Fibromyalgia

Fibromyalgia is a long-term condition that involves widespread body pain. The pain happens along with fatigue. It also can involve issues with sleep, memory and mood. Researchers think that fibromyalgia affects the way the brain and spinal cord process painful and nonpainful signals. That increases your overall sensitivity to pain.

Symptoms often start after a triggering event. Triggers can include injuries, surgery, infections or emotional stress. Or the symptoms can build up over time, with no single event to trigger them.

Women are more likely to get fibromyalgia than are men. Many people who have fibromyalgia also have:

• Headaches.
• Jaw and facial pain due to temporomandibular joint (TMJ) disorders.
• Irritable bowel syndrome.
• Anxiety.
• Depression.

There's no cure for fibromyalgia. But medicines and other treatments can help control the symptoms. Exercise, talk therapy and techniques that lower stress also may help.

The main symptoms of fibromyalgia include:

• Widespread pain. Fibromyalgia pain often is described as a constant dull ache that has lasted for at least three months. The pain is considered widespread if it happens on both sides of the body and above and below the waist.
• Fatigue. People with fibromyalgia often wake up tired, even though they say they sleep for a long time. Often, the pain disrupts sleep. Many people with fibromyalgia have other sleep disorders. These include restless legs syndrome and sleep apnea.
• Thinking-related troubles. A symptom known as "fibro fog" makes it harder to pay attention and focus on mental tasks.

Fibromyalgia often happens with other conditions, such as:

• Irritable bowel syndrome.
• Chronic fatigue syndrome.
• Migraine and other types of headaches.
• Interstitial cystitis, also called painful bladder syndrome.
• TMJ disorders.
• Anxiety.
• Depression.
• Postural tachycardia syndrome.
• Post-COVID syndrome, also known as long COVID.

With fibromyalgia, many researchers think nerves are affected in a way that causes the brain and spinal cord to change. This change involves an irregular rise in levels of certain chemicals in the brain that signal pain.

In addition, the brain's pain receptors seem to develop a sort of memory of the pain. They can start to overreact to painful and nonpainful signals.

Many factors likely lead to these changes, including:

• Genes. Fibromyalgia tends to run in families. So certain gene changes might make you more likely to get the condition.
• Infections. Some illnesses appear to trigger fibromyalgia or make it worse.
• Physical or emotional events. Sometimes, fibromyalgia can be triggered by a physical event, such as a car accident. Ongoing stress also may trigger the condition.

Risk factors for fibromyalgia include:

• Being assigned female at birth. Fibromyalgia is more common in women than in men.
• Family history. You may be more likely to get fibromyalgia if a parent or sibling also has the condition.
• Other medical conditions. Your risk of fibromyalgia rises if you have osteoarthritis, rheumatoid arthritis, lupus or obesity.

The pain, fatigue, and poor sleep linked with fibromyalgia can affect your personal life and career. It also can be stressful to live with a condition that's often misunderstood by others. That can lead to mental health conditions such as depression and anxiety.

To find out if you have fibromyalgia, your healthcare professional starts by asking you about your symptoms and health history. You also get a physical exam. Your care team checks for the main sign of fibromyalgia: widespread pain throughout the body for at least three months.

You must have pain in at least four of these five areas:

• Left upper region, including the shoulder, arm or jaw.
• Right upper region, including the shoulder, arm or jaw.
• Left lower region, including the hip, buttock or leg.
• Right lower region, including the hip, buttock or leg.
• Axial region, which includes the neck, back, chest or stomach area.

Tests

You might need blood tests or imaging tests. These tests can help find out if a condition other than fibromyalgia is the cause of your symptoms.

Other conditions that can cause ongoing pain and tiredness include:

• Rheumatoid arthritis.
• Lupus.
• Myalgic encephalomyelitis/chronic fatigue syndrome.

You also may need tests to find conditions that can happen along with fibromyalgia. For example, your doctor may recommend an overnight sleep study if sleep apnea is suspected.

In general, treatments for fibromyalgia include both medicine and other techniques. The goal is to lessen your symptoms and improve your overall health. No one treatment works for all symptoms, so it can help to try a few.

Medicines

Medicines can help ease the pain of fibromyalgia and improve sleep. Common choices include:

• Pain relievers. Nonprescription pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may be helpful. Your doctor may recommend you take them along with other medicines. Opioid medicines are not recommended. They can lead to side effects, dependence and pain that gets worse over time.
• Antidepressants. These medicines may help even if you don't have depression with fibromyalgia. Duloxetine (Cymbalta) and milnacipran (Savella) may help ease fibromyalgia pain and fatigue. Your doctor may prescribe amitriptyline or the muscle relaxant cyclobenzaprine to help with pain or sleep.
• Anti-seizure medicines. Epilepsy medicines often help ease some types of pain. Pregabalin (Lyrica) is used as a fibromyalgia treatment. And gabapentin (Gralise, Neurontin) sometimes helps ease fibromyalgia symptoms.

Other therapies

Other treatments can help reduce the effect that fibromyalgia has on your body and your life. Examples include:

• Physical therapy. A physical therapist can teach you exercises to boost your strength, flexibility and stamina. Water-based exercises might be especially helpful.
• Occupational therapy. An occupational therapist can help you make changes to your work area or the way you do certain tasks. The changes cause less stress on your body.
• Counseling. Talking with a counselor can help strengthen your belief in your abilities. It also can teach you ways to deal with stressful situations. It can be especially helpful to see a counselor who is trained in cognitive behavioral therapy.

Self-care is key as you take charge of fibromyalgia.

• Manage stress. Work with your healthcare team on a plan to save your energy and manage stress. Give yourself time each day to relax. That may mean learning how to say no to others without guilt. But try not to change your whole routine. People who quit work or drop all activity tend to do worse than do those who stay active. Try stress management techniques such as deep-breathing exercises or mindfulness meditation. Think about joining a fibromyalgia support group too. It helps you meet people who understand what you're going through.
• Get quality sleep. Fatigue is one of the main symptoms of fibromyalgia, which makes sleep crucial. Adults should aim to get at least seven hours of rest a night. Keep your bedroom cool, dark and quiet at night. Try to go to bed and get up at the same times each day. And limit daytime napping.
• Exercise regularly. At first, exercise may make your pain worse. But if you start slowly and become more active over time, it often relieves symptoms. Talk with your doctor or another member of your healthcare team if you're not active already. They may recommend aerobic exercises that get your heart pumping such as walking, swimming, biking and water aerobics. A physical therapist can help you develop a home exercise program too. Stretching, good posture and relaxation exercises also are helpful.
• Pace yourself. Keep your activity on an even level. If you do too much on your good days, you may have more bad days. Likewise, don't do too little on the days when your symptoms flare.
• Practice other healthy habits. Eat nutritious foods. Do not use tobacco products. Limit caffeine. Do something that you find fun and fulfilling every day.

Complementary and alternative treatments to help manage pain and stress aren't new. Some, such as meditation and yoga, have been practiced for thousands of years. Their use has become more popular, especially with people who have chronic illnesses such as fibromyalgia.

Some of these treatments do appear to safely relieve stress and reduce pain. Talk with a member of your healthcare team before you try a new complementary or alternative treatment.

• Acupuncture. Acupuncture is a Chinese technique. A trained practitioner places very fine needles through the skin to various depths. According to Western theories of acupuncture, the needles cause changes in blood flow and levels of brain chemicals called neurotransmitters. Some studies suggest that acupuncture helps relieve fibromyalgia symptoms.
• Massage therapy. This is one of the oldest methods of healthcare still in practice. It involves the use of different techniques to move the body's muscles and soft tissues. Massage can reduce heart rate, relax muscles and improve the range of motion in joints. It also can boost the amount of natural pain-relieving chemicals the body makes. It often helps relieve stress and anxiety too.
• Yoga and tai chi. These practices combine meditation, slow movements, deep breathing and relaxation. Both have been found to be helpful in controlling fibromyalgia symptoms.

Many symptoms of fibromyalgia are similar to those of various other conditions. So you may see more than one doctor before you learn that you have fibromyalgia. Your healthcare team may refer you to a doctor who treats arthritis and other similar conditions, called a rheumatologist.

What you can do

Before your appointment, you may want to write a list that includes:

• Detailed descriptions of your symptoms.
• Information about medical problems you've had in the past.
• Information about the medical problems of your parents or siblings.
• All the medicines and dietary supplements you take.
• Questions you want to ask your healthcare professional.

What to expect from your doctor

Your healthcare professional gives you a physical exam and asks you questions. For example, you may be asked if you have problems sleeping and if you've been feeling depressed or anxious.