What is fibromyalgia?

Fibromyalgia is a long-term (chronic) condition.

It causes:

  • pain in the muscles and bones (musculoskeletal pain)
  • areas of tenderness
  • general fatigue
  • sleep and cognitive disturbances

This condition can be hard to understand, even for healthcare providers. Its symptoms mimic those of other conditions, and there aren’t any real tests to confirm the diagnosis. As a result, fibromyalgia is often misdiagnosed.

In the past, some healthcare providers even questioned whether fibromyalgia was real. Today, it is much better understood. Some of the stigma that used to surround it has eased.

Fibromyalgia can still be challenging to treat. But medications, therapy, and lifestyle changes can help you to manage your symptoms and to improve your quality of life.

Fibromyalgia causes what’s now referred to as “regions of pain.” Some of these regions overlap with what was previously referred to as areas of tenderness called “trigger points” or “tender points.” However, some of these previously noted areas of tenderness have been excluded.

The pain in these regions feels like a consistent dull ache. Your healthcare provider will consider a diagnosis of fibromyalgia if you’ve experienced musculoskeletal pain in 4 out of the 5 regions of pain outlined in the 2016 revisions to the fibromyalgia diagnostic criteria.

This diagnostic protocol is referred to as “multisite pain.” It’s in contrast to the 1990 fibromyalgia diagnostic criteria definition for “chronic widespread pain.”

This process of diagnosis focuses on the areas of musculoskeletal pain and severity of pain as opposed to an emphasis on pain duration, which was the previously the focal criteria for a fibromyalgia diagnosis.

Other symptoms of fibromyalgia include:

  • fatigue
  • trouble sleeping
  • sleeping for long periods of time without feeling rested (nonrestorative sleep)
  • headaches
  • depression
  • anxiety
  • trouble focusing or paying attention
  • pain or a dull ache in the lower belly
  • dry eyes
  • bladder problems, such as interstitial cystitis

In people with fibromyalgia, the brain and nerves may misinterpret or overreact to normal pain signals. This may be due to a chemical imbalance in the brain or abnormality in the dorsal root ganglion affecting central pain (brain) sensitization.

Fibromyalgia can also affect your emotions and energy level.

Learn which of its symptoms could have the biggest impact on your life.

Fibromyalgia fog | Fog

Fibromyalgia fog – also known as “fibro fog” or “brain fog” – is a term some people use to describe the fuzzy feeling they get. Signs of fibro fog include:

  • memory lapses
  • difficulty concentrating
  • trouble staying alert

According to a 2015 study published in Rheumatology International, some people find mental fogginess from fibromyalgia more upsetting than pain.

Fibromyalgia symptoms in women | Symptoms in women

Fibromyalgia symptoms have generally been more severe in women than in men. Women have more widespread pain, IBS symptoms, and morning fatigue than men. Painful periods are also common.

However, when the 2016 revisions to the diagnostic criteria are applied, more men are being diagnosed with fibromyalgia, which may reduce the degree of distinction between the pain levels men and women experience. More research needs to be done to further evaluate that distinction.

The transition to menopause could make fibromyalgia worse.

Complicating things is the fact that some symptoms of menopause and fibromyalgia look almost identical.

Men also get fibromyalgia. Yet, they may remain undiagnosed because this is seen as a woman’s disease. However, current statistics show that as the 2016 diagnostic protocol is more readily applied, more men are being diagnosed.

Men also have severe pain and emotional symptoms from fibromyalgia. The condition affects their quality of life, career, and relationships, according to a 2018 survey published in the American Journal of Public Health.

Part of the stigma and difficulty in getting diagnosed stems from society’s expectation that men who are in pain should “suck it up.”

Men who do venture in to see a doctor can face embarrassment, and the chance that their complaints won’t be taken seriously.

In the past, people were diagnosed with fibromyalgia if they had widespread pain and tenderness in at least 11 out of 18 specific trigger points around their body. Healthcare providers would check to see how many of these points were painful by pressing firmly on them.

Common trigger points included the:

  • back of the head
  • tops of the shoulders
  • upper chest
  • hips
  • knees
  • outer elbows

For the most part, trigger points are no longer a part of the diagnostic process.

Instead, healthcare providers may diagnose fibromyalgia if you’ve had pain in 4 out of the 5 areas of pain as defined by the 2016 revised diagnostic criteria, and you have no other diagnosable medical condition that could explain the pain.

Pain is the hallmark fibromyalgia symptom. You’ll feel it in various muscles and other soft tissues around your body.

The pain can range from a mild achiness to an intense and almost unbearable discomfort. Its severity could dictate how well you cope day to day.

Fibromyalgia appears to stem from an abnormal nervous system response. Your body overreacts to things that shouldn’t normally be painful. And you may feel the pain in more than one area of your body.

However, available research still doesn’t pinpoint an exact cause for fibromyalgia. Research continues to evolve in better understanding this condition and its origin.

Chest pain

When fibromyalgia pain is in your chest, it can feel frighteningly similar to the pain of a heart attack.

Chest pain in fibromyalgia is actually centered in the cartilage that connects your ribs to your breastbone. The pain may radiate to your shoulders and arms.

Fibromyalgia chest pain may feel:

  • sharp
  • stabbing
  • like a burning sensation

And similar to a heart attack, it can make you struggle to catch your breath.

Back pain

Your back is one of the most common places to feel pain. About 80 percent of Americans have low back pain at some point in their lives. If your back hurts, it may not be clear whether fibromyalgia is to blame, or another condition like arthritis or a pulled muscle.

Other symptoms like brain fog and fatigue can help pinpoint fibromyalgia as the cause. It’s also possible to have a combination of fibromyalgia and arthritis.

The same medications you take to relieve your other fibromyalgia symptoms can also help with back pain. Stretching and strengthening exercises can help provide support to the muscles and other soft tissues of your back.

Leg pain

You can also feel fibromyalgia pain in the muscles and soft tissues of your legs. Leg pain can feel similar to the soreness of a pulled muscle or the stiffness of arthritis. It can be:

  • deep
  • burning
  • throbbing

Sometimes fibromyalgia in the legs feels like numbness or tingling. You may have a creepy crawling sensation. An uncontrollable urge to move your legs is a sign of restless legs syndrome (RLS), which can overlap with fibromyalgia.

Fatigue sometimes manifests in the legs. Your limbs can feel heavy, as if they’re held down by weights.

Healthcare providers and researchers don’t know what causes fibromyalgia.

According to the latest research, the cause appears to be a multiple-hit theory that involves genetic disposition (hereditary characteristics) complemented by a trigger, or a set of triggers, such as infection, trauma, and stress.

Let’s take a closer look at these potential factors and several more that may influence why people develop fibromyalgia.

Infections

A past illness could trigger fibromyalgia or make its symptoms worse. The flu, pneumonia, GI infections, such as those caused by Salmonella and Shigella bacteria, and the Epstein-Barr virus all have possible links to fibromyalgia.

Genes

Fibromyalgia often runs in families. If you have a family member with this condition, you’re at higher risk for developing it.

Researchers think certain gene mutations may play a role. They’ve identified a few possible genes that affect the transmission of chemical pain signals between nerve cells.

Trauma

People who go through a severe physical or emotional trauma may develop fibromyalgia. The condition has been linked to post-traumatic stress disorder (PTSD).

Stress

Like trauma, stress can leave long-lasting effects on your body. Stress has been linked to hormonal changes that could contribute to fibromyalgia.

Healthcare providers don’t fully understand what causes the chronic widespread nature of fibromyalgia pain. One theory is that the brain lowers the pain threshold. Sensations that weren’t painful before become very painful over time.

Another theory is that the nerves overreact to pain signals.

They become more sensitive, to the point where they cause unnecessary or exaggerated pain.

In autoimmune diseases like rheumatoid arthritis (RA) or multiple sclerosis (MS), the body mistakenly targets its own tissues with proteins called autoantibodies. Just like it would normally attack viruses or bacteria, the immune system instead attacks the joints or other healthy tissues.

Fibromyalgia symptoms look very similar to those of autoimmune disorders. These symptom overlaps have led to the theory that fibromyalgia could be an autoimmune condition.

This claim has been hard to prove, in part because fibromyalgia doesn’t cause inflammation, and to-date reproducing autoantibodies haven’t been found.

Yet, it’s possible to have an autoimmune disease and fibromyalgia simultaneously.

Fibromyalgia flare-ups can be the result of:

  • stress
  • injury
  • an illness, such as the flu

An imbalance in brain chemicals may cause the brain and nervous system to misinterpret or overreact to normal pain signals.

Other factors that increase your risk of developing fibromyalgia include:

  • Gender. Most fibromyalgia cases are currently diagnosed in women, although the reason for this gender disparity isn’t clear.
  • Age. You’re most likely to be diagnosed in middle age, and your risk increases as you get older. However, children can develop fibromyalgia also.
  • Family history. If you have close family members with fibromyalgia, you may be at greater risk for developing it.
  • Disease. Although fibromyalgia isn’t a form of arthritis, having lupus or RA may increase your risk of also having fibromyalgia.

Your healthcare provider may diagnose you with fibromyalgia if you’ve had widespread pain for 3 months or longer. “Widespread” means the pain is on both sides of your body, and you feel it above and below your waist.

After a thorough examination, your healthcare provider must conclude that no other condition is causing your pain.

No lab test or imaging scan can detect fibromyalgia. Your healthcare provider may use these tests to help rule out other possible causes of your chronic pain.

Fibromyalgia can be hard for healthcare providers to distinguish from autoimmune diseases because the symptoms often overlap.

Some research has pointed to a link between fibromyalgia and autoimmune diseases like Sjogren’s syndrome.

Currently, there isn’t a cure for fibromyalgia.

Instead, treatment focuses on reducing symptoms and improving quality of life with:

  • medications
  • self-care strategies
  • lifestyle changes

Medications can relieve pain and help you sleep better. Physical and occupational therapy improve your strength and reduce stress on your body. Exercise and stress-reduction techniques can help you feel better, both mentally and physically.

In addition, you may wish to seek out support and guidance. This may involve seeing a therapist or joining a support group.

In a support group, you can get advice from other people who have fibromyalgia to help you through your own journey.

The goal of fibromyalgia treatment is to manage pain and improve quality of life. This is often accomplished through a two-pronged approach of self-care and medication.

Common medications for fibromyalgia include:

Pain relievers

Over-the-counter pain relievers such as ibuprofen (Advil) or acetaminophen (Tylenol) can help with mild pain.

Narcotics, such as tramadol (Ultram), which is an opioid, were previously prescribed for pain relief. However, research has shown they’re not effective. Also, the dosage for narcotics is typically increased rapidly, which can pose a health risk for those prescribed these drugs.

Most healthcare providers recommend avoiding narcotics to treat fibromyalgia.

Antidepressants

Antidepressants such as duloxetine (Cymbalta) and milnacipran HCL (Savella) are sometimes used to treat pain and fatigue from fibromyalgia. These medications may also help improve sleep quality and work on rebalancing neurotransmitters.

Antiseizure drugs

Gabapentin (Neurontin) was designed to treat epilepsy, but it may also help reduce symptoms in people with fibromyalgia. Pregabalin (Lyrica), another anti-seizure drug, was the first drug FDA-approved for fibromyalgia. It blocks nerve cells from sending out pain signals.

A few drugs that aren’t FDA-approved to treat fibromyalgia, including antidepressants and sleep aids, can help with symptoms. Muscle relaxants, which were once used, are no longer recommended.

Researchers are also investigating a few experimental treatments that may help people with fibromyalgia in the future.

If the medications your healthcare provider prescribes don’t entirely relieve your fibromyalgia symptoms, you can look for alternatives. Many natural treatments focus on lowering stress and reducing pain. You can use them alone or together with traditional medical treatments.

Natural remedies for fibromyalgia include:

Therapy can potentially reduce the stress that triggers fibromyalgia symptoms and depression.

Group therapy may be the most affordable option, and it will give you a chance to meet others who are going through the same issues.

Cognitive behavioral therapy (CBT) is another option that can help you manage stressful situations. Individual therapy is also available if you prefer one-on-one help.

It’s important to note that most alternative treatments for fibromyalgia haven’t been thoroughly studied or proven effective.

Ask your healthcare provider about the benefits and risks before trying any of these treatments.

Some people report that they feel better when they follow a specific diet plan or avoid certain foods. But research hasn’t proven that any one diet improves fibromyalgia symptoms.

If you’ve been diagnosed with fibromyalgia, try to eat a balanced diet overall. Nutrition is important in helping you to keep your body healthy, to prevent symptoms from getting worse, and to provide you with a constant energy supply.

Dietary strategies to keep in mind:

  • Eat fruits and vegetables, along with whole grains, low-fat dairy, and lean protein.
  • Drink plenty of water.
  • Eat more plants than meat.
  • Reduce the amount of sugar in your diet.
  • Exercise as often as you can.
  • Work toward achieving and maintaining your healthy weight.

You may find that certain foods make your symptoms worse, such as gluten or MSG. If that’s the case, keep a food diary where you track what you eat and how you feel after each meal.

Share this diary with your healthcare provider. They can help you identify any foods that aggravate your symptoms. Avoiding these foods can be beneficial helping you manage your symptoms.

Fibromyalgia can leave you feeling tired and worn out.

A few foods will give you the energy boost you need to get through your day.

Fibromyalgia pain can be uncomfortable and consistent enough to interfere with your daily routine. Don’t just settle for pain. Talk to your healthcare provider about ways to manage it.

One option is to take pain relievers such as:

  • aspirin
  • ibuprofen
  • naproxen sodium
  • help with discomfort
  • lower pain levels
  • help you better manage your condition

These medications bring down inflammation. Though inflammation is not a primary part of fibromyalgia, it may be present as an overlap with RA or another condition. Pain relievers may help you sleep better.

Please note that NSAIDS do have side effects. Caution is advised if NSAIDS are used for an extended period of time as is usually the case in managing a chronic pain condition.

Talk with your healthcare provider to create a safe treatment plan that works well in helping you manage your condition.

Antidepressants and anti-seizure drugs are two other medication classes your healthcare provider may prescribe to manage your pain.

The most effective pain reliever does not come in a medication bottle.

Practices like yoga, acupuncture, and physical therapy can:

Fibromyalgia fatigue can be just as challenging to manage as pain.

Learn a few strategies to help you sleep better and feel more alert during the day.

Your quality of life can be affected when you live with pain, fatigue, and other symptoms on a daily basis. Complicating things are the misunderstandings many people have about fibromyalgia. Because your symptoms are hard to see, it’s easy for those around you to dismiss your pain as imaginary.

Know that your condition is real. Be persistent in your pursuit of a treatment that works for you. You may need to try more than one therapy, or use a few techniques in combination, before you start to feel better.

Lean on people who understand what you’re going through, like:

  • your healthcare provider
  • close friends
  • a therapist

Be gentle on yourself. Try not to overdo it. Most importantly, have faith that you can learn to cope with and manage your condition.

Fibromyalgia is a chronic condition that causes:

  • widespread pain
  • fatigue
  • difficulty sleeping
  • depression

Currently, there’s no cure, and researchers don’t fully understand what causes it. Treatment focuses on medications and lifestyle changes to help ease the symptoms.

About 4 million Americans ages 18 and over, or about 2 percent of the population, have been diagnosed with fibromyalgia. Most fibromyalgia cases are diagnosed in women, but men and children can also be affected.

Most people get diagnosed in middle age.

Fibromyalgia is a chronic (long-term) condition. However, some people may experience remission-type periods in which their pain and fatigue improve.