Fibromyalgia: Symptoms and Complications

Fibromyalgia symptoms affect many bodily systems

Fibromyalgia symptoms are many and include widespread pain, fatigue, sleep problems, memory issues, digestive concerns, and a host of things you may not even realize are part of the condition.

While fibromyalgia symptoms aren't well understood, they're very real. You may have fairly consistent levels of fibromyalgia symptoms or you may experience periods of low activity (remission) or suddenly intensified symptoms (flares).

This article details the full range of possible fibromyalgia symptoms and what they feel like, so you and your healthcare provider can identify fibromyalgia and find the right treatments for you.

fibromyalgia symptoms
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Fibromyalgia Pain Symptoms

The hallmark symptom of fibromyalgia is widespread pain that can range or fluctuate from mild to incapacitating. To be considered widespread, the pain must be on both sides of your body plus above and below the waist.

In fibromyalgia, the brain processes pain signals in abnormal ways. That leads to unusual pain types:

  • Hyperalgesia, which is a heightened response to painful stimuli ("turning up the volume" of pain)
  • Allodynia, which is pain from stimuli that usually aren't painful, such as light touch or moderate heat or cold
  • Paresthesia, which is abnormal nerve sensations including tingling, burning, or itching

Some people also have pain that moves in waves through the body. It's common in fibromyalgia to have multiple types of pain symptoms.

The word fibromyalgia means connective tissue (fibro) and muscle (myo) pain (algia). While those things are true of the condition, fibromyalgia symptoms go well beyond that, including nerve pain, cognitive dysfunction, and much more.

Fibromyalgia pain may change from day to day or even over the course of the day. It may be:

  • Sharp
  • Diffuse
  • Throbbing
  • Stabbing

A measurement of widespread pain is called a tender point exam. Healthcare providers check for pain in 18 places (9 paired points) throughout the body. This used to be part of the primary method of diagnosing fibromyalgia and can be used to gauge the success of treatments.

You may not be aware of pain in the tender point locations, but they're painful when the provider applies pressure.

Muscle and Joint Symptoms

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 (tendons, ligaments, and fascia).

Muscle and joint 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 where tendons attach to bones and muscles
  • Temporomandibular joint disorder (TMJ)

Research suggests these fibromyalgia symptoms are tied to increased rates of functional disability. They can lead to a slower walking speed, shorter stride, and balance problems on a level similar to that of rheumatoid arthritis or osteoarthritis. 

You don't have to have all of the possible fibromyalgia symptoms to be diagnosed with fibromyalgia.

Cognitive Symptoms

"Fibro fog," also known as "brain fog," is one of the more pervasive symptoms of fibromyalgia. Symptoms of cognitive dysfunction 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)

Many people living with the illness find cognitive dysfunction as debilitating as the pain itself—or even more so.

Energy and Sleep Symptoms

In fibromyalgia, fatigue is about more than just being tired—it's persistent exhaustion that isn't improved by rest. This chronic fatigue compounds feelings of fogginess and disorientation and contributes to high rates of depression.

Fibromyalgia is closely tied to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). They have similar symptoms and some common underlying physiology, and many people have both of them.

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. This pair of symptoms all but guarantees to leave you exhausted and drained.

Symptoms and overlapping sleep disorders include:

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

Treating sleep disorders can help you feel not only better rested, but can lessen other fibromyalgia symptoms, as well.

Neurosensory Symptoms

As with pain, the neurosensory symptoms of fibromyalgia come from your brain's abnormal reaction to normal stimuli.

Symptoms can include:

  • 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)

While the cause isn't well understood, the symptoms are believed to be largely related to hyperactive neurotransmitters (chemical messengers in the brain) and overstimulation of certain nerve pathways.

Digestive and Elimination Symptoms

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

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)

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

Psychological Symptoms

Fibromyalgia and depression are closely linked. Some of that may be due to the long-term emotional impact of the condition.

However, some scientists believe it's due to something shared by the two conditions: neurotransmitter dysregulation. Both fibromyalgia and major depression involve problems with:

  • Serotonin
  • Norepinephrine
  • Dopamine

This is why you may be prescribed antidepressants for fibromyalgia even if you don't have depression.

In addition to depression, other psychological fibromyalgia symptoms may include:

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

About 86% of people with fibromyalgia are expected to have a major depressive episode at some point in their lives, according to research.

Reproductive Symptoms

Hormones are believed to play a cause-and-effect role in fibromyalgia. On one hand, hormones are believed to trigger symptoms. For example, you may have flares related to your menstrual cycle.

On the other hand, fibromyalgia may cause hormonal imbalances that trigger symptoms of the reproductive system, predominately in biological females.

Symptoms may include:

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

Loss of sex drive, impotence, and erectile dysfunction are common in people with fibromyalgia, but they're believed to be linked to depression and anxiety, or treatments for them, rather than to fibromyalgia itself.

When to See a Healthcare Provider

Fibromyalgia symptoms might seem strange, especially when they come and go and can even change considerably from hour to hour. Rest assured that you're not the first person to feel this way about them, and healthcare providers who treat fibromyalgia are used to all of that.

You should talk to your provider if you have any of the following symptoms:

  • Chronic, severe, or recurrent pain that interferes with your daily life
  • Pain that causes you emotional stress, anxiety, or depression
  • Chronic fatigue and/or unrefreshing sleep
  • Inability to concentrate or think clearly
  • You have pain plus other potential fibromyalgia symptoms that worry you

At your appointment, try not to focus on just the "big" symptoms, as that may lead them in the wrong direction. Give a complete picture, including all of the symptoms you've been experiencing.

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

If your provider doesn't understand fibromyalgia well, ask for a referral to a rheumatologist. That's a doctor who specializes in musculoskeletal and autoimmune conditions.

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

Frequently Asked Questions

  • What are the typical first signs of fibromyalgia?

    The first signs vary greatly and fibromyalgia can start suddenly or gradually. Watch for the major symptoms:

    • Pain
    • Fatigue
    • Cognitive dysfunction
    • Insomnia
    • Headaches (especially changes in headache type, frequency, or severity)
    • Depression
    • Digestive issues
  • Where are common locations of fibromyalgia pain?

    According to diagnostic criteria, fibromyalgia has to involve widespread pain (both sides of the body, above and below the waist).

    More localized pain is common but varies from person to person, and even day to day in the same person. The most consistent area of pain is probably the spine.

  • What does a fibromyalgia flare-up feel like?

    During a flare, symptoms are more intense overall. The pain is sometimes described as a full-body migraine. Exhaustion is especially common, as is the feeling of a fogged-in brain.

  • Can COVID trigger fibromyalgia?

    So far, it appears that long-haul COVID-19 symptoms may include fibromyalgia or at least symptoms very similar to it. Biological males and people with obesity appear to have a higher risk of this.

    Also, COVID-19 infection has been found to trigger flares in people who already have fibromyalgia.

  • Does fibromyalgia cause weight gain?

    It can, yes. This is believed to be due to several factors:

    • Being more sedentary due to fibromyalgia symptoms and depression
    • Possible changes in the metabolism due to the illness
    • Medications that are tied to weight gain, especially Lyrica (pregabalin)

    Carrying extra weight also appears to make fibromyalgia symptoms worse.`

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