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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.
No one knows for sure what causes fibromyalgia. But experts have some ideas, such as:
The main symptoms of
People with fibromyalgia may have other problems, such as:
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.
Doctors diagnose fibromyalgia based on two things:
Before the diagnosis, your
doctor will make sure that you don't have other conditions that
cause pain. These include
lupus, and other
Treatment is focused on
managing pain, fatigue, depression, and other symptoms. You may be able to control your
people with fibromyalgia also find
complementary therapies helpful. These include
tai chi, acupuncture, massage, behavioral therapy, and relaxation techniques.
Learning about fibromyalgia:
Living with fibromyalgia:
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:
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.
The symptoms of
fibromyalgia vary from person to person. Symptoms can last from days to months or years.
The most common symptoms are:
Other symptoms that can occur
along with pain include:
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.
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.
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.
Certain things may make you more likely to have
fibromyalgia. Things that increase your risk (risk factors) include:
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
If you have fibromyalgia, call your doctor if you have:
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:
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.
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
Doctors use a set of criteria
to diagnose fibromyalgia. Your doctor will look for:
A person may not meet these criteria but may still
have fibromyalgia. That is why diagnosis can be so difficult.
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
The treatment you need or want may be based on:
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 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.
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 is a vital part of managing
fibromyalgia. For example you can:
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.
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 is the most
important part of treating fibromyalgia. There are many things you can
do over time to treat your symptoms:
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
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
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.
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:
Often medicines may be combined (such as fluoxetine and
amitriptyline) for the most effective treatment of symptoms of pain and sleep
medicines are being studied and used for treating fibromyalgia,
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.
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:
Other treatments that have been used to treat
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
If you have fibromyalgia and are thinking
about trying a complementary therapy, get the facts before you begin. Consider
these questions with your doctor:
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.
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.
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.
website offers patient information fact sheets about rheumatic diseases, about
medicines used to treat rheumatic diseases, and about care
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.
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
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.
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.
Arnold LM, et al. (2008). Patient perspectives on the impact of fibromyalgia. Patient Education and Counseling, 73(1): 114–120.
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.
Häuser W, et al. (2009). Treatment of fibromyalgia syndrome with antidepressants. JAMA, 301(2): 198–209.
Meisler JG (2000). Toward optimal health: The experts discuss fibromyalgia. Journal of Women's Health and Gender-Based Medicine, 9(10): 1055–1060.
Richards SCM, Scott DL (2002). Prescribed exercise in people with fibromyalgia: Parallel group randomised controlled trial. BMJ, 325(7357): 185.
Taylor AG, et al. (2003). Fibromyalgia section of Pain. In JW Spencer, JJ Jacobs, eds., Complementary and Alternative Medicine: An Evidence-Based Approach, pp. 384–395 . St. Louis: Mosby.
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.
October 20, 2011
Anne C. Poinier, MD - Internal Medicine & Karin M. Lindholm, DO - Neurology
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