Fibromyalgia: Symptoms, diagnosis and treatments

Fibromyalgia is a chronic condition that causes widespread pain all over the body, fatigue and poor sleep, and it often also causes problems with mood, memory and concentration. It affects about 2% of the U.S. population and roughly twice as many women as men. Fibromyalgia tends to be diagnosed in middle age, but people of all ages can develop the condition, according to the Centers for Disease Control and Prevention (CDC). 

The cause of fibromyalgia is not known, although scientists are studying potential explanations. People with the condition may have abnormal pain perception processing, meaning they may have lower pain threshold than people without fibromyalgia. They are also more likely to have lupus and rheumatoid arthritis — autoimmune disorders in which the immune system attacks healthy tissues and causes painful inflammation, the CDC said.   

Researchers believe that any factors likely contribute to the development of fibromyalgia, including family history of chronic pain, exposure to certain infections and history of physical or psychological trauma, Kevin Boehnke, a research assistant professor in the Chronic Pain and Fatigue Research Center at the University of Michigan, told Live Science by email. 

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What are the symptoms of fibromyalgia?

Fibromyalgia is mainly characterized by pain felt throughout the body, as well as fatigue and trouble sleeping, but it can also include a wide variety of other symptoms, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). 

These other symptoms may include:

• Muscle and joint stiffness
• Muscles that are tender to touch
• Numbness or tingling in the limbs 
• Problems with concentrating, thinking clearly and memory (sometimes called "fibro fog")
• Heightened sensitivity to light, noise, odors and temperatures
• Problems with digestion, such as bloating or constipation

Fibromyalgia symptoms tend to flare or fluctuate over time, Afton Hassett, a clinical psychologist and associate professor in the Department of Anesthesiology at the University of Michigan, told Live Science by email.

"A flare-up of symptoms can be caused by several things and often these are highly individualized. For most, excessive activity on the days that they feel good can result in a symptom flare up the next day," she said. "Other common triggers for a flare-up include poor sleep, stress, and feeling anxious or depressed."

What are the causes of fibromyalgia?

The causes of fibromyalgia are not known. 

People with fibromyalgia may perceive pain differently to those without the condition due to some sort of disruption that affects the  transmission of pain signals in the nervous system. The same mechanism may also be responsible for fatigue, sleep disturbances and other symptoms characteristic of the disorder, according to NIAMS. That is because neurotransmitters, or chemical messengers, involved in relaying pain signals also help regulate memory, sleep and mood, Boehnke told Live Science. These neurotransmitters include serotonin, dopamine and noradrenaline, for example.

Genetic factors may be responsible for up to 50% of susceptibility to fibromyalgia, which would explain why this condition tends to run in families, according to a 2019 review published in the journal Molecular Pain. People with the condition may have genetic alterations that make them more sensitive to the effects of stress, which is a common trigger for flare-ups, and they may also carry specific versions of genes directly involved in pain perception.

Environmental factors may also increase the chances of developing fibromyalgia by affecting how these genes are expressed, the review authors noted.

"Most genetic diseases and conditions work that way — there is a genetic predisposition but there is also something that triggers the start of the illness," Hassett said. "With fibromyalgia a physical or emotional trauma can be the triggering event. But also infectious diseases like Lyme disease, Epstein-Barr virus or even COVID-19 are thought to initiate fibromyalgia-like symptoms in a subset of people." (Lyme disease is a bacterial infection spread by ticks, and Epstein-Barr virus is the virus behind "mono.")

Related: The virus behind 'mono' might trigger multiple sclerosis in some 

Fibromyalgia may also be linked to numerous health issues, including inflammation and dysfunctions within the immune system, according to a 2021 review published in the International Journal of Molecular Sciences. 

Up to 25% of patients with an autoimmune condition like rheumatoid arthritis or psoriatic arthritis get a secondary diagnosis of fibromyalgia. It’s possible that some people with severe fibromyalgia may carry autoantibodies — immune proteins that inadvertently attack the body's tissues — characteristic of other autoimmune diseases, Dr. Deepak Ravindran, a consultant in pain medicine based in England, told Live Science by email.  

What are the possible complications of fibromyalgia?

Fibromyalgia is not a fatal disease. However, people with the condition are at higher risk of developing health complications and mental health problems than those without fibromyalgia, according to the CDC.

People with fibromyalgia often have issues with mobility and weakened muscles due to pain and fatigue. Other complications can include dietary deficiencies caused by digestive symptoms and altered eating patterns. Frequent symptom flare-ups can require hospitalization and may worsen mental health, Ravindran said. 

According to the CDC, people with fibromyalgia experience higher rates of major depressive disorder and death by suicide and injury than people without the condition, although their overall mortality rates are similar to the general population.  

How is fibromyalgia diagnosed?

Doctors usually diagnose fibromyalgia based on the patient's history and a physical examination, and they may use laboratory and imaging tests, such as blood tests and X-rays, to rule out other conditions that have similar symptoms. There are no specific biomarkers — biological molecules found in the body — that are currently used to diagnose fibromyalgia, according to the NIAMS.

Preliminary diagnosis of fibromyalgia is based on a widespread pain index (WPI) and symptom severity (SS score), according to the 2010 guidelines released by the American College of Rheumatology. Doctors use a checklist of areas of the body — lower left leg, upper right arm, left hip, for example — to find out how widespread a patient's pain is. They also ask patients to rate the severity of their symptoms on a scale from 0 to 3.

According to the 2010 guidelines, a patient satisfies the diagnostic criteria for fibromyalgia  if the following three conditions are met:

• Their WPI and SS scores indicate a certain level of pain and severity.
• Their symptoms have been consistent for at least three months.
• The patient does not have a disorder that would explain the pain.

How is fibromyalgia treated?

There is no cure for fibromyalgia, so treatment focuses on relieving the symptoms, according to the NIAMS. Treatment plans may include a combination of medications, psychological therapy and self-management approaches, such as physical exercise, yoga or tai chi.

The U.S. Food and Drug Administration (FDA) has approved three medications for fibromyalgia and several others that are routinely used. These medications mostly target the neurotransmitter systems that are involved in processing pain signals in the spinal cord and brain, Hassett said. The three medications include the anti-seizure drug pregabalin (brand name Lyrica) and two antidepressants, duloxetine (Cymbalta) and milnacipran (Savella). Over-the-counter painkillers, including acetaminophen (such as Tylenol) or nonsteroidal anti-inflammatory drugs (such as aspirin and ibuprofen), may slightly ease the pain and stiffness caused by fibromyalgia, NIAMS said.

Unfortunately, no one medication seems to work well for the majority of people with chronic pain, Hassett said. 

"The most successful treatment is multi-modal, meaning that several domains (aspects of health) are addressed in the treatment plan using a combination of therapies. The people who do best with fibromyalgia are those who understand their unique illness well and have devised strategies to maximize their health," she said. For example, they aim to have a consistent sleep schedule and minimize their stress levels. "Good, consistent self-care is vital for avoiding symptom flare-ups," Hassett said.

Movement-based activities are central to the treatment of fibromyalgia, Boehnke told Live Science. "There are many types of movement that can help with fibromyalgia symptoms, and the 'right' movement is that which aligns with the preferences and needs of the patient," he said.

Therapies that include aerobic, strength and flexibility exercises can help reduce the severity of fibromyalgia symptoms. However, the mechanism of action by which movement helps patients with fibromyalgia is unclear, according to a 2019 meta-analysis published in the European Journal of Physical and Rehabilitation Medicine. 

Furthermore, people with fibromyalgia may benefit from attending talk therapy, including cognitive behavioral therapy, as well as practicing mindfulness and meditation. 

Complementary and alternative medicine treatments such as acupuncture and massage may also help relieve some of the symptoms, such as pain and sleep problems, Boehnke said. (That said, while some studies of acupuncture for fibromyalgia suggest that it may help relieve some patient's symptoms, overall, the evidence is mixed and more research is needed, according to Mayo Clinic.) 

In addition, emerging evidence suggests that non-invasive neuromodulation — techniques that involve active stimulation of nerves with magnetic fields and electrical currents — may help ease symptoms of fibromyalgia. 

For example, repetitive transcranial magnetic stimulation (rTMS) has shown promising results in treating anxiety, pain, depression and sleep disorders in fibromyalgia patients in clinical trials, according to a 2021 review published in the journal ACS Chemical Neuroscience. Another technique, transcranial direct current stimulation (tDCS), may also offer patients some pain relief, although more research is needed to understand what regions of the brain doctors should target to best treat patients' symptoms, according to a 2020 meta-analysis published in the Journal of Pain.