Fibromyalgia

Fibromyalgia is a condition where pain and stiffness is felt around your joints and in your muscles and bones. Symptoms include widespread pain, fatigue and sleep disturbances. Treatment aims to improve your sleep, increase your ability to do the things you want to do while also reducing your pain.

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Key points

  1. Fibromyalgia is a term used to describe widespread pain and tenderness in different areas of your body.
  2. It is thought to be a disorder of the way the nervous system processes sensory information (nociplastic pain) and becomes more sensitive to sensory input than normal.
  3. Fibromyalgia pain lasts longer than 3 months and often comes and goes. People with fibromyalgia usually have other symptoms including fatigue, poor sleep, difficulty concentrating and sensitivity of their bladder and bowels.
  4. Living with fibromyalgia can be hard to understand and may be difficult to accept. Most people live well with fibromyalgia once they have learned ways of coping with the problems it can pose – even if the pain is still there.
  5. The goals of treatment are to improve your sleep, increase your ability to do the things you want to do while also reducing your pain.
  6. Medications are not very effective in treating fibromyalgia. Fortunately, It is possible to live well and manage the symptoms of fibromyalgia without medications. 

What causes fibromyalgia?

It is thought that people with fibromyalgia may have an extra-sensitive nervous system that overacts in response to sensory input. However, there is no indication that there is ongoing harm to your body from this condition. Even though it's painful, it's not causing damage to your muscles, joints and bones.

There is no single cause of fibromyalgia. Researchers think it may involve genetic and environmental factors, alone or in combination. For example, factors such as infectious illness, physical trauma, emotional trauma or hormonal changes may contribute to the generalised pain, fatigue and sleep disturbances. 

You also have a greater risk of developing fibromyalgia if one of your parents or siblings has the condition. However, for many people, fibromyalgia starts without any obvious cause.

There is evidence that people with other rheumatological conditions such as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis may be at greater risk of also developing fibromyalgia, but this does not mean they cause fibromyalgia. Fibromyalgia is different to polymyalgia rheumatica, a type of arthritis in which symptoms are felt more in the muscles, and which responds readily to medication.

While fibromyalgia does not cause joint inflammation, there is some emerging research that there may be neuroinflammation, that is, inflammation in the central nervous system. This may be one part of the overall nervous system changes involved in the condition.

What are the symptoms of fibromyalgia?

Pain

The main symptom of fibromyalgia is widespread pain. Although the pain may start in one area it can move around, and some activities, such as carrying groceries, can be particularly uncomfortable in the area involved. Some degree of pain is always present and is felt mainly in your muscles, often with stiffness, especially in the morning, but this eases after moving.

Fatigue

Most people with fibromyalgia have fatigue and the kind of tiredness felt with flu or lack of sleep. Sometimes the fatigue is severe and is a greater problem than the pain. Tiredness may always be present or it may ‘sweep’ over you in waves.

Tender points

undefinedA characteristic of fibromyalgia is a number of ‘tender points’ at common locations in your body. A muscle examination reveals these tender areas which can be extremely painful when pressed but otherwise may not hurt at all. You may not even be aware of the presence of these tender points until a doctor performs a ‘tender point evaluation’. These tender points are not required for a diagnosis of fibromyalgia, although researchers may use them to identify who might participate in a research study.

Problems with thinking

Researchers have found that people with fibromyalgia are more likely to have their cognition (thinking) affected. This can include problems with memory, concentration and decision-making. This is known as 'fibro fog'.

If you also experience depression, you may find 'fibro fog' to be a significant problem, as the depression makes it worse.

Sleep disturbances

Sleeping problems are common and you can wake up feeling tired, even after sleeping through the night. This tiredness can range from listlessness to exhaustion and can vary from one day to the next. Disturbed sleep is also common. 

Depression and anxiety

It is common for anyone with a pain condition to also experience depression and/or anxiety, so there is a higher risk for someone with fibromyalgia to develop one of these conditions than there is for people living without a pain condition. This does not mean that fibromyalgia symptoms are an indication of mental illness.

Other symptoms

You may experience headaches (especially migraine and tension headaches), abdominal pain, muscle tension, allergies, dry eyes, tender lymph nodes and irritable bowel syndrome or irritable bladder syndrome.

Who is at risk of getting fibromyalgia?

Fibromyalgia is more common in women, although men also can develop it. The condition most commonly starts in middle adulthood but can occur in adolescence and old age. If you have a rheumatic disease such as osteoarthritis, lupus, rheumatoid arthritis or ankylosing spondylitis, you are at higher risk of developing fibromyalgia.

How is fibromyalgia diagnosed?

Fibromyalgia is diagnosed based on your symptoms, a physical examination (which may include checking for tender points) and tests to exclude other causes of ongoing pain and fatigue. Fibromyalgia is diagnosed by your GP if you describe widespread pain that has been present for at least 3 months, sleep disturbance, feeling “foggy” in your head, and only once other possible causes of these symptoms have been eliminated. There is no blood test, X-ray or scan to diagnose for fibromyalgia. A questionnaire can be used to help your GP identify whether you have met the criteria for fibromyalgia.

How is fibromyalgia treated?

Fibromyalgia is a life-long problem. It is possible to live well and manage the symptoms without medications. Medications are not helpful for many people. The most effective treatments involve:

  • gradually increase your physical activity levels (a physiotherapist may be helpful in designing an activity plan for you)
  • working with an occupational therapist to structure your daily activities to be able to manage a consistent level of activity including work and leisure
  • using psychological support if necessary
  • sometimes using medication (if it is found to help). 

Most people live well with fibromyalgia once they have learned ways of coping with the problems it can pose – even if the pain is still there. The goals of treatment are to improve your sleep, increase your ability to do the things you want to do, while also reducing your pain as much as possible.

Medication

Medications are not very effective in treating pain due to fibromyalgia. Common pain relievers such as paracetamol, anti-inflammatories and codeine rarely give much relief from the pain of fibromyalgia. However, there are some medications that may help you to get on with daily activities. No medication is likely to eliminate the pain altogether. Medication can be used alongside physiotherapy, exercise, diet, relaxation and different ways of thinking and responding to pain. Read more about medications for fibromyalgia.

Exercise

Most people with fibromyalgia are likely to have more pain when they first start exercising. You are also more likely to have more pain after exercise, whereas for other people pain goes down for 30 minutes after exercise.

However, the consensus across all studies is that exercise is helpful for people with fibromyalgia. The long-term effects of exercise are some reduction in pain intensity and greater tolerance for daily activities (which reduces disability). It also leads to improved mood and better sleep.

So that you have less pain when you exercise, reduce the intensity of your exercise and then gradually increase it again over time.

Self-management 

There are many other ways to help you live with fibromyalgia.

Option Description

Exercise

Exercise lifts your mood, increases muscle tone, improves blood flow, eases digestive problems and helps you sleep.

  • It can be challenging to exercise if you are in pain. The key is to start at a low level, and gradually increase.
  • Ideally, you should include stretching, strengthening and aerobic exercise.
  • A physiotherapist or exercise physiologist with knowledge of fibromyalgia may help to design a programme for you.
  • Exercise may not give you the “afterglow” other people experience after exercising, so it is important to be consistent for some time before the benefits are present.

Relaxation techniques/physical therapy

  • Relaxation therapies, such as acupuncture, massage, infra-red heat, hot packs and manipulation may help ease your muscle tension.
  • Movement therapies, such as yoga and tai chi can improve mobility and decrease muscle tightness. 

Psychological therapies and counselling

  • Psychological therapies such as cognitive behavioural therapy (CBT) counselling can help you adjust to living with your symptoms.

Activity management

  • Maintaining a regular pattern of activity and rest can reduce the peaks and troughs of fluctuating fatigue and pain. This means planning daily and weekly schedules.
  • An occupational therapist can help you adapt your daily routines.

Reducing stress

  • Stress aggravates most symptoms. Unfortunately, stress is a part of everyday life, so it is important to look at ways to reduce its effect. Learning a variety of ways to relax reduces pain and promotes restful sleep. Read more about beating stress.

Mindfulness

  • Mindfulness reduces stress, tension and anxiety. It can help you to avoid focusing too much on your pain and to direct your thoughts in a way that is helpful for managing it. Read more about mindfulness.

Read more about how chronic pain is treated and non-medicine treatments for pain.

Learn more

Fibromyalgia Arthritis New Zealand 
Physical activity Arthritis New Zealand, 2011
Fibromyalgia: what you need to know Body and Health Canada

References

  1. 2012 Canadian guidelines for the diagnosis and management of fibromyalgia syndrome: executive summary Pain Res Manag 2013; 18(3):119–126. 
  2. Bidonde J, Busch AJ, Schachter CL, Overend TJ, Kim SY, Góes, S M et al. (2017). Aerobic exercise training for adults with fibromyalgia Cochrane Database of Systematic Reviews, 2017.
  3. Littlejohn G, Guymer E. Neurogenic inflammation in fibromyalgia Semin Immunopathol. 2018 40(3), 291–300.
  4. Løge-Hagen JS, Sæle A, Juhl C, Bech P, Stenager E, Mellentin AI. Prevalence of depressive disorder among patients with fibromyalgia – systematic review and meta-analysis Journal of Affective Disorders, 2019, 245, 1098–1105.

Reviewed by

Dr Bronwyn Lennox Thompson is a senior lecturer & Academic Coordinator, Postgraduate Programmes Pain & Pain Management, Orthopaedic Surgery & Musculoskeletal Medicine, University of Otago Christchurch. Her main interest areas include resilience, daily coping choices, and knowledge translation from research to clinic.  
Credits: Health Navigator Editorial Team. Reviewed By: Dr Bronwyn Lennox Thompson, senior lecturer, Orthopaediac Surgery & Musculoskeletal Medicine, University of Otago, Christchurch Last reviewed: 01 Sep 2018