• Definition
    • Fibromyalgia is a common syndrome in which a person has long-term pain that is spread throughout the body. The pain is most often linked to fatigue, sleep problems, headaches, depression, and anxiety.

      People with fibromyalgia may also have tenderness in the joints, muscles, tendons, and other soft tissues.

  • Alternative Names
    • Fibromyositis; Fibrositis

  • Causes
    • The cause is unknown. Possible causes or triggers of fibromyalgia include:

      • Physical or emotional trauma.
      • Abnormal pain response: Areas in the brain that control pain may react differently in people with fibromyalgia.
      • Sleep disturbances.
      • Infection, such as a virus, although none has been identified.

      Fibromyalgia is most common among women age 20 to 50.

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

  • Symptoms
    • Pain is the main symptom of fibromyalgia. It may be mild to severe.

      • Painful areas are called tender points. Tender points are found in the soft tissue on the back of the neck, shoulders, chest, lower back, hips, shins, elbows, and knees. The pain then spreads out from these areas.
      • The pain may feel like a deep ache, or a shooting, burning pain.
      • The joints are not affected, although the pain may feel like it is coming from the joints.

      People with fibromyalgia tend to wake up with body aches 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 activity, cold or damp weather, anxiety, and stress.

      Fatigue, depressed mood, and sleep problems occur in almost all people with fibromyalgia. Many people say that they cannot get to sleep or stay asleep, and they feel tired when they wake up.

      Other symptoms of 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:

      • Ongoing problems with sleep
      • Fatigue
      • Thinking or memory problems

      It is no longer necessary to find tender points during the exam to make a diagnosis.

      Results from blood and urine tests, and imaging tests are normal. However, these tests may be done to rule out other conditions with similar symptoms. Studies of breathing during sleeping may be done to find out if you have a condition called sleep apnea.

  • Treatment
    • The goals of treatment are to help relieve pain and other symptoms, and to help a person cope with the symptoms.

      The first type of treatment may involve:

      • Physical therapy
      • Exercise and fitness program
      • Stress-relief methods, including light massage and relaxation techniques

      If these treatments do not work, your health care provider may also prescribe an antidepressant or muscle relaxant.

      • The goal of these medicines is to improve your sleep and help you better tolerate pain.
      • Medicine should be used along with exercise and behavior therapy.
      • Duloxetine (Cymbalta), pregabalin (Lyrica), and milnacipran (Savella) are drugs that are approved specifically for treating fibromyalgia.

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

      • Anti-seizure drugs, such as gabapentin.
      • Other antidepressants, such as amytriptyline.
      • Muscle relaxants, such as cyclobenzeprine.
      • Pain relievers, but avoid narcotics, since they usually do not help.
      • Sleeping aids: If you have sleep apnea, an apparatus called CPAP may be prescribed.

      Cognitive-behavioral therapy is an important part of treatment. This therapy helps you learn how to:

      • Deal with negative thoughts.
      • Keep a diary of pain and symptoms.
      • Recognize what makes your symptoms worse.
      • Seek out enjoyable activities.
      • Set limits.

      Support groups may also be helpful.

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

      • Eat a well-balanced diet.
      • Avoid caffeine.
      • Practice a good sleep routine to improve quality of sleep.
      • Exercise regularly, starting with low-level exercise.
      • Try acupressure and acupuncture treatments.

      Your doctor may refer you to a pain clinic if your condition is severe.

  • 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
    • Call your health care provider if you have symptoms of fibromyalgia.

  • Prevention
    • There is no known prevention.

  • References
    • Bennett RM. Fibromyalgia, chronic fatigue syndrome, and myofascial pain. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 274.

      Marvisi M, Balzarini L, Mancini C, Ramponi S, Marvisi C. Fibromyalgia is frequent in obstructive sleep apnea and responds to CPAP therapy. Eur J Intern Med. 2015;26(9):e49-50. PMID: 26129987

      McBeth J, Prescott G, Scotland G, et al. Cognitive behavior therapy, exercise, or both for treating chronic widespread pain. Arch Intern Med. 2012(1);48-57. PMID: 22082706

      Wolfe F, Clauw DJ, Fitzcharles MA, et al. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR preliminary diagnostic criteria for fibromyalgia. J Rheumatol. 2011;38:1113. PMID: 21285161

      Wolfe F, Clauw DJ, Fitzcharles MA, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res. 2010;62(5):600-610. PMID: 20461783

      Wolfe F, Rasker JJ. Fibromyalgia. In: Firestein GS, Budd RC, Gabriel SE, et al, eds. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 52.