Anxiety in Fibromyalgia: Symptoms, Causes, and Treatments

Anxiety is a common problem for people with fibromyalgia and is associated with more severe symptoms and lower quality of life.

In someone with fibromyalgia, anxiety is often listed as a symptom, but just as frequently considered a common overlapping condition. No matter how it’s classified, though, anxiety can be destructive and even disabling, especially on top of the myriad other symptoms you face with this condition.

Learning what triggers your anxiety, how to recognize it, its potential causes, and how to deal with it are important parts of living well with fibromyalgia.

Fibromyalgia Anxiety Triggers

When you have fibromyalgia, you not only have the standard stress and anxiety triggers that everyone faces, you have added ones. Your many fibromyalgia symptoms limit what you can do and they’re unpredictable, both of which may lead to problems at work, at home, and in your relationships.

You may find yourself calling in sick, canceling plans a lot, and missing out on things you enjoy. A lot of people with fibromyalgia, and chronic illness in general, end up feeling isolated.

If you have problems with sensory overload, which is common in fibromyalgia, you may fear certain situations and face anxiety when you know you’ll have to face one. A trip to the grocery store can end in a panic attack that leaves you worried about how you'll get through the next shopping trip.

Depending on your employment and health insurance situations, you may face financial hardships because of your illness, which can greatly increase overall stress levels and strain relationships with spouses or domestic partners.

Stress is believed to play a major role in triggering flares of fibromyalgia symptoms, so learning to manage it is always in your best interest. When you have anxiety, it becomes significantly more important.

Anxiety Symptoms

Not all the symptoms of anxiety are obvious, especially because some of them are similar to fibromyalgia symptoms, so it pays to recognize them for what they are so you can get a proper diagnosis and find treatments that work for you.

Anxiety can cause physical symptoms, thought-related symptoms, and behavior-related symptoms. Some common physical symptoms of anxiety include:

• Pounding, rapid heartbeat
• Aches and pains
• Dizziness
• Shortness of breath
• Sweating
• Tremors and twitches
• Headaches
• Fatigue
• Insomnia
• Upset stomach
• Feeling weak
• Sleep problems
• Difficulty concentrating
• Hyperventilating (rapid breathing)

Pain, dizziness, fatigue, insomnia, other sleep problems, and difficulty concentrating are all fibromyalgia symptoms, and sweating is a side effect of some common fibromyalgia drugs. That means you might miss them as potential anxiety symptoms. The key is to look for clusters of symptoms that come and go together.

Thought-related symptoms of anxiety may be easier to distinguish. They can include:

• Nervousness
• Irritability
• Being “on edge”
• Feelings of terror, impending doom, or being out of control
• Thoughts or beliefs that are hard to control
• Restlessness
• Panic attacks

Behaviorally, anxiety can make you work hard to avoid things that have or could trigger symptoms, such as a crowded store or noisy environment.

Depending on what those specific triggers are, they may have a severe impact on your life. After all, you can't very well avoid work because you had a panic attack there during a crisis last week.

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Causes

Researchers haven’t pinned down the exact causes of anxiety or anxiety attacks. It’s believed that many factors play a role in it, including genetics and brain chemistry. Your environment and levels of psychological stress may be wrapped up in it, as well.

Fibromyalgia and anxiety may go together so often because of common underlying physiology. They're believed to share several physiological abnormalities, such as:

• Dysfunction of neurotransmitters, including serotonin and GABA
• Dysfunction of the opioid and endocannabinoid systems
• Central sensitization

Neurotransmitter Dysfunction

Neurotransmitters are chemical messengers in your brain. The neurotransmitters serotonin and gamma-aminobutyric acid (GABA) play several important roles in the brain. Low activity levels of both chemicals are linked to anxiety and fibromyalgia.

Serotonin is sometimes called a “feel-good” chemical. It’s involved in mood (especially anxiety and depression), the sleep/wake cycle, pain perception, attention, digestion, and sexual function.

GABA’s principal function is to calm your brain after something (e.g., stress, excitement, anxiety) gets it riled up. GABA is directly involved with anxiety regulation, sleep, relaxation, and muscle function.

Given their jobs, it’s easy to see why abnormally low activity of these brain chemicals can lead not only to increased anxiety, but also to pain, fatigue, insomnia, cognitive dysfunction, and other symptoms of fibromyalgia.

Opioid and Endocannabinoid Systems

Your body has systems named for the substances they react to, both those produced by your body and the ones you take in.

• The opioid system: This system responds to and processes opioid painkillers and similar chemicals produced by your brain, including endorphins and enkephalins.
• The endocannabinoid system: “Endo” means “within” and denotes substances produced by your body. “Cannabinoids” are chemicals from the cannabis plant, which gives us hemp and marijuana, or chemicals that are similar to them. The endocannabinoid system, therefore, responds to and processes cannabinoids.

Anxiety and fibromyalgia both involve abnormalities in the opioid and endocannabinoid systems. 

One type of opioid receptor appears to play a role in regulating emotional states. It’s hypothesized that the kappa-opioid receptor may be especially active in people with anxiety and drugs that block this activity have been suggested as possible treatments.

Fibromyalgia is believed to involve a reduced number of opioid receptors in the brain and disordered opioid processing.

Both anxiety and fibromyalgia are linked to abnormal activity of a substance that’s involved in opioid activity in the brain and the receptor it binds with (the mu opioid receptor).

The exact significance of these abnormalities aren’t yet known, but the common or similar dysfunctions suggests a physiological relationship between the two conditions.

Central Sensitization

The “central” in central sensitization indicates the central nervous system, which is composed of your brain, spinal cord, and nerves of the spinal cord. “Sensitization” means it’s become oversensitive to stimuli, through repeated exposure or other mechanisms.

Fibromyalgia, anxiety, and numerous other conditions (including migraine and irritable bowel syndrome) are linked to central sensitization and fall under the umbrella term of central sensitivity syndromes.

Fibromyalgia is considered the quintessential central sensitization syndrome. It involves hypersensitivity to painful stimuli and often other aspects of the environment, including temperature, light, noise, and smell. Anxiety is an exaggerated response to stress or other triggers.

It’s theorized that all central sensitivity syndromes are all related to each, most likely representing different points on a spectrum. It's common for someone with one of these conditions to eventually develop others.

Diagnosis

If you’re experiencing anxiety, and especially if it's frequent or debilitating, talk to your healthcare provider about it. They may do some testing to check for other medical conditions that could be behind your symptoms, or they may determine it’s a symptom of fibromyalgia.

“Anxiety” or “anxiety attacks” aren’t actually a diagnosis, so, depending on your symptoms, you may be diagnosed with an anxiety disorder such as generalized anxiety disorder or panic disorder.

No matter what diagnosis you end up with, if you feel you need treatment for your anxiety, don’t hesitate to ask for it.

Treatment

Many anxiety treatments are available. Depending on your specific symptoms and needs, you may end up with some combination of the following:

• Psychotherapy, including cognitive behavioral therapy (CBT) or exposure therapy
• Medications, such as benzodiazepines, selective serotonin reuptake inhibitors (SSRIs), or serotonin-norepinephrine reuptake inhibitors (SNRIs)
• Supplements, such as GABA, L-theanine, kava kava, and valerian root
• Lifestyle Modifications, including adequate sleep, meditation, exercise, or relaxation techniques such as deep breathing

Finding support can be an important part of managing your anxiety. If you don't feel supported by friends and family, you may want to seek out a support group, either in your community or online.

A Word From Verywell

If anxiety is disrupting your life, don’t just write it off as one more fibromyalgia symptom you have to live with. You have a lot of options for managing your anxiety. It may take some time and experimentation, so try to be patient while you’re going through the process.

Keep in mind that the ultimate goal for you and your healthcare provider is finding treatments that can help manage your symptoms as well as possible and improve your quality of life.