Symptoms of Fibromyalgia

Fibromyalgia is a bewildering and largely misunderstood condition characterized by widespread pain and tenderness accompanied by fatigue, sleep problems, memory issues, and gastrointestinal concerns. Because the array of possible symptoms is so extensive (and there remains no clear consensus on how to diagnose it), many feel lost as to what is affecting them and what to do about it. The most important thing to remember is that fibromyalgia may be poorly understood, but it is very real.

By becoming more aware of the signs and symptoms of the condition and what it feels like, you can help your healthcare provider help you identify fibromyalgia and access treatment that may greatly improve your quality of life.

fibromyalgia symptoms
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Fibromyalgia is a condition in which pain signals are abnormally processed. Patients with fibromyalgia have both hyperalgesia, which refers to increased pain response from a painful stimuli, as well as allodynia, which refers to pain evoked by stimuli that usually are not painful.

Fibromyalgia is not the same thing as muscles aches (myalgia), joint pain (arthralgia), or even nerve pain (neuralgia).

Fibromyalgia causes chronic, widespread pain that can range in severity from mild to incapacitating. To be considered widespread, the pain must occur on both sides of your body, as well as above and below the waist.

Misinterpreted pain signals can provoke different responses in different people. In some, the pain can move in waves through the body or trigger abnormal sensations such as tingling, burning, or itching, especially in the arms (referred to as paresthesia).

Even a stimulus that doesn't typically provoke pain, such as touch or temperature, can oftentimes result in a painful or burning sensation (referred to as allodynia).

While fibromyalgia is characterized by widespread chronic pain, the pain can often be localized around the elbows, shoulders, knees, neck, hips, chest, lower back, and back of the head. We refer to these as tender points. The pain in these areas may not be felt deeply but rather exist just below the surface of the skin.

Fibromyalgia pain may alternately be described as sharp, diffuse, severe, throbbing, or stabbing. While some people will have fairly consistent levels of fibromyalgia symptoms, others may experience periods of low activity (remission) or the sudden intensification of symptoms (flares). Flares and severe pain episodes are often accompanied by heart palpitations.

You do not have to have all of the symptoms to be diagnosed with fibromyalgia.

Muscle and Joint

Fibromyalgia isn't a joint disease like arthritis, but it can cause joint-related symptoms. Most, and possibly all, fibromyalgia cases involve symptoms of the soft tissues, including the muscles and connective tissues (such as the tendons, ligaments, and fascia).

Symptoms may include:

  • Morning stiffness
  • Muscle spasms or twitches (fasciculations)
  • Muscle weakness, especially in the legs
  • Diffuse, non-inflammatory swelling of the limbs, hands, and feet
  • Joint pain around tendon inserts
  • Temporomandibular joint disorder (TMJ)

According to a study published in Frontiers in Human Neuroscience, the symptoms of fibromyalgia are associated with increased rates of functional disability. High levels of this kind of pain and stiffness, as well as other concerns listed below, can result in the loss of walking speed, stride, and balance on a level similar to that of rheumatoid arthritis or osteoarthritis.


"Fibro fog," also known as "brain fog," is one of the more pervasive symptoms of fibromyalgia. Many people living with the illness will tell you that the symptoms of cognitive impairment are nearly as debilitating as the pain itself.

Symptoms may include:

  • Forgetfulness
  • Confusion
  • Trouble concentrating
  • Temporary loss of familiarity with your surroundings
  • Impaired comprehension
  • Difficulty speaking known words (dysphasia)
  • Difficulty orienting direction or space (topographagnosia)
  • Difficulty processing information you hear (central auditory processing disorder)
  • Difficulty processing numbers or math (dyscalculia)

Energy and Sleep

In fibromyalgia, fatigue is about more than just being tired; it's persistent exhaustion that fails to improve despite rest. The chronic fatigue not only compounds feelings of fogginess and disorientation, but it also contributes to high rates of depression in people living with the condition.

It is no surprise that fibromyalgia is so closely associated with chronic fatigue syndrome (CFS), both of which share similar symptoms.

Fatigue is among the most characteristic symptoms of fibromyalgia, affecting four out of every five people who have it.

Fibromyalgia-related fatigue often goes hand-in-hand with sleep problems, the coupling of which is all but guaranteed to leave you exhausted and drained.

Symptoms may include:

  • Light or regularly broken sleep
  • Sleep starts (hypnic jerks)
  • Obstructive sleep apnea
  • Restless leg syndrome (RLS)
  • Insomnia


These neurosensory symptoms are similar to pain in that the stimuli may be normal, but your brain's response to them isn't.

While the cause is not well understood, the symptoms are believed to be largely related to the hyperactivity of chemical messengers known as neurotransmitters and the overstimulation of certain nerve pathways.

Among the symptoms:

  • Headaches
  • Chronic migraines
  • Dizziness and vertigo
  • Fainting (syncope)
  • Sensitivity to temperature, humidity, and an atmospheric pressure
  • Sensitivity to light (photophobia)
  • Sensitivity to noise (hyperacusis)
  • Sensitivity to smells (hyperosmia)

Digestive and Urinary

Digestive problems are common in people with fibromyalgia, with as many as 50 percent diagnosed with symptoms of irritable bowel syndrome (IBS). Like fibromyalgia, IBS is believed to be caused by an abnormal central nervous system response.

People with fibromyalgia will also frequently have interstitial cystitis (IC), a condition that causes chronic pain in the bladder.

Symptoms may include:

  • Bloating
  • Nausea
  • Abdominal cramps
  • Diarrhea
  • Constipation
  • Indigestion
  • Frequent passing of gas
  • Difficulty swallowing (dysphagia)
  • Frequent urination
  • Frequent need to urinate (urinary urgency)
  • Pain during urination (dysuria)
  • Bladder spasms
  • Pain during sexual intercourse (dyspareunia)


Fibromyalgia and depression are closely linked. While it may be fair to assume that the long-term emotional impact of the fibromyalgia may be at the heart of the psychological symptoms (such as panic disorder) others are not so sure.

Some scientists, in fact, believe that symptoms may be due, at least in part, to the fibromyalgia's effect on the central nervous system, namely neurotransmitter dysregulation.

As much as 86 percent of people with fibromyalgia are expected to have a major depressive episode at some point in their lives, according to research from the University of North Carolina.

In addition to depression, other symptoms may include:

  • Anxiety or panic attacks
  • Free-floating anxiety (generalized anxiety disorder)
  • Mood swings
  • Unaccountable irritability


Hormones are believed to play a cause-and-effect role in fibromyalgia. On one hand, hormones are believed to trigger symptoms (as evidenced by women who suffer flares during their periods).

On the other, fibromyalgia may cause hormonal imbalances that trigger reproductive tract symptoms, predominately in women.

Symptoms may include:

  • Extremely painful periods
  • Pelvic pain
  • Chronic pain of the vulva (vulvodynia)
  • Premature menopause (premature ovarian failure)

While the loss of sex drive, impotence, and erectile dysfunction are also common in people with fibromyalgia, they are believed to be linked to depression and anxiety rather than to fibromyalgia itself.

When to See a Healthcare Provider

Fibromyalgia is such a perplexing condition that it is often difficult to know when to seek care or even how to explain how you're feeling to your healthcare provider. Start by reminding yourself that whatever you're going through is real. That fact that it may not make any sense is of little consequence.

To that end, do not hesitate to see a healthcare provider if you are experiencing some or all of the following symptoms.

  • You have chronic, severe, or recurrent pain that is interfering with your daily life.
  • The pain is causing you emotional stress, anxiety, or depression.
  • You are chronically fatigued and/or having unrefreshing sleep.
  • You are unable to concentrate or think clearly.
  • If you have accompanying symptoms that worry you.

Fibromyalgia Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Old Woman

When seeing your healthcare provider , it is important not to leave out any details or focus on just the "big" symptoms, which can lead him or her in the wrong direction. Give a complete picture, whether the details you're sharing seem significant or not.

If your healthcare provider doesn't understand enough about fibromyalgia, make an appointment to see a specialist known as a rheumatologist who specializes in musculoskeletal and autoimmune diseases and conditions.

You can find a board-certified specialist in your area through the online locator managed by the American College of Rheumatology.

Frequently Asked Questions

  • What are the typical first signs of fibromyalgia?

    Pain, fatigue, and brain fog are the most common symptoms of fibromyalgia. Other symptoms include insomnia, headaches, depression, and digestive issues.

  • Where are common locations of fibromyalgia pain?

    Fibromyalgia affects the soft tissue including muscles, tendons, ligaments, and fascia. Common pain locations include:

    • Lower-front neck
    • Upper chest just beneath the collarbone
    • Back of the neck at the base of the skull
    • Back of the shoulder
    • Shoulder blade area
    • Outside of the elbow
    • Upper-outer quadrant of the buttock
    • Outside of the hip
    • Inner knee
  • What does a fibromyalgia flare-up feel like?

    Fibromyalgia symptoms can fluctuate with periods of remission. During a flare-up, symptoms can be intense. The pain can vary between sharp, diffuse, severe, throbbing, or stabbing. Other symptoms, like fatigue and brain fog, can be more problematic during a flare-up.

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