Fibromyalgia

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, or an injury. Mental stress may also contribute. However, the amount of stress may not be the problem. Rather it may be how people react to the stress.

Some affected people may also have a connective tissue disorder, such as rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints.... read more or systemic lupus erythematosus Systemic Lupus Erythematosus (SLE) Systemic lupus erythematosus is a chronic autoimmune inflammatory connective tissue disorder that can involve joints, kidneys, skin, mucous membranes, and blood vessel walls. Problems in the... read more (lupus). Sometimes a viral or other infection (such as Lyme disease Lyme Disease Lyme disease is a tick-transmitted infection caused by Borrelia species, primarily by Borrelia burgdorferi and sometimes by Borrelia mayonii in the United States. These... read more or perhaps COVID-19 infection COVID-19 COVID-19 is an acute respiratory illness that can be severe and is caused by the coronavirus named SARS-CoV-2. Symptoms of COVID-19 vary significantly. Two types of tests can be used to diagnose... read more ) or traumatic event can trigger fibromyalgia.

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 after overuse. Specific areas of muscle are often 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, and sometimes depressed or tense. Fatigue is common, as are mental problems such as difficulty concentrating and a general feeling of mental cloudiness. Many affected people are perfectionists, or have a type A personality. They may also have migraines Migraines A migraine headache is typically a pulsating or throbbing pain that ranges from moderate to severe. It can affect one or both sides of the head. It is often worsened by physical activity, light... read more or tension headaches Tension-Type Headaches A tension-type headache is usually mild to moderate pain that feels like a band tightening around the head. Stress, sleep disturbances, neck or jaw pain, or eye strain may trigger these headaches... read more , interstitial cystitis Interstitial Cystitis Interstitial cystitis is noninfectious bladder inflammation. Interstitial cystitis causes pain over the bladder, in the pelvis, or in the lower abdomen, and the frequent and urgent need to urinate... read more (a bladder condition that may include pain when urinating), and irritable bowel syndrome Irritable Bowel Syndrome (IBS) (with some combination of constipation, diarrhea, abdominal discomfort, and bloating). People may have pins-and-needles sensations, typically affecting both sides of the body.

The same conditions that may contribute to the development of fibromyalgia can make symptoms worse. They include emotional stress, poor sleep, injury, and fatigue. Fearing that symptoms represent a serious illness can also make symptoms worse. Having a doctor, family member, or friend imply that the disorder is “all in the head” can worsen symptoms as well. People may also feel frustrated because they are often told that they "look good" even though they are feeling unwell.

Doctors suspect fibromyalgia in people who have the following:

Doctors consider the diagnosis of fibromyalgia in people who have had widespread pain for at least 3 months, particularly when it is accompanied by various other physical symptoms such as fatigue. Pain is considered widespread when people have pain in the left and right side of the body, above and below the waist, and in the top of the spine, wall of the chest or middle of the spine, or low back.

In the past, doctors based the diagnosis in part on the presence of tenderness at some of 18 designated tender points. Now, however, the number of tender points is not considered as important as the presence of typical symptoms, especially widespread pain not limited to the joints.

There is no diagnostic test for fibromyalgia. However, doctors want to be sure that another disorder (such as hypothyroidism Hypothyroidism Hypothyroidism is underactivity of the thyroid gland that leads to inadequate production of thyroid hormones and a slowing of vital body functions. Facial expressions become dull, the voice... read more , polymyalgia rheumatica Polymyalgia Rheumatica Polymyalgia rheumatica involves inflammation of the lining of joints, causing severe pain and stiffness in the muscles of the neck, back, shoulders, and hips. The cause is unknown. The neck... read more , or another muscle disorder) is not causing the symptoms, often by doing blood tests. Blood tests can detect antinuclear antibodies (ANA), which are present in many people with connective tissue disorders, such as lupus Systemic Lupus Erythematosus (SLE) Systemic lupus erythematosus is a chronic autoimmune inflammatory connective tissue disorder that can involve joints, kidneys, skin, mucous membranes, and blood vessel walls. Problems in the... read more . However, having a positive ANA test is so common, especially in women, that a positive test alone is not sufficient to diagnose the disease.

Fibromyalgia may not be easily recognized in people who also have rheumatoid arthritis Rheumatoid Arthritis (RA) Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints.... read more or lupus Systemic Lupus Erythematosus (SLE) Systemic lupus erythematosus is a chronic autoimmune inflammatory connective tissue disorder that can involve joints, kidneys, skin, mucous membranes, and blood vessel walls. Problems in the... read more because these disorders cause some similar symptoms, such as fatigue and pain in the muscles, joints, or both. However, a doctor's examination can often distinguish fibromyalgia from these disorders.

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

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