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:

Anxiety and depression. These can make you feel worse.
Sleep problems and tiredness.
Headaches.
Morning stiffness.
Trouble concentrating.
Irritable bowel syndrome .

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 two things:

Widespread pain on both sides of your body above and below the waist
Tenderness in at least 11 of 18 points when they are pressed

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.

Frequently Asked Questions

Learning about fibromyalgia:	What is fibromyalgia? What causes it? What are the symptoms? Does it permanently damage my joints or muscles?
Being diagnosed:	How does my doctor know if I have fibromyalgia?
Getting treatment:	How is fibromyalgia treated? What medicines are used to treat it? What can I do at home to treat it? Are any complementary or alternative treatments helpful for people with fibromyalgia?
Living with fibromyalgia:	Will my symptoms improve? How does exercise help? What kind of exercise is best for me? What are some ways I can relieve stress? How can I get a good night's sleep more often? What is "fibro fog"? What can I do about it?

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.¹ 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, Lyme disease, mononucleosis, or depression.
Having been through a traumatic event (such as a car accident).
Having a family history of fibromyalgia.

When To Call a 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:

Rheumatologists , who have the most experience with diagnosing fibromyalgia.
Pain management specialists , who have experience with treatment.

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.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

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. Your doctor will look for:

Widespread pain that has been present for at least 3 months. Pain is considered to be widespread if it is above and below your waist and on the right and left sides of your body.
Pain and tenderness at 11 or more of 18 specific spots. The pain usually occurs only when the areas are pressed. Experts call these tender points. But you may also hear them called trigger points. (Some people may have fewer than 11 tender points but still may have fibromyalgia.)

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 has been found to work well for many people.²

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.¹

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 hypnotherapy, have been shown to help people who have fibromyalgia.²

Counseling can help you learn to manage your pain, learn to relax, and reduce stress. These can help decrease pain and fatigue. And it can improve your mood and help you function.²

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.³
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.

Medication 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:

Tricyclic antidepressants, such as amitriptyline.
Cyclobenzaprine (Flexeril).
Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac).
Serotonin and norepinephrine reuptake inhibitors (SNRIs)—also called mixed (or dual) reuptake inhibitors—such as milnacipran (Savella).
Atypical antidepressants. These are drugs that don't fit well into the general categories of antidepressant medicines. Bupropion (Wellbutrin) is an example of an atypical antidepressant that is used for fibromyalgia.
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.

Other medicines are being studied and used for treating fibromyalgia, including:

Pain medicines such as tramadol (Ultram), sometimes combined with acetaminophen.²

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

Complementary and alternative therapy

Most people with fibromyalgia try some type of alternative therapy.⁴ They may relieve stress, ease muscle tension, and help you feel better and healthier. Some of these therapies have been shown to be effective for many people. But for other therapies, such as tender point injections, there is no evidence that they help.

Therapies that have been shown to be effective for many people include the following:

Biofeedback has been shown to help people who have fibromyalgia.²
A small study found that tai chi may help people who have fibromyalgia. In this study, people who took part in a tai chi class felt better. They had less pain, slept better, and were able to exercise more and be more active.⁵

Other treatments that have been used to treat fibromyalgia include:

Acupuncture.
Massage therapy.
Relaxation techniques such as yoga, meditation, or prayer.
Vitamins , dietary supplements, and herbal products.
Transcutaneous electrical nerve stimulation (TENS).
Reflexology. This is the practice of applying pressure to points on the body that benefit other parts of the body.
Chiropractic therapy .

What to think about

You may find one or more complementary or alternative therapies to be helpful in relieving some of your symptoms. Keep in mind that there is only limited information about how well these treatments (and others you may have heard about) work for treating fibromyalgia.

If you have fibromyalgia and are thinking about trying a complementary therapy, get the facts before you begin. Consider these questions with your doctor:

Is it safe? 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.)
Does it work? Because the symptoms of fibromyalgia can come and go, you may find it hard to judge whether a certain treatment is really working. Symptoms of fibromyalgia often improve on their own. Or the treatment may be causing a placebo effect that is making you feel better. Keep in mind that when you get better after treatment, the treatment may not be the reason for the improvement. Also remember that a treatment that works for one person may not work for you. It may take time. And you may have to try several different treatments to find an approach that works for you.
Will it improve my general health? Even if complementary therapies aren't effective in treating fibromyalgia, many of them are safe, healthy habits that may improve your general well-being and may be worth trying.

With a hard-to-treat condition like fibromyalgia, it can be tempting to jump at the promise of an effective treatment. Be careful. Avoid products that claim to have a secret ingredient or that claim to cure fibromyalgia. Avoid those that encourage unhelpful behaviors such as excessive resting or avoiding activity.

Also make sure you know how much a treatment is going to cost before you agree to it. An expensive, unproven treatment that may or may not help you may not be worth the high cost. Beware of treatment providers or products that require a large financial investment at the start or a series of costly treatments.

Other Places To Get Help

Organizations

National Fibromyalgia Association
2121 South Towne Centre Place
Suite 300
Anaheim, CA 92806
Phone:	(714) 921-0150
Fax:	(714) 921-6920
Web Address:	www.fmaware.org

The National Fibromyalgia Association was founded to support people who have fibromyalgia and other chronic pain illnesses. This group has an educational website and publishes an international magazine called Fibromyalgia AWARE. The group also helps develop continuing medical education programs and provides a means for fibromyalgia experts to share their research and expertise with patients and health care professionals.

American College of Rheumatology
2200 Lake Boulevard NE
Atlanta, GA 30319
Phone:	(404) 633-3777
Fax:	(404) 633-1870
Web Address:	www.rheumatology.org

The American College of Rheumatology (ACR) and the Association of Rheumatology Health Professionals (ARHP, a division of ACR) are professional organizations of rheumatologists and associated health professionals who are dedicated to healing, preventing disability from, and curing the many types of arthritis and related disabling and sometimes fatal disorders of the joints, muscles, and bones. Members of the ACR are physicians; members of the ARHP include research scientists, nurses, physical and occupational therapists, psychologists, and social workers. Both the ACR and the ARHP provide professional education for their members. The ACR website offers patient information fact sheets about rheumatic diseases, about medicines used to treat rheumatic diseases, and about care professionals.

Arthritis Foundation
P.O. Box 7669
Atlanta, GA 30357
Phone:	1-800-283-7800
Web Address:	www.arthritis.org

The Arthritis Foundation provides grants to help find a cure, prevention methods, and better treatment options for arthritis. It also provides a large number of community-based services nationwide to make living with arthritis easier, including self-help courses; water- and land-based exercise classes; support groups; home study groups; instructional videotapes; public forums; free educational brochures and booklets; the national, bimonthly consumer magazine Arthritis Today; and continuing education courses and publications for health professionals.

National Center for Complementary and Alternative Medicine (NCCAM), National Institutes of Health
9000 Rockville Pike
Bethesda, MD 20892
Phone:	1-888-644-6226
Fax:	1-866-464-3616 toll-free
TDD:	1-866-464-3615 toll-free
Email:	info@nccam.nih.gov
Web Address:	www.nccam.nih.gov

The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) explores complementary and alternative healing practices in the context of rigorous science, trains complementary and alternative medicine researchers, and gives out authoritative information.

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Phone:	1-877-22-NIAMS (1-877-226-4267) toll-free
Phone:	(301) 495-4484
Fax:	(301) 718-6366
TDD:	(301) 565-2966
Email:	niamsinfo@mail.nih.gov
Web Address:	www.niams.nih.gov

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is a governmental institute that serves the public and health professionals by providing information, locating other information sources, and participating in a national federal database of health information. NIAMS supports research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases and supports the training of scientists to carry out this research. The NIAMS website provides health information referrals to the NIAMS Clearinghouse, which has information packages about diseases.

Related Information

References

Citations

Bradley LA, Alarcon GS (2005). Fibromyalgia section of Miscellaneous rheumatic diseases. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 2, pp. 1869–1910. Philadelphia: Lippincott Williams and Wilkins.

Goldenberg DL, et al. (2004). Management of fibromyalgia syndrome. JAMA, 292(19): 2388–2395.

Nielson WR, Jensen MP (2004). Relationship between changes in coping and treatment outcome in patients with fibromyalgia syndrome. Pain, 109(3): 233–41.

Wahner-Roedler DL, et al. (2004). Use of complementary and alternative medical therapies by patients referred to a fibromyalgia treatment program at a tertiary care center. Mayo Clinic Proceedings, 80(1): 55–60.

Wang C, et al. (2010). A randomized trial of tai chi for fibromyalgia. New England Journal of Medicine, 363(8): 743–754.

Other Works Consulted

Afshar B (2002). Clearing the fog section of Relieving symptoms. In Good Living with Fibromyalgia, pp. 18–19. Atlanta: Arthritis Foundation.

Arnold LM, et al. (2007). Gabapentin in the treatment of fibromyalgia. Arthritis and Rheumatism, 56(4): 1336–1344.

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Busch A, et al. (2007). Exercise for treating fibromyalgia syndrome. Cochrane Database of Systematic Reviews (4).

Carville SF, et al. (2007). EULAR evidence based recommendations for the management of fibromyalgia syndrome. Annals of the Rheumatic Diseases, 67(4): 536–541.

Crofford LJ, Appleton BE (2001). Complementary and alternative therapies for fibromyalgia. Current Rheumatology Reports, 3(2): 147–156.

Crofford LJ, et al. (2005). Pregabalin for the treatment of fibromyalgia syndrome. Arthritis and Rheumatism, 52(4): 1264–1273.

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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, Rasker JJ (2009). Fibromyalgia. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 8th ed., vol. 1, pp. 555–569. Philadelphia: Saunders Elsevier.

Credits

By	Healthwise Staff
Primary Medical Reviewer	Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer	Karin M. Lindholm, DO - Neurology
Last Revised	June 11, 2012

Topic Contents