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What is fibromyalgia?

Fibromyalgia is a syndrome associated with chronic, widespread disabling pain. Those who have fibromyalgia have aching muscles and sore necks, shoulders, and backs. They sleep poorly and are often stiff when they wake up or when they move after sitting for long periods of time. The intensity and location of the pain and the degree of fatigue may vary from day to day and may become worse with excessive exercise and with stress.

Fibromyalgia is thought to affect 5 million Americans over the age of 18. Between 80% and 90% of the people affected by fibromyalgia are women, but men and children can also be affected. People with certain health conditions that affect muscles, bones, and joints (rheumatic diseases) like arthritis and lupus may also have a higher risk of fibromyalgia. For most rheumatologists, doctors who specialize in rheumatic diseases, it is the second or third most common condition diagnosed.

The pain, fatigue, and numerous other symptoms that are associated with fibromyalgia can frustrate both patient and physician. The condition often makes the affected individuals miserable but does not cause inflammation or visible damage to the affected tissues. While the pain and other symptoms come and go at random, they do not progress to a disease state or remit over time. While some depression is associated with fibromyalgia, it does not cause the condition; the prevalence of depression is about the same as it is with any chronic illness.

Healthcare practitioners familiar with the condition can make a diagnosis using the criteria established in 2010 by the American College of Rheumatology (ACR). (See the Tests section for more on this.) New research into understanding fibromyalgia centers mostly on how pain is processed in the brain and spinal cord rather than the pain receptors in the rest of the body. The change in perspective may lead to new means of diagnosing the disorder in the future.

Currently, there is no cure for fibromyalgia, but there are treatments available to manage the condition. People with the condition may need to be treated by a team of professionals that includes a general practitioner, a physical therapist, and possibly a rheumatologist. Such teams are typically available at pain clinics specializing in treatments for arthritis and other rheumatic diseases.

No single cause of fibromyalgia has been identified, but it is thought that there are both genetic and environmental components, that something acts as a trigger in people who are predisposed to the condition. Some families have a higher incidence of the disorder. Some cases appear to start with a physical trauma or a severe illness, while other cases arise without a discernible "event."

Some researchers think that the symptoms may be due to sleep disorders, while others believe that fibromyalgia may be due to a microorganism. Still others suspect altered skeletal muscle metabolism or chronic overreaction of the immune system to be the cause. Current research is focusing more on abnormalities in neural processes and pain processing pathways as the cause of fibromyalgia symptoms. While answers to what is causing the condition may be years away, healthcare practitioners can identify people with fibromyalgia and try to help them live relatively normal lives.

Accordion Title
About Fibromyalgia
  • Signs and Symptoms

    There are many variable signs and symptoms associated with fibromyalgia, but the condition almost always starts with:

    • Chronic widespread pain
    • Pain upon pressure in particular areas called "tender points"
    • Some degree of chronic fatigue and interrupted sleep


    Other common symptoms include:

    • Body stiffness, especially in the morning and with prolonged sitting
    • Depression and anxiety (may coexist)
    • Difficulty concentrating, memory lapses
    • Headaches
    • Painful menstruation
    • Parasthesia (numbness and tingling in hands and feet)


    Those affected may also experience one or more of the following:

    • Chest pain, irregular heartbeat, shortness of breath
    • Constipation
    • Diarrhea
    • Difficulty swallowing
    • Dizziness, balance problems
    • Dry eyes, difficulty focusing
    • Dry mouth
    • Gas and cramping, abdominal pain
    • Heartburn
    • Irritable bowel syndrome (IBS)
    • Itchy, dry, or blotchy skin
    • Localized edema (such as swollen fingers)
    • Neurally mediated hypotension (blood pressure that lowers when standing)
    • Painful sexual intercourse
    • Pelvic pain
    • Restless legs syndrome and periodic limb movement during sleep
    • Rhinitis consisting of nasal congestion/discharge and sinus pain (but no allergic immune response)
    • Sensitivity to light, sound, touch, temperature, and odors
    • Sensitivity to medications (more likely to have side effects)
    • Temporomandibular joint dysfunction (TMD), pain in jaw joints and surrounding muscles
    • Urinary frequency, urge, and irritation


    Fibromyalgia can and does co-exist with many other chronic illnesses such as chronic fatigue syndrome, rheumatoid arthritis, ankylosing spondylitis, Sjögren syndrome, thyroid disease, multiple sclerosis, and lupus. The symptoms of these conditions may be mingled with those associated with fibromyalgia, making diagnosis more of a challenge.

  • Tests

    Fibromyalgia is usually diagnosed by documenting the patient's medical history, ruling out disorders and diseases that may be mimicking or exacerbating fibromyalgia, and by utilizing the criteria last updated by the American College of Rheumatology (ACR) in 2010.

    The ACR criteria evaluate pain location and severity. They also take into account a person's symptoms — how the person feels. A person would be considered to have fibromyalgia if that person met the following:

    • Has had pain and symptoms over the past week
    • Number of painful areas out of 19 parts of the body
    • Plus the level of severity of these symptoms:
      • Fatigue
      • Waking unrefreshed
      • Cognitive (memory or thought) problems
    • Plus the number of other general physical symptoms
    • Symptoms have been present at a similar severity level for at least 3 months.
    • The person does not have another disorder that would explain the pain.


    Laboratory Tests
    Laboratory tests can be useful to help diagnose conditions with symptoms similar to fibromyalgia, such as rheumatoid arthritis, Sjögren syndrome, thyroid disease, and lupus. It is not usually cost effective or necessary to do extensive screening. General tests that may be ordered include:


    A healthcare practitioner will typically consider the following in developing a diagnosis: results of the general tests, the patient's history (including family history and risk factors for certain diseases), and results of the physical examination. Based on these findings, some additional tests could be done.

    Meanwhile, researchers continue to look for new testing protocols that may be more specific for fibromyalgia.

    Non-Laboratory Tests
    Electromyography (EMG) may be performed to assess the health of muscles and the nerves that control them. For more on this procedure, read the Electromyography article on the Mayo Clinic web site. Occasionally, an imaging scan such as an MRI (magnetic resonance imaging) may be ordered to help rule out the possibility of multiple sclerosis or other diseases that may cause symptoms similar to fibromyalgia.

  • Treatment

    Currently, there is no cure for fibromyalgia. Few people achieve complete remission of their symptoms, but most learn to manage their condition. Fibromyalgia is not inherently crippling, and it does not decrease the lifespan of those affected by it. Treatment centers on lifestyle changes and symptom relief. Support groups and counseling may help those affected deal with the physical, psychological, financial, and social frustrations that their condition can cause.

    For those who can tolerate it, a gentle exercise program is strongly recommended. Regular aerobic exercise and stretching can help maintain muscle conditioning, improve sleep, and decrease pain and stiffness. Caution should be used, especially when starting to exercise, as overexertion can cause painful flare-ups. Stress reduction and limiting caffeine and alcohol also may help to reduce symptoms.

    Drug therapies may be able to offer at least short-term symptom improvement, including decreased pain and increased quality of sleep. Research shows that the most effective treatment for fibromyalgia, however, is physical exercise, particularly aerobic exercise. 

View Sources

NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used. To access online sources, copy and paste the URL into your browser.

Sources Used in Current Review

American College of Rheumatology. 2016. Fibromyalgia. Available online at: http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Fibromyalgia. Accessed March 12, 2016.

Baek, S. et al. February 2016. Lengthened Cutaneous Silent Period in Fibromyalgia Suggesting Central Sensitization as a Pathogenesis. PLOS One. Available online at http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0149248. Accessed March 12, 2016.

Centers for Disease Control and Prevention. (April 2015) Fibromyalgia. Available online at http://www.cdc.gov/arthritis/basics/fibromyalgia.htm. Accessed March 12, 2016.

National Institute of Arthritis and Musculoskeletal and Skin Disease. July 2014. Fibromyalgia. Available online at http://www.niams.nih.gov/health_info/fibromyalgia/#b. Accessed March 6, 2016.

Üçeyler, N. et al. October 2015. Increased cortical activation upon painful stimulation in fibromyalgia syndrome. BMC Neurology. Available online at http://bmcneurol.biomedcentral.com/articles/10.1186/s12883-015-0472-4. Accessed March 12, 2016.

U.S. Food and Drug Administration. (November 2015) The Public Health Evidence for FDA Oversight of Laboratory Developed Tests: 20 Case Studies. Available online at http://www.fda.gov/downloads/AboutFDA/ReportsManualsForms/Reports/UCM472777.pdf. Accessed March 12, 2016.

Wallace DJ, Silverman SL, Conklin J, et al. Systemic lupus erythematosus and primary fibromyalgia can be distinguished by testing for cell-bound complement activation products. Lupus Science & Medicine 2016;3. Available online at http://lupus.bmj.com/content/3/1/e000127.full?sid=02cc960a-4d0e-4a49-9b53-1121de3892ed. Accessed March 5, 2016.

Wolfe, F., et al. May 2010.Arthritis Care & Research. The American College of Rheumatology Preliminary Diagnositc Criteria for Fibromyalgia and Measurement of Symptom Severity. Available online at https://www.rheumatology.org/Portals/0/Files/2010_Preliminary_Diagnostic_Criteria.pdf. Accessed March 12, 2016.

Sources Used in Previous Reviews

Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].

Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby's Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.

Davis, C. What's in a Name: Fibro vs. CFS. Arthritis Foundation [On-line information]. Available online at http://www.arthritis.org/resources/news/news_fibro_cfs.asp.

Sprott, H. (2003 March 03). What Can Rehabilitation Interventions Achieve in Patients With Primary Fibromyalgia? Curr Opin Rheumatol 15(2):145-150, 2003 [On-line journal]. Available online at http://www.medscape.com/viewarticle/449859.

(2003 October). Fibromyalgia. American College of Rheumatology, Fact Sheet [On-line information]. Available online at http://www.rheumatology.org/public/factsheets/fibromya.asp.

(2001 November, Updated). Fibromyalgia: What It Is and How to Manage It. Familydoctor.org [On-line information]. Available online at http://familydoctor.org/x1599.xml.

(2003 February). Fibromyalgia and Exercise. Familydoctor.org [On-line information]. Available online at http://familydoctor.org/061.xml.

Jeffrey P. Larson. Fibromyalgia. AccessMed Health Information Library [On-line information]. Available online at http://www.ehendrick.org/healthy/.

Russell, J. (2002). New Developments in the Management of Fibromyalgia Syndrome. ACR 2002 Annual Meeting [On-line information]. Available online at http://www.medscape.com/viewarticle/445110.

Lorden, L. It's a Guy Thing: Men with Fibromyalgia. National Fibromyalgia Association [On-line information]. Available online at http://fmaware.org/patient/coping/men.htm.

Nirula, A. (2002 January 24, Updated). Fibromyalgia. MedlinePlus Health Information Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000427.htm.

FM Monograph, What is Fibromyalgia? National Fibromyalgia Partnership, Inc. [On-line information]. Available online through http://www.fmpartnership.org/.

(2003 September). New information on fibromyalgia. The Harvard Medical School Family Health Guide [On-line information]. Available online at http://www.health.harvard.edu/fhg/updates/update0903a.shtml.

What is Fibromyalgia? American College of Rheumatology [On-line information]. Available online at http://www.rheumatology.org/publications/primarycare/number1/hrh0002-98.asp.

Simms, R. Treatment of Fibromyalgia Syndrome. American College of Rheumatology [On-line information]. Available online at http://www.rheumatology.org/publications/primarycare/number1/hrh0004-98.asp.

Abraham, V. et. al. What is the Fibromyalgia Sndrome and Why is it Important? American College of Rheumatology [On-line information]. Available online at http://www.rheumatology.org/publications/primarycare/number1/hrh0003-98.asp.

Sprott, H. (2003 March 03). What Can Rehabilitation Interventions Achieve in Patients With Primary Fibromyalgia? Curr Opin Rheumatol 15(2):145-150 [On-line information]. Available online at http://www.medscape.com/viewarticle/449859.

Millea, P. and Holloway, R. (2000 October 1). American Family Physician [On-line journal]. Available online at http://www.aafp.org/afp/20001001/1575.html.

Kimberly H. Groner MSN, RN, CANP. University of Michigan Chronic Pain and Fatigue Research Center, Ann Arbor, MI.

Denise L. Taylor-Moon, B.A. Program Associate, University of Michigan Chronic Pain and Fatigue Research Center, Ann Arbor, MI.

Rooks, D. (2007 February 16). Fibromyalgia Treatment Update. Medscape from Curr Opi Rheumatol 2007;19(2):111-117 [On-line journal article]. Available online at http://www.medscape.com/viewarticle/551891. Accessed on 9/9/07.

Clauw. D. (2006 September 21). Diagnosing and Treating Fibromyalgia in a Patient With Rheumatoid Arthritis. An Expert Interview With Daniel J. Clauw, MD. Medscape Rheumatology [On-line information]. Available online at http://www.medscape.com/viewarticle/544596. Accessed on 9/9/07.

Jeffrey, S. (2007 June 22). First Treatment Approved for Fibromyalgia. Medscape Medical News 2007 [On-line information]. Available online at http://www.medscape.com/viewarticle/558742. Accessed on 9/9/07.

Barclay, L. and Lie, D. (2007 July 26). Multidimensional Approach Recommended for Fibromyalgia Treatment. Medscape Medical News and CME [On-line information]. Available online at http://www.medscape.com/viewarticle/560409. Accessed on 9/9/07.

(2005 March). What Is Fibromyalgia? Fast Facts: An Easy-to-Read Series of Publications for the Public [NIAMS] [On-line information]. Available online at http://www.niams.nih.gov/hi/topics/fibromyalgia/fffibro.htm. Accessed on 9/9/07.

Mayo Clinic Staff (2007 August 29). Fibromyalgia symptoms or not? Understand the fibromyalgia diagnosis process. MayoClinic.com [On-line information]. Available online through http://www.mayoclinic.com. Accessed on 9/9/07.

David Trock, MD, FACP, FACR. Chief, Section of Rheumatology, Danbury Hospital, Danbury, CT. Assistant Clinical Professor of Medicine, Yale University School of Medicine.

Crofford, L. (Updated 2010 May). Fibromyalgia. American College of Rheumatology [On-line information]. Available online through http://www.rheumatology.org. Accessed May 2011.

Buckner Winfield, J. (Updated 2011 February 4). Fibromyalgia. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/329838-overview. Accessed May 2011.

Clauw, D. (Updated 2010 June 29). Fibromyalgia, Frequently Asked Questions. National Women's Health Information Center [On-line information]. Available online at http://womenshealth.gov/faq/fibromyalgia.cfm. Accessed May 2011.

Mayo Clinic Staff (2011 January 22). Fibromyalgia. MayoClinic.com [On-line information]. Available online at http://www.mayoclinic.com/print/fibromyalgia/DS00079/METHOD=print&DSECTION=all. Accessed May 2011.

(2009 April). Fibromyalgia. National Institute of Arthritis and Musculoskeletal and Skin Diseases [On-line information]. Available online at http://www.niams.nih.gov/Health_Info/Fibromyalgia/. Accessed May 2011.

Biundo, J. (Revised 2008 April). Fibromyalgia. Merck Manual Home Edition [On-line information]. Available online at http://www.merckmanuals.com/home/sec05/ch074/ch074c.html?qt=fibromyalgia&alt=sh. Accessed May 2011.

Wolfe, F. et. al. (2010 May). The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity. Arthritis Care & Research Vol. 62, No. 5, May 2010, Pp 600–610. [On-line information]. Available online through http://www.rheumatology.org. Accessed May 2011.