Fibromyalgia: Symptoms, Diagnosis and Treatment

What is fibromyalgia?

Fibromyalgia is a long-term condition in which pain is felt across many parts of the body, along with fatigue, poor sleep and difficulty thinking clearly. It affects an estimated 2 to 8% of people, more often women, and commonly starts in middle age, though it can begin at any age.

It isn’t caused by damage or inflammation in the muscles or joints. Instead, the nervous system processes pain differently and amplifies it. This is described as nociplastic pain. See central sensitisation.

Fibromyalgia symptoms

• Widespread pain, often aching, burning or stiff, that may move around
• Fatigue that rest doesn’t fix
• Unrefreshing sleep
• Problems with memory and concentration, often called “fibro fog”
• Sensitivity to touch, noise, light, temperature or smells
• Headaches, irritable bowel symptoms and jaw pain
• Low mood and anxiety, which commonly come with long-term symptoms

Symptoms often flare with stress, poor sleep, illness or overdoing it.

What causes fibromyalgia?

The exact cause isn’t fully understood. It runs in families, and often follows physical or emotional stress, an injury, an infection or another painful condition. Research shows changes in how the brain and spinal cord process pain signals. People with other conditions such as rheumatoid arthritis or lupus are also more likely to develop fibromyalgia.

How is it diagnosed?

There’s no blood test or scan for fibromyalgia. It’s diagnosed from your symptoms using set criteria, after other conditions that can cause similar symptoms are considered. Blood tests are often done to rule these out. See how fibromyalgia is diagnosed.

Fibromyalgia treatment

The European League Against Rheumatism (EULAR) reviewed the evidence in 2017. Its recommendations:

• Exercise was the only treatment to receive a strong recommendation. Both aerobic and strengthening exercise help, started gently and increased gradually.
• Psychological therapies, such as cognitive behavioural therapy, were recommended, especially for people with mood problems or unhelpful coping.
• Meditative movement such as tai chi, yoga and qigong, and mindfulness, may help with sleep, fatigue and quality of life.
• Combined programmes that bring several approaches together suit people with more severe symptoms.
• Medicines may help some people with severe pain or sleep problems, but they aren’t the main treatment, and their benefits are often modest.

Learning about the condition is also a key first step, because understanding why you hurt makes it easier to start moving.

Living well with fibromyalgia

• Build activity slowly, and pace to avoid boom-and-bust cycles
• Protect your sleep with a regular routine
• Plan for flare-ups
• Look after mood and stress
• Stay connected with work and people that matter to you

When to see a GP

See a GP if you have widespread pain, fatigue and poor sleep lasting three months or more. Joint swelling, fevers, rashes or weight loss point to other causes and should be checked.

References

1. Clauw DJ. Fibromyalgia: a clinical review. JAMA. 2014;311(15):1547-55.
2. Häuser W, Ablin J, Fitzcharles MA, et al. Fibromyalgia. Nat Rev Dis Primers. 2015;1:15022.
3. Macfarlane GJ, Kronisch C, Dean LE, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017;76(2):318-328.
4. Sarzi-Puttini P, Giorgi V, Marotto D, et al. Fibromyalgia: an update on clinical characteristics, aetiopathogenesis and treatment. Nat Rev Rheumatol. 2020;16(11):645-660.
5. Fitzcharles MA, Cohen SP, Clauw DJ, et al. Nociplastic pain: towards an understanding of prevalent pain conditions. Lancet. 2021;397(10289):2098-2110.
6. healthdirect. Fibromyalgia.
7. Better Health Channel (Victorian Government). Fibromyalgia.