Fibromyalgia is characterized by poor sleep, fatigue, and widespread aching and stiffness in soft tissues, including muscles, tendons, and ligaments.

• Poor sleep, stress, strains, injury, and possibly certain personality characteristics may increase the risk of fibromyalgia.
• Pain is widespread, and certain parts of the body are tender to touch.
• Fibromyalgia is diagnosed when people feel pain in specific areas of the body and have typical symptoms.
• Improving sleep, exercising, applying heat, and getting massages usually help.

This disorder used to be called fibrositis or fibromyositis syndrome. But because inflammation (indicated by the “itis” suffix) is not present, the suffix was dropped, and the name became fibromyalgia.

Fibromyalgia is about 7 times more common among women. It usually occurs in young or middle-aged women but can also occur in men, children, and adolescents.

Fibromyalgia is not dangerous or life threatening. Nonetheless, persistent symptoms can be very disruptive.

Causes

People with fibromyalgia seem to have a heightened sensitivity to pain. That is, areas in their brain that process pain interpret painful sensations as being more intense than seems to occur in people who do not have fibromyalgia. Usually, the cause of fibromyalgia is unknown. However, certain conditions may contribute to developing the disorder. They include poor sleep, repetitive strains, an injury, and repeated exposure to dampness and cold. Mental stress may also contribute. However, stress per se may not be the problem. Rather it may be how people react to the stress. Many affected people are perfectionists or have a type A personality.

Some affected people may also have a connective tissue disorder, such as rheumatoid arthritis or systemic lupus erythematosus (lupus). Sometimes a viral or other infection (such as Lyme disease) or traumatic event can trigger fibromyalgia.

Symptoms

Most people feel a general achiness, stiffness, and pain. Symptoms can occur throughout the body. Any soft tissue (muscles, tendons, and ligaments) may be affected. But soft tissue of the neck, upper shoulders, chest, rib cage, lower back, thighs, arms, and areas around certain joints are especially likely to be painful. Less often, the lower legs, hands, and feet are painful and stiff. Symptoms may occur periodically (in flare-ups) or most of the time (chronically).

Pain may be intense. It usually worsens with fatigue, straining, or overuse. Specific areas of muscle may be tender when firm fingertip pressure is applied. These areas are called tender points. During flare-ups, muscles become tight, or spasms may occur.

Many affected people do not sleep well and feel anxious, depressed, and tired. They may also have migraine or tension headaches, interstitial cystitis (a type of bladder inflammation that causes pain when urinating), and irritable bowel syndrome (with some combination of constipation, diarrhea, abdominal discomfort, and bloating—see Irritable Bowel Syndrome (IBS)).

The same conditions that may contribute to the development of fibromyalgia can make symptoms worse. They include emotional stress, poor sleep, injury, exposure to damp or cold, and fatigue. Fearing that symptoms represent a serious illness can also make symptoms worse.

Fibromyalgia tends to be chronic but may resolve on its own if stress decreases. Even with appropriate treatment, most people continue to have symptoms to some degree.

Diagnosis

The diagnosis is based on the pattern and location of the pain. Some parts of the body have tender points. To detect tender points, doctors firmly press specific areas of the body to determine whether the person feels pain in one spot (a tender point). In the past, doctors based the diagnosis on the presence of tenderness at 11 or more of the 18 designated tender points. Now, however, the number of tender points is not considered as important as the presence of a few tender points along with typical symptoms, especially widespread pain.

Doctors want to be sure that another disorder (such as hypothyroidism, polymyalgia rheumatica, or another muscle disorder) is not causing the symptoms, often by doing blood tests. But no test can confirm the diagnosis of fibromyalgia.

Fibromyalgia may not be recognized in people who also have rheumatoid arthritis or lupus because these disorders cause some similar symptoms, such as fatigue and pain in the muscles, joints, or both.

Fibromyalgia: Finding the Tender Points Tender points are areas of tenderness that develop in people with fibromyalgia.

Treatment

People can feel better when treated appropriately. Usually, the most helpful approach includes the following:

• Reducing stress, including recognizing that there is no underlying life-threatening disease causing the pain
• Stretching the affected muscles gently (holding the stretch about 30 seconds and repeating it 5 times)
• Doing exercises to improve physical conditioning (aerobic exercises) and gradually increasing the intensity (for example, by using a treadmill, exercise bicycle, or elliptical machine or by swimming)
• Applying heat to or gently massaging the affected area
• Keeping warm
• Getting enough sleep

Improving sleep is essential. For example, people should avoid caffeine and other stimulants in the evening and sleep in a quiet, dark room with comfortable bedding. They should not eat or watch TV in bed. Doctors may prescribe low doses of tricyclic antidepressants. These drugs are taken 1 or 2 hours before bedtime and used only to improve sleep rather than to relieve depression. They include trazodone, amitriptyline, and nortriptylineSome Trade Names
AVENTYL
. CyclobenzaprineSome Trade Names
FLEXERIL
, a muscle relaxant, can also help people sleep. Like tricyclic antidepressants, cyclobenzaprineSome Trade Names
FLEXERIL
is taken only at bedtime. These drugs are usually safer than sedatives, most of which can be habit-forming. However, tricyclic antidepressants and cyclobenzaprineSome Trade Names
FLEXERIL
can have side effects, such as drowsiness and dry mouth, particularly in older people. Taking these drugs at other times can cause daytime drowsiness.

AspirinSome Trade Names
BAYER
or other nonsteroidal anti-inflammatory drugs (NSAIDs) are generally of limited benefit. Pain relievers, such as tramadolSome Trade Names
RYZOLT ULTRAM
or acetaminophenSome Trade Names
TYLENOL
, can help. Opioids, which can be habit-forming and become less effective over time, are best avoided when treating chronic disorders such as fibromyalgia. PregabalinSome Trade Names
LYRICA
(an anticonvulsant sometimes used to relieve pain), duloxetineSome Trade Names
CYMBALTA
, and milnacipran are sometimes used to treat fibromyalgia. These drugs may help when used as part of a treatment program that includes improving sleep, exercising, and managing stress. Occasionally, anesthetics (such as lidocaineSome Trade Names
XYLOCAINE
) are injected directly into a particularly tender area, but these injections should not be used repetitively.

Last full review/revision February 2013 by Joseph J. Biundo, MD