CFS & Fibromyalgia Understanding Fibromyalgia Print An Overview of Fibromyalgia Medically reviewed by Medically reviewed by Claudia Chaves, MD on November 10, 2019 Claudia Chaves, MD is board-certified in cerebrovascular disease and neurology, with a subspecialty certification in vascular neurology. Learn about our Medical Review Board Claudia Chaves, MD on November 10, 2019 Written by linkedin Written by Adrienne Dellwo Adrienne Dellwo is an experienced journalist who was diagnosed with fibromyalgia and has written extensively on the topic. Learn about our editorial policy Adrienne Dellwo Fibromyalgia Overview Symptoms Causes Diagnosis Treatment In This Article Table of Contents Expand Symptoms Causes Diagnosis Treatment View All Fibromyalgia is a chronic disorder characterized by widespread pain that is often accompanied by fatigue, depression, sleep disturbance, cognitive impairment, and digestive and urinary symptoms. It is a poorly understood disorder in which pain signals processed by the brain appear to be exaggerated, amplifying the sensation of pain in muscles and soft tissues. There are no tests to identify it, so fibromyalgia is diagnosed by excluding other possible causes. Treatment may involve over-the-counter pain relievers, antidepressants, physical therapy, self-care, and medications specifically approved to treat fibromyalgia, such as Lyrica (pregabalin). Symptoms What does fibromyalgia feel like? It's about more than just muscle aches and joint pain. It is persistent, widespread pain that can move through the body in waves, causing sensations described as throbbing, diffuse, intense, or stabbing. Even mild changes in temperature or pressure (including touch) may trigger discomfort. While some people maintain fairly consistent levels of symptoms, others will go through periods of remission alternating with periods of activity (flares). Beyond pain, fibromyalgia is associated with an almost dizzying array of symptoms affecting multiple organ systems. They include: Fatigue, usually chronic, affecting four out of five people with the disorderMuscle and joint symptoms such as muscle spasms, muscle weakness, and jaw painCognitive symptoms such as the loss of concentration, disorientation, and "brain fog"Sleep disorders such as broken sleep, sleep starts, and insomniaNeurosensory symptoms such as vertigo, migraine, or sensitivity to light, sound, or smellsGastrointestinal symptoms such as diarrhea, constipation, bloating, or crampingUrinary symptoms including bladder pain, pain during urination, or the frequent urge to urinatePsychiatric symptoms such as depression, mood swings, hypervigilance, or panic attacksReproductive symptoms such as painful periods, pelvic pain, or early menopause Temporary hair loss, heart palpitations, and the benign overgrowth of fatty tissue (lipomas) may also occur. Fibromyalgia Signs and Symptoms Causes No one really knows what causes fibromyalgia. It is clustered with similar disorders, such as chronic fatigue syndrome (CFS) and irritable bowel syndrome (IBS), which are believed to be caused by an excessive response of the central nervous system to otherwise normal stimuli. People with fibromyalgia tend to unusually high concentrations of two chemicals, known as substance P and glutamate, in their body. Substance P and glutamate are involved in the transmission and regulation of pain information. By having such elevated levels of substance P and glutamate, the pain messages to and from the brain may effectively be over-exaggerated. Similarly, a number of smaller studies have shown that people with fibromyalgia tend to have decreased blood flow to the thalamus, the section of the brain that acts as the center of pain perception. It is strongly believed that this may also contribute to the heightened pain perception. While fibromyalgia is today recognized as a syndrome by the medical community, there remains debate as to whether it is a purely somatic (physical) disorder. The symptoms of fibromyalgia are clearly influenced by depression, anxiety, sleep problems, and stresses that can either enhance the perception of pain or directly affect neurological function. At this stage, we simply don't know. What we do know is that certain risk factors may increase the odds of getting fibromyalgia. Among them: Women are nine times more likely to have fibromyalgia than men. It has been suggested that decreases in estrogen during menstruation and around the time of menopause. Age is also a factor. Despite being considered a disorder affecting post-menopausal women, fibromyalgia is most often diagnosed between the ages of 20 and 50, although symptoms usually develop several years prior. Children can also have fibromyalgia.Stress appears to precipitate fibromyalgia symptoms. When accompanied by sleep problems, the perception of pain is further heightened as is the risk of fatigue and depression.Genetics are also believed to be a factor. Research suggests that having a parent or sibling with fibromyalgia significantly increases your risk. Fibromyalgia Causes and Risk Factors Diagnosis With no lab or imaging tests able to confirm the disorder, diagnosis of fibromyalgia requires first excluding other possible causes of your symptoms. It can be a painstaking process that should be overseen by a rheumatologist or, alternately, a neurologist or general practitioner experienced with fibromyalgia or other connective tissue issues. In 2010, the American College of Rheumatology (ACR) updated their diagnostic criteria for fibromyalgia, taking into consideration the distribution of the pain, the duration of the pain, and your perception of the pain and other symptoms. The ACR criteria include two score-based evaluations: The first, called the widespread pain index (WPI), assigns one point for each of the 19 body parts in which you’ve experienced pain (for a maximum of 19 points).The second, called the symptom severity (SS) scale, assigns 0 to 3 points—0 meaning no symptoms, 3 meaning serious symptoms—to each of four characteristic symptoms of the disorder (for a maximum of 12 points). While these are physicians' tools, knowing more about them can give you a sense of what your doctor will factor into his diagnosis decision making. Fibromyalgia Doctor Discussion Guide Get our printable guide for your next doctor's appointment to help you ask the right questions. Download PDF Email the Guide Send to yourself or a loved one. Sign Up This Doctor Discussion Guide has been sent to {{form.email}}. There was an error. Please try again. To be diagnosed with fibromyalgia, you need to satisfy the following three conditions: You must have either a) WPI of 7 or more with an SS score of 5 or more, or b) a WPI of 3 to 6 and an SS score of 9 or more.You must have had these symptoms for at least three months.There must be no other medical explanation for your symptoms. How Fibromyalgia Is Diagnosed Treatment There is no single pill that can treat fibromyalgia or ensure the sustained remission of symptoms. A multi-faceted approach is needed, which may include over-the-counter (OTC) and prescription medications, physical therapy and counseling, lifestyle interventions, and complementary therapies. Because no two cases of fibromyalgia are alike, treatment can vary from one person to the next. Medications and Therapy Medications are typically the backbone of therapy. The choice of drugs is largely dependent on the types and severity of your symptoms and how well you tolerate any side effects. Among them: OTC pain relievers like Tylenol (acetaminophen) and nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or Aleve (naproxen) may provide short-term relief of minor pain.Prescription pain relievers such as Celebrex (celecoxib) or Voltaren (diclofenac) are longer lasting.Antidepressants can ease pain and fatigue while elevating mood by raising serotonin levels. The antidepressants Cymbalta (duloxetine) and Savella (milnacipran) are approved to treat fibromyalgia.Anticonvulsants may also be effective in treating pain. They include Lyrica (pregabalin), which is approved for the treatment of fibromyalgia, and others like Neurontin (gabapentin), which may be prescribed off-label. Sleep problems are typically treated with low-dose antidepressants, like Elavil (amitriptyline), rather than sleeping pills. Muscle relaxers, like Flexeril (cyclobenzaprine), can also do double-duty by alleviating muscle tension while helping a person sleep. In addition to medications, your doctor may refer you to specialists who can help you overcome physical or emotional challenges, including physical therapists, occupational therapists, psychiatrists, or counselors. Lifestyle Modifications and Complementary Treatments Stress alleviation is among the primary facets of any fibromyalgia treatment plan. Relaxation techniques and mind-body therapies are obvious and helpful options. But eating better, exercising, and avoiding things like caffeine, alcohol, and smoking can also help elevate your mood. In particular, physical activity triggers the release of serotonin, dopamine, and endorphins, what many dub "feel-good" chemicals. Complementary approaches to treatment include: Meditation, guided imagery, and deep breathing (pranayama) to alleviate stressYoga and Tai Chi, which incorporate controlled movements and the release of tensionMassage therapy, especially gentler forms like Shiatsu or aromatherapy massageProgressive muscle relaxation (PMR), which focuses the release of tension by body partBiofeedback, which can teach you how to control the stress responseMedical marijuana, which can reduce pain, elevate mood, and help you sleep better5-HTP (5-hydroxytryptophan), a naturally-occurring amino acid that can be taken as a supplement, which may help raise serotonin levels Finding Relief From Fibromyalgia A Word From Verywell Despite increased public awareness, fibromyalgia remains a mystery to many peoples, some of whom may doubt its existence or suggest that it’s "all in your head." It is not. Don’t let other people’s misconceptions prevent you from seeking the care you need. Find support from friends and family, opening up about not only what you feel but how you feel. Join a local support group or contact the National Fibromyalgia & Chronic Pain Association to find one near you. Building a support system can provide you with the confidence and education to become an advocate for your own care. If your doctor is unable to help or understand your concerns, find a rheumatologist in your area through the online locator offered by the American College of Rheumatology. Drug co-pay and patient assistance programs are also available to help defray the cost of treatment, if you are eligible. The Big List of Fibromyalgia Symptoms Was this page helpful? Thanks for your feedback! Learn about treatment and lifestyle changes to cope with fibromyalgia and chronic fatigue syndrome. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Office on Women's Health. Fibromyalgia. Updated April 1, 2019 Foerster BR, Petrou M, Harris RE, et al. Cerebral blood flow alterations in pain-processing regions of patients with fibromyalgia using perfusion MR imaging. AJNR Am J Neuroradiol. 2011;32(10):1873-8. doi:10.3174/ajnr.A2614 Berger A, Dukes E, Martin S, Edelsberg J, Oster G. Characteristics and healthcare costs of patients with fibromyalgia syndrome. Int J Clin Pract. 2007;61(9):1498-508. doi:10.1111/j.1742-1241.2007.01480.x Park DJ, Lee SS. New insights into the genetics of fibromyalgia. Korean J Intern Med. 2017;32(6):984-995. doi:10.3904/kjim.2016.207 Wolfe F, Clauw DJ, Fitzcharles MA, et al. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. J Rheumatol. 2011;38(6):1113-22. doi:10.3899/jrheum.100594 Sarzi puttini P, Caruso I. Primary fibromyalgia syndrome and 5-hydroxy-L-tryptophan: a 90-day open study. J Int Med Res. 1992;20(2):182-9. doi:10.1177/030006059202000210 Additional Reading Bellato, E.; Marini, E.; Castoldi, F. et al. Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment. Pain Res Treat. 2012; 2012: 426130. DOI: 10.1155/2012/426130. Foerster, B.; Petrou, M.; Harris, R. et al. Cerebral Blood Flow Alterations in Pain-Processing Regions of Patients with Fibromyalgia Using Perfusion MR Imaging. AJNR Am J Neuroradiol. 2011; 32(10): 1873-78. Park, D. and Lee, S. New insights into the genetics of fibromyalgia. Korean J Intern Med. 2017; 32(6):984-95. DOI: 10.3904/kjim.2016.207. Wolfe, F.; Clauw, D.; Fitzcharles, M.; et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res. 2010; 62(5):600-10. DOI: 10.1002/acr.20140. Continue Reading