Is Your Fibromyalgia Primary or Secondary?

Senior African American man rubbing his shoulder

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Is your fibromyalgia primary or secondary? It's a fact that tends to be frequently overlooked or glossed over. Fibromyalgia (FMS) can be either primary, also known as idiopathic fibromyalgia, or secondary. In primary fibromyalgia, the causes are not known whereas, in secondary fibromyalgia, we know (or at least have a pretty good idea) why it developed. Primary fibromyalgia is the more common form.


Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. While we still don't know exactly what's going on in the body that leads to fibromyalgia, we do know that chronic pain can cause changes in the brain and central nervous system that lead to central sensitization—essentially making the body overreact to pain and other stimuli (noise, smell, bright lights, etc.). That's why it's believed people with rheumatoid arthritis (RA), lupus, multiple sclerosis (MS) and other chronic pain conditions frequently develop FMS.

Causes of Secondary Fibromyalgia

Secondary fibromyalgia has similar symptoms as primary fibromyalgia. Possible causes of secondary fibromyalgia include:

  • Physical injury: For example, secondary fibromyalgia sometimes develops in people who have had neck injuries.
  • Ankylosing spondylitis: Ankylosing spondylitis is a form of chronic inflammation of the spine and the sacroiliac joints located in the low back where the sacrum meets the iliac bones.
  • Surgery: Trauma, particularly in the upper spinal region, may trigger the development of fibromyalgia.
  • Lyme disease
  • Hepatitis C
  • Endometriosis


In general, medication and self-care are used to treat both kinds of fibromyalgia. The emphasis is on minimizing symptoms and improving general health. No one treatment works for all symptoms.

Medications can help reduce the pain of fibromyalgia and improve sleep. Common medications include:

  • Pain relievers: Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may be helpful.
  • Antidepressants: Duloxetine (Cymbalta) and milnacipran (Savella) may help with pain and fatigue.
  • Anti-seizure drugs: Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin, Gralise) is sometimes helpful, while pregabalin (Lyrica) was the first drug approved by the Food and Drug Administration to treat fibromyalgia.

Primary vs. Secondary and Treatments

It's important to make the distinction between primary and secondary when we talk about treatments. For example, some people have success with acupuncture in treating their fibromyalgia. It could be because acupuncture is one of the best treatments for an original condition, myofascial pain syndrome (MPS, or CMP for chronic myofascial pain). While it is impossible to say for sure whether acupuncture relieves fibromyalgia symptoms directly (some studies show it can), or whether relieving the MPS symptoms had a secondary effect of calming fibromyalgia symptoms.


The pain and lack of sleep associated with fibromyalgia can interfere with the ability to function at home or on the job. The frustration of dealing with an often-misunderstood condition also can result in depression and anxiety.

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