Fibromyalgia

Also known as: Fibromyalgia syndrome, FMS (fibromyalgia syndrome), Chronic widespread pain syndrome, Central sensitivity syndrome, Fibrositis, Fibro

Last updated: December 18, 2024

Fibromyalgia is a chronic pain condition marked by widespread musculoskeletal pain along with fatigue, sleep disturbance, and cognitive symptoms. It may involve altered pain processing in the central nervous system, often described as increased sensitivity to sensory input. Symptoms often occur without a single clear tissue injury and can fluctuate over years, with periods of improvement and worsening. Education and self-management support are common parts of care.

Key Facts

•Fibromyalgia be described as a chronic pain condition characterized by widespread musculoskeletal pain along with fatigue, sleep disturbance, and cognitive symptoms
•Widespread musculoskeletal pain that involve both sides of the body and fluctuate, sometimes worsening with stress, poor sleep, or overexertion
•Diagnosed through history, physical exam, and imaging
•First-line treatment includes exercise, weight management, and activity modification

What It Is

Fibromyalgia may be described as a chronic pain condition characterized by widespread musculoskeletal pain along with fatigue, sleep disturbance, and cognitive symptoms. It can involve altered pain processing within the central nervous system, often described as increased sensitivity to sensory input (central sensitization). Symptoms typically occur without a single identifiable tissue injury and can fluctuate in intensity over time. Fibromyalgia often overlaps with other functional or chronic pain conditions and may be associated with mood symptoms and autonomic complaints.

Affected Anatomy

This condition affects several structures in and around the joint:

•Central nervous system pain-processing pathways (brain regions involved in pain modulation, including cortical and subcortical networks)
•Spinal cord dorsal horn nociceptive processing circuits (central sensitization mechanisms)
•Peripheral small nerve fibers in skin and soft tissues (small-fiber sensory pathways that can contribute to pain and dysesthesia in some people)
•Skeletal muscles and myofascial tissues (diffuse tenderness and pain amplification rather than focal structural injury)
•Hypothalamic-pituitary-adrenal (HPA) axis stress-response system (neuroendocrine regulation that can relate to fatigue and sleep disruption)
•Autonomic nervous system (sympathetic/parasympathetic balance that can relate to orthostatic symptoms and temperature sensitivity)
•Sleep-regulation networks (sleep architecture and restorative sleep mechanisms that can influence pain and fatigue)

Common Symptoms

Symptoms can vary in intensity and may change over time. Common experiences include:

•Widespread musculoskeletal pain that can involve both sides of the body and may fluctuate, sometimes worsening with stress, poor sleep, or overexertion
•Fatigue that can be persistent and may feel disproportionate to activity level, sometimes described as low stamina or post-exertional worsening
•Nonrestorative sleep and sleep disturbances that can include frequent awakenings and difficulty maintaining sleep
•Cognitive difficulties (often described as “fibro fog”) that can include reduced attention, slowed processing, and word-finding difficulty
•Morning stiffness or generalized achiness that can improve during the day but may recur with inactivity or prolonged positioning
•Headaches or migraine-like symptoms that can co-occur with widespread pain and sleep disruption
•Paresthesias or sensory hypersensitivity (such as tingling, sensitivity to touch, light, sound, or temperature) that can occur without focal neurologic deficits
•Mood symptoms such as anxiety or depressive symptoms that can accompany chronic pain and may influence symptom severity

Causes and Risk Factors

Multiple factors can contribute to the development of this condition:

Causes

•Central sensitization and altered pain modulation, which can involve increased responsiveness of pain pathways and reduced endogenous pain inhibition
•Genetic susceptibility, which can contribute to differences in pain sensitivity and stress-response regulation in some individuals
•Triggering events such as physical trauma, surgery, infection, or significant psychological stress, which can precede symptom onset in some cases
•Sleep disturbance and disordered sleep physiology, which can amplify pain perception and fatigue and may contribute to symptom persistence
•Neuroendocrine and autonomic dysregulation, which can relate to stress responses, fatigue, and multisystem symptoms
•Comorbid conditions and chronic pain overlap (such as migraine or irritable bowel syndrome), which can reflect shared mechanisms of pain amplification

Risk Factors

•Sex assigned female at birth, which can be associated with higher reported prevalence in many clinical populations
•Family history of fibromyalgia or chronic pain conditions, which can suggest heritable vulnerability to pain amplification
•History of chronic stress, trauma exposure, or adverse life events, which can be associated with symptom onset or worsening in some individuals
•Sleep disorders (such as insomnia or sleep-disordered breathing), which can contribute to nonrestorative sleep and heightened pain sensitivity
•Coexisting rheumatologic or pain conditions (such as rheumatoid arthritis, osteoarthritis, or chronic low back pain), which can increase likelihood of widespread pain syndromes
•Mood disorders (including anxiety and depressive disorders), which can co-occur and may influence pain perception and coping
•Sedentary lifestyle or deconditioning, which can be associated with reduced functional capacity and increased symptom burden
•Certain infections or post-infectious syndromes, which can precede chronic widespread pain in some individuals

How It's Diagnosed

Diagnosis typically involves a combination of clinical assessment and imaging studies:

•Clinical history focusing on widespread pain distribution, symptom duration, fatigue, sleep quality, and cognitive symptoms, often including assessment of symptom variability and triggers
•Physical examination that can include evaluation of generalized tenderness, functional movement, neurologic screening, and assessment for alternative pain generators
•Use of standardized diagnostic criteria (such as American College of Rheumatology-based symptom severity and widespread pain indices), which can support consistent classification in clinical settings
•Laboratory testing that can help evaluate alternative or coexisting conditions (such as thyroid disease, inflammatory disorders, or anemia) when clinically indicated by symptoms or examination
•Assessment for overlapping conditions that can mimic or coexist with fibromyalgia (such as inflammatory arthritis, myopathy, neuropathy, or sleep disorders), often guided by targeted history and examination
•Sleep evaluation when symptoms suggest a primary sleep disorder (for example, screening for sleep apnea or restless legs), which can influence fatigue and pain amplification
•Patient-reported outcome measures that can quantify pain interference, fatigue, sleep quality, and function over time to support longitudinal assessment

Treatment Options

Treatment approaches range from conservative measures to surgical interventions, often starting with the least invasive options:

Self-Care and Activity Modification

•Education and self-management support, which can include understanding pain amplification mechanisms and setting functional goals
•Graded aerobic activity programs, which can improve function and may reduce symptom severity when progressed gradually
•Cognitive behavioral therapy and other psychological interventions, which can support coping skills, sleep strategies, and symptom-related distress
•Sleep-focused interventions, which can include behavioral sleep strategies and evaluation of coexisting sleep disorders that may worsen symptoms
•Medications that can modulate pain signaling (including certain antidepressants and anticonvulsant-class agents), which may reduce pain and improve sleep in some individuals
•Management of comorbid conditions (such as migraine, irritable bowel syndrome, anxiety, or depression), which can reduce overall symptom burden
•Complementary approaches such as mindfulness-based practices, tai chi, yoga, or acupuncture, which can improve quality of life for some individuals

Physical Therapy and Exercise

•Strengthening and flexibility-focused physical therapy approaches, which can address deconditioning, movement sensitivity, and functional limitations
•Multidisciplinary pain rehabilitation programs, which can integrate physical reconditioning, behavioral therapy, and functional restoration strategies

Surgery

•Surgical interventions, which generally may not address fibromyalgia itself and can be considered only when a separate, clearly defined structural condition is present

Prognosis and Recovery

The course of this condition varies between individuals:

•Fibromyalgia typically spans years and can involve fluctuating symptom intensity, with periods of relative improvement and exacerbation.
•Functional outcomes often can improve with multimodal management, particularly when sleep, activity tolerance, and mood symptoms are addressed together.
•Pain and fatigue may persist in some individuals, although symptom burden can lessen over time with sustained self-management and supportive care.
•Stress, poor sleep, and comorbid medical or mental health conditions can contribute to symptom flares and may influence long-term quality of life.
•Early recognition and coordinated care can be associated with improved function and reduced unnecessary testing, although individual responses can vary.

Physical Therapy (Physiotherapy)(Procedure)
Rheumatoid Arthritis (RA)(Condition)

Frequently Asked Questions

Common symptoms include: Widespread musculoskeletal pain that can involve both sides of the body and may fluctuate, sometimes worsening with stress, poor sleep, or overexertion; Fatigue that can be persistent and may feel disproportionate to activity level, sometimes described as low stamina or post-exertional worsening; Nonrestorative sleep and sleep disturbances that can include frequent awakenings and difficulty maintaining sleep; Cognitive difficulties (often described as “fibro fog”) that can include reduced attention, slowed processing, and word-finding difficulty; Morning stiffness or generalized achiness that can improve during the day but may recur with inactivity or prolonged positioning.

Diagnosis typically involves: Clinical history focusing on widespread pain distribution, symptom duration, fatigue, sleep quality, and cognitive symptoms, often including assessment of symptom variability and triggers; Physical examination that can include evaluation of generalized tenderness, functional movement, neurologic screening, and assessment for alternative pain generators; Use of standardized diagnostic criteria (such as American College of Rheumatology-based symptom severity and widespread pain indices), which can support consistent classification in clinical settings; Laboratory testing that can help evaluate alternative or coexisting conditions (such as thyroid disease, inflammatory disorders, or anemia) when clinically indicated by symptoms or examination.

Treatment options range from conservative measures to surgical interventions, including: Education and self-management support, which can include understanding pain amplification mechanisms and setting functional goals; Graded aerobic activity programs, which can improve function and may reduce symptom severity when progressed gradually; Strengthening and flexibility-focused physical therapy approaches, which can address deconditioning, movement sensitivity, and functional limitations; Cognitive behavioral therapy and other psychological interventions, which can support coping skills, sleep strategies, and symptom-related distress; Sleep-focused interventions, which can include behavioral sleep strategies and evaluation of coexisting sleep disorders that may worsen symptoms.