Fibromyositis; FM; Fibrositis
Fibromyalgia is a condition 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.
Usually when you're in pain, you can quickly find the cause, like the muscle you strained while working out, or the cut you gave yourself while slicing carrots. Yet for people with fibromyalgia, the source of their pain is harder to pinpoint. Although they experience pain daily, it can take some time to find the cause, and to get the right treatment for it. Fibromyalgia is still somewhat of a mystery, because no one knows what causes it and it's often mistaken for conditions with similar symptoms, like Lyme disease or depression. Some people think fibromyalgia stems from physical or emotional trauma. Others believe it's caused by an abnormal response to pain. Whatever the cause, fibromyalgia leads to widespread areas of pain on both sides of the body, and both below and above the waist. The pain may feel like an ache, or a sharp stabbing feeling, and it doesn't go away. To be diagnosed with fibromyalgia, you need to have physical findings at at least 11 specific tender points, which can be in your arms, buttocks, chest, knees, lower back, neck, rib cage, shoulders, or thighs. Doctors may diagnose fibromyalgia without a tender point examination by using the widespread pain index (WPI), and the symptoms severity scale score (SS). If the symptoms have been present at a similar level for at least 3 months and there is no other disorder that would otherwise explain the pain. The pain may get worse when you exercise, go outside in cold weather, or are under a lot of stress. In addition to pain, you may have problems concentrating or fatigue, and waking up unrefreshed. And you may have any of a long list of other symptoms as well including in the GI tract, urinary system, nervous system, and skin. There's no cure for fibromyalgia, but there are treatments to control your symptoms. Your doctor will probably start you on an exercise regimen and have you work with a physical therapist. Some have found real help from acupuncture, learning Tai Chi, or taking yoga classes. You may also need to take medicine to help you sleep and relieve your pain. Medicines that are commonly prescribed for fibromyalgia include antidepressants, antiseizure medications, pain relievers, and sleep aids. Meanwhile, talking to a therapist can help you better manage and live with your pain, and deal with any negative thoughts you may have about your condition. Despite improvements in the way doctors diagnose and treat fibromyalgia, it's still a chronic condition. But by working with your doctor, you can manage the symptoms and learn to live with them, so that you can control your fibromyalgia, rather than the other way around.
The cause is not known. Researchers think that fibromyalgia is due to a problem with how the central nervous system processes pain. 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 more common in females as compared to males. Women ages 20 to 50 are most affected.
The following conditions may be seen with fibromyalgia or have similar symptoms:
Pain is the main symptom of fibromyalgia.
The areas where pain occurs are called tender points. These points are found in the soft tissue on the back of the head, neck, shoulders, chest, lower back, hips, elbows, and knees. The pain then spreads out from these areas. The qualities of the pain are:
- It may be mild to severe.
- It may feel like a deep ache, or a stabbing, burning pain.
- It may feel like it is coming from the joints, although the joints are not affected.
People with fibromyalgia tend to wake up with body pain 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:
- Physical activity
- Cold or damp weather
- Anxiety and stress
Most of the people with fibromyalgia have fatigue, depressed mood, and sleep problems. 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
- Thinking or memory problems
It is not necessary to find tender points during the exam to make a diagnosis.
Results from the physical exam, blood and urine tests, and imaging tests are normal. 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.
Fibromyalgia may also occur in people who have other forms of arthritis, such as:
- Rheumatoid arthritis
- Systemic lupus erythematosus
The goals of treatment are to help relieve pain and other symptoms, and to help the 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. Sometimes, combinations of medicines are helpful.
- 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 medicines that are approved specifically for treating fibromyalgia.
Other medicines are also used to treat the condition, such as:
- Anti-seizure drugs, such as gabapentin
- Other antidepressants, such as amitriptyline
- Muscle relaxants, such as cyclobenzaprine
- Pain relievers, such as tramadol
If you have sleep apnea, a device called continuous positive airway pressure (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
Complementary and alternative treatments may also be helpful. These may include:
- Tai chi
Support groups may also help.
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. Start with low-level exercise.
Your provider may refer you to a pain clinic if your condition is severe.
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 provider if you have symptoms of fibromyalgia.
There is no known prevention.
Bennett RM. Fibromyalgia, chronic fatigue syndrome, and myofascial pain. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 274.
Borg-Stein J, Brassil ME, Borgstrom HE. Fibromyalgia. In: Frontera, WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 102.
Clauw DJ. Fibromyalgia: a clinical review. JAMA. 2014;311(15):1547-1555. PMID: 24737367
Clauw DJ. Fibromyalgia and related syndromes.In: Hochberg MC, Gravallese EM, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 91.
Crofford LJ. Fibromyalgia. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. Kelley and Firestein's Textbook of Rheumatology. 10th ed. Philadelphia, PA: Elsevier; 2017:chap 52.
Gilron I, Chaparro LE, Tu D, et al. Combination of pregabalin with duloxetine for fibromyalgia: a randomized controlled trial. Pain. 2016;157(7):1532-1540. PMID: 26982602
Lauche R, Cramer H, Häuser W, Dobos G, Langhorst J. A systematic overview of reviews for complementary and alternative therapies in the treatment of the fibromyalgia syndrome. Evid-Based Complement Alternat Med. 2015; 2015:610615.
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-e50. PMID: 26129987
Wu YL, Chang LY, Lee HC, Fang SC, Tsai PS. Sleep disturbances in fibromyalgia: a meta-analysis of case-control studies. J Psychosom Res. 2017; 96:89-97. PMID: 28545798
Last reviewed on: 1/29/2018
Reviewed by: Gordon A. Starkebaum, MD, ABIM Board Certified in Rheumatology, Seattle, WA. Editorial review and update on 03/28/2019 by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.