What Is Fibromyalgia? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Fibromyalgia is a chronic (long-term) disorder defined by pain and tenderness throughout your body, as well as fatigue.

People with fibromyalgia tend to have a heightened sense of pain. This feeling is sometimes described as a constant muscle ache.

Formerly known as fibrositis, fibromyalgia is often considered a rheumatic, or “arthritis-like,” disorder. But unlike arthritis and certain related conditions, it doesn't cause damage to joints, muscles, or other tissues. (1)

Fibromyalgia isn't a progressive disease, which means that it won't steadily worsen over time.

There's no cure for fibromyalgia, but treatments are available that may help relieve symptoms and improve your quality of life, notes the American College of Rheumatology. (2)

Fibromyalgia is known for causing widespread pain and tenderness throughout the body, as well as fatigue. It can also cause:

• Difficulty sleeping
• Problems with memory or concentration (“fibro fog”)
• Dizziness
• Numbness and tingling in the hands and feet
• Sensitivity to bright lights or loud noises
• Headaches
• Digestive issues
• Dry eyes or mouth

Because the symptoms of fibromyalgia overlap with those of many other conditions, diagnosing fibromyalgia can be difficult. In fact, it’s not uncommon to see several doctors and have many medical tests to rule out other conditions before getting a diagnosis of fibromyalgia, according to patient advocacy group the National Fibromyalgia Association (NFA). (3)

Learn More About the Signs and Symptoms of Fibromyalgia

Historically, fibromyalgia was diagnosed by having a doctor check 18 specific points on the body to see how many of them were painful when pressed firmly. This was called a “tender point” exam.

However, doctors are moving away from the tender point exam in the diagnosis of fibromyalgia. Now, if you experience widespread pain — over a large area of your body — for more than three months, with no other possible cause, you’ll likely be diagnosed with the condition, notes the Mayo Clinic. (5)

At present, there are no tests that can be used to definitively diagnose fibromyalgia. However, your doctor may recommend a blood test to rule out other conditions.

For example, a complete blood count (CBC) can rule out conditions such as anemia, which can cause weakness and fatigue. Similarly, checking your blood for rheumatoid factors — or proteins that typically are signs of rheumatic diseases, like rheumatoid arthritis — can rule out these conditions.

None of these tests will confirm a fibromyalgia diagnosis, but they will effectively eliminate other possible causes for your symptoms.

Prognosis of Fibromyalgia

Fibromyalgia in and of itself doesn’t cause disability or shorten life expectancy, according to a study published in March 2018 in Dialogues in Clinical Neuroscience. (6) Nor does it damage muscles or organs or directly cause death, according the American Academy of Family Physicians. (7)

However, risk for anxiety and depression is higher among people with fibromyalgia, which may also increase risk for suicide.

In addition, people with the condition are also more likely to have diabetes, heart disease, and high blood pressure, among other health problems, which may lead to poorer overall health and even death.

Although currently available treatments can help to manage the symptoms of fibromyalgia, there’s no cure for the condition.

Many people with fibromyalgia live with widespread pain and debilitating fatigue for many years. As a result, the condition is a leading cause of disability and presents many challenges for people as they try go about their day-to-day activities.

Symptoms have also been known to worsen over time in some people with fibromyalgia, so taking steps to maintain overall health — including exercise, a healthy diet, reducing stress — are particularly important for those with the condition.

Alternative and Complementary Therapies

Exercise According to the American College of Rheumatology, physical exercise is the most effective treatment for fibromyalgia. Gentle stretching and aerobic exercise can relieve pain and prevent deconditioning or getting weaker from lack of exercise. It can also improve sleep. (2)

Engaging in exercise may be the last thing on your mind when you hurt all over from fibromyalgia, but in fact, not exercising can make your pain worse. The best approach to being physically active when you have fibromyalgia is to start low and go slow. In other words, start with a few minutes of activity, and gradually increase the amount of time you’re active over several weeks or months to build your strength and endurance.

It’s better to do a little less than you’re capable of than to push too hard and trigger a fibromyalgia flare. Additionally, if you’re having a flare, reduce the time and intensity of your exercise sessions, but don’t be completely inactive.

Generally, working with a physical or occupational therapist can be helpful in getting started with an exercise regimen, the Mayo Clinic says.

Specifically, a physical therapist can teach you exercises designed to improve your strength, flexibility, and stamina. Water-based exercises might be particularly beneficial for people with fibromyalgia, according to the Mayo Clinic.

In addition, an occupational therapist may help you make adjustments to your home or workplace that will cause less stress on your body.

Stress Reduction Some other lifestyle approaches that may improve fibromyalgia symptoms include stress reduction, not smoking, following a healthy diet, losing weight if you’re overweight, and establishing good sleep habits.

One possible way to reduce stress is to undergo counseling. Talking with a therapist can help strengthen your belief in your abilities and teach you strategies for dealing with stressful situations.

Cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) — types of talk therapy that help individuals reframe their thoughts and change behaviors — can help address brain fog by helping you develop targeted coping strategies and address stress by teaching you to use skills such as relaxation, acceptance, mindfulness, and identifying how to best use your energy.

They can reduce fatigue by helping you identify your stressors and your limiting beliefs.

Mindfulness In addition, mindfulness meditation has been shown to reduce stress, depression, anxiety, and the impact of symptoms of fibromyalgia. Improvements in sleep, pain, and fatigue have also been observed.

Mindfulness is a contemplative practice emphasizing moment-to-moment awareness as a means of working through stressful events. You can learn and practice mindfulness in courses offered online or in your local community, and by using any of a variety of apps, such as Calm, Headspace, Buddhify, or 10 Percent Happier.

Healthy Diet Like everyone, people with fibromyalgia should eat foods that support their body. This means a diet high in fruits, vegetables, whole grains and low-fat dairy if you’re not sensitive to them, healthy oils, legumes, and low-fat protein, like fish and chicken.

It also means cutting out foods that you know are bad for you — like junk, processed, fatty, sugary foods, and soda.

For some people, making dietary changes can ease their fibromyalgia symptoms, particularly when their meals contain good sources of vitamin D such as cold-water fish or fortified milk or orange juice, include foods high in magnesium such as dried beans and leafy greens, and are rich in antioxidants from deeply colored fruits and vegetables.

In general, you should discuss nutritional approaches with a registered dietitian nutritionist or your doctor. However, research suggests that carbohydrates, and particularly sugars, may contribute to brain fog in fibromyalgia because people with the condition don’t metabolize carbohydrates and sugars normally.

Beyond that, some research suggests that avoiding dietary excitotoxins — chemicals that excite the neurons in the brain — can provide additional symptom improvement. The most common excitotoxins in the Western diet are food additives used to enhance or sweeten the flavor of foods. Monosodium glutamate is an example of such an additive, according to past research. (8)

Supplements Some vitamin and herbal supplements may also help with fibromyalgia symptoms, although research evidence to date is limited. For example, both vitamin D and magnesium levels have been found to be low in people with the condition.

Vitamin D appears to have some effects on nerve and muscle function, and some studies have suggested that low levels of vitamin D may be associated with the chronic pain of fibromyalgia. Taking a vitamin D supplement is a relatively safe intervention and could be started after a discussion with your physician and possibly a measurement of your vitamin D levels, according to an article published in August 2020 in Nutrients. (9)

S-adenosylmethionine (SAMe) is a substance that occurs naturally throughout the body and is involved in many of the body’s processes, including pain. Research has shown that this over-the-counter (OTC) dietary supplement, taken as a tablet, can help treat depression and the chronic pain associated with osteoarthritis, and some studies, such as one published in June 2017 in The Journal of Clinical Psychology, show that taking SAMe may offer fibromyalgia pain relief, as well as help with fatigue and stiffness. (10)

Finally, melatonin is a natural hormone found in the body, thought to be involved in promoting sleep. In pill form it’s often used as a sleep aid, but has also been used for depression, chronic fatigue, and fibromyalgia, according to research published in December 2019 in Mayo Clinic Proceedings: Innovations, Quality & Outcomes. (11)

Talk to your doctor before trying any of these supplements, as they can affect how well your prescription medications work and have side effects.

Acupuncture Acupuncture is one of the oldest forms of treatment for chronic pain and is based on ancient Chinese medical practices. There have been several studies on the usefulness of acupuncture as a natural remedy for fibromyalgia symptoms. Although this treatment seems to offer some functional improvement in people with fibromyalgia, the results are not long-lasting, and it does not improve pain April 2020 in Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update. (12)

Topical Capsaicin Capsaicin comes from pepper plants and may be a natural remedy for fibromyalgia pain relief. It’s the active ingredient in a variety of OTC sprays and lotions. When applied to a painful area of the body, capsaicin stimulates the release of a body chemical called substance P. As substance P is depleted, the pain sensation seems to decrease.

Massage Other types of alternative and complementary approaches that can be used in fibromyalgia include massage therapy. In general, massage therapy seems to help with many types of muscle pain, including fibromyalgia, and it’s safe.

Reiki Specifically, the Japanese technique Reiki has been used for pain control, relaxation, and stress relief. It’s thought to work with a system of energy that flows through the body.

Biofeedback Biofeedback is an alternative therapy that uses the mind-body connection to help you learn to control your chronic pain with the power of your mind. It’s helpful for many painful conditions when it’s used along with other therapies.

Chiropractic In addition, chiropractic medicine is an alternative form of treatment that uses spinal manipulation and realignment to relieve fibromyalgia pain, improve function, and promote natural healing. Most research suggests it may be effective for relief of back, neck, or headache pain.

Learn More About Treatment for Fibromyalgia: Medication, Alternative and Complementary Therapies, and More

Prevention of Fibromyalgia

There’s no proven way to prevent fibromyalgia, according to the Cleveland Clinic. (13)

However, in general, maintaining a healthy diet, exercising regularly, and getting enough rest are good rules to follow if you want to prevent any chronic medical condition, including fibromyalgia.

If you have fibromyalgia, being informed is the best way to get good treatment and understand what lifestyle measures will help with symptoms. And, sticking to your doctor-prescribed treatment plan is the best way to keep symptoms in check, the Cleveland Clinic says.

Fibromyalgia is one of the most common chronic pain disorders, although estimates of the number of Americans it affects vary. According to the NFA, about 10 million adults in the United States have fibromyalgia, while the CDC says four million U.S. adults, or about 2 percent of the population, has it. (14,15)

Although fibromyalgia can occur in anyone, it's more common in women. Between 75 and 90 percent of people diagnosed with the disorder are women, the NFA estimates.

The disorder affects people of all races and ethnicities. Most people with fibromyalgia are diagnosed between ages 20 and 50, with symptoms typically showing up months or even years beforehand. Even children can have fibromyalgia.

But the incidence of the condition rises with age, so that by age 80, 8 percent of people meet the criteria for fibromyalgia, says the NFA.

Having certain other medical conditions may raise the risk for fibromyalgia.

In many cases, it isn’t clear whether these conditions might trigger the onset of fibromyalgia, or whether they are instead an effect of fibromyalgia — or whether both conditions are due to some other underlying cause.

Per the NFA, people with fibromyalgia often also have: (17)

• ADHD
• Allergies
• Neck or back pain, including disk disease
• Chronic fatigue syndrome
• Endocrine disorders, such as thyroid problems
• Esophageal motility disorders (problems with swallowing)
• Painful menstrual periods
• Breathing issues, such as hyperventilation
• Sjögren’s syndrome, an autoimmune disorder that causes dry eyes and mouth
• Lyme disease
• Heart valve problems
• Enthesopathies (detachment of a tendon or ligament)
• Irritable bowel syndrome (IBS)
• Tension headaches or migraine
• Temporomandibular joint (TMJ) syndrome, a condition that causes jaw pain
• A mood disorder, such as anxiety or depression
• Restless legs syndrome, a limb movement disorder characterized by unpleasant sensations in the legs
• Endometriosis, a condition in which tissue grows outside a woman's uterus
• A rheumatic disease, such as osteoarthritis, rheumatoid arthritis, lupus, or ankylosing spondylitis
• Vestibular disorders, such as vestibular neuritis or Ménière’s disease
• Sleep disorders, such as obstructive sleep apnea or chronic insomnia

In addition, although rheumatoid arthritis (RA) and fibromyalgia are two distinct disorders, people with RA are more likely to also develop fibromyalgia, according to the Arthritis Foundation. (18) When the two conditions occur together, pain from one can trigger or exacerbate pain from the other.

Among the key differences between RA and fibromyalgia are that RA is an autoimmune disease while fibromyalgia is not, and RA causes inflammation in and around the joints while fibromyalgia does not attack the joints. The pain of fibromyalgia tends to be widespread, seemingly coming from many points of the body at once.

Each condition is treated differently. However, staying physical active can be helpful in both.

Similarly, people with psoriatic arthritis, a systemic autoimmune disease and an inflammatory form of arthritis, also seem to be at greater risk for developing fibromyalgia. While there are different types of psoriatic arthritis, ultimately, they all cause joint pain, stiffness, and loss of function.

Doctors suspect co-occurring fibromyalgia when a person with psoriatic arthritis experiences persistent pain and fatigue, possibly accompanied by other symptoms of fibromyalgia, such as fibro fog, sleep problems, and irritable or overactive bladder.

One hazard of not recognizing fibromyalgia in a person with psoriatic arthritis is that a doctor might increase a drug dosage or change drug treatments for the psoriatic arthritis unnecessarily, possibly compromising that person’s treatment. Another hazard is that the fibromyalgia goes untreated.

Favorite Sources of Information and Connection

American Chronic Pain Association

You know you’re in pain. Now what can you do about it? The American Chronic Pain Association provides support and education in pain management skills to people with chronic, painful conditions, their families, and their healthcare providers. It also provides tools to track fibromyalgia symptoms and communicate how you’re feeling to others.

American College of Rheumatology

When you need authoritative information on fibromyalgia, the patient area of this professional organization website can help, with the basics on diagnosis, treatment, and healthy living with fibromyalgia.

Favorite Support Groups and Group Locators

National Fibromyalgia and Chronic Pain Association Support Group Locator

Sometimes meeting others with similar challenges face-to-face makes all the difference. The National Fibromyalgia and Chronic Pain Association provides links to local support groups throughout the United States on this page.

Living With Fibro

Whether you want to ask about a potential treatment or just vent about how you’re feeling, this online support group provides a forum to discuss a range of topics and concerns.

Crowdsourced Info on Medication and Other Therapies

Syndio Health

Founded by people with chronic illness, Syndio Health gives you the opportunity to post reviews of the medication, other therapies, and lifestyle modifications you’ve tried for fibromyalgia, and to read reviews from others.

Best Ways to Find Clinical Trials for Fibromyalgia

ClinicalTrials.gov

Interested in research? This website provides a searchable database of clinical trials nationwide, including those related to fibromyalgia.

CenterWatch

For participating in research studies, this may be your best bet. It provides information about clinical trials that are currently enrolling patients and will also notify you of new trials that match your interests.

Additional reporting by Brian P. Dunleavy.