treatments that have been used to treat fibromyalgia include:

Talk with your doctor about the safety and potential side effects of the treatment. Remember that fibromyalgia doesn't physically harm you or damage your body. A treatment that could be harmful may not be worth the risk, especially when its benefits are unproven. Avoid treatments that may be harmful, such as unusual diets or excessive vitamin or mineral supplements. (A daily multiple vitamin-mineral supplement is okay. Try to avoid taking more than 100% of the recommended daily allowance for any vitamin or mineral unless your doctor prescribes a special supplement.)

Most mind and body practices—such as acupuncture, meditation, and yoga—are safe when used under the care of a well-trained professional. Choose an instructor or practitioner as carefully as you would choose a doctor.

References

Citations

  1. Glombiewski JA, et al. (2010). Psychological treatments for fibromyalgia. Pain, 151(2): 280–295.

Other Works Consulted

  • Arnold LM, et al. (2008). Patient perspectives on the impact of fibromyalgia. Patient Education and Counseling, 73(1): 114–120.
  • Häuser W, et al. (2009). Treatment of fibromyalgia syndrome with antidepressants. JAMA, 301(2): 198–209.
  • U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/guidelines/default.aspx.
  • Wolfe F, et al. (2010). The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care and Research, 62(5): 600–610.
  • Wolfe F, et al. (2013) Fibromyalgia. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 9th ed., Vol. 1, pp 733–751. Philadelphia: Saunders.

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