| Fibromyalgia
		
			| Topic OverviewWhat is fibromyalgia?Fibromyalgia is widespread
			 pain in the muscles and soft tissues above and below the waist and on both
			 sides of the body.  People with fibromyalgia feel pain, tenderness, or both even when there
			 is no injury or inflammation. Fibromyalgia can cause long-lasting (chronic) pain. It has no cure. But with treatment, most people
			 with fibromyalgia are able to work and do their regular activities. When it is not controlled, you may not have any energy. Or you may feel
			 depressed or have trouble sleeping.  But there are many things you can do to help manage your symptoms. What causes fibromyalgia?No one knows for sure what causes fibromyalgia. But experts have some ideas, such as:    Nerve cells may be too sensitive.Chemicals in the brain
			 (neurotransmitters) may be out of balance.The  deep phase of sleep may be disrupted and affect the amount of hormones that your body releases. 
 What are the symptoms?The main symptoms of
			 fibromyalgia are:   Deep or burning pain in your trunk, neck, low back, hips, and shoulders. Tender points (or trigger points)  on the body that hurt when pressed. 
 People with fibromyalgia may have other problems, such as: Symptoms
			 tend to come and go. You may have times when you hurt more, followed by times when symptoms happen less often, hurt less, or are absent (remissions).
Some people find that their symptoms are worse in cold and damp weather, during times of stress, or when they try to do too much.
 How is fibromyalgia diagnosed?Doctors diagnose fibromyalgia based on:  How much of your body is affected by pain. If you have pain above and below your waist and on both the left and right sides of your body, it is considered widespread. The more widespread your pain, the more likely it is that you have fibromyalgia.How bad your pain and other symptoms are. People who have fibromyalgia usually have pain. They usually also have fatigue, trouble sleeping, and trouble thinking. The more severe these symptoms are, the more likely it is that you have fibromyalgia.
 Fibromyalgia is sometimes diagnosed or described using pain and tenderness at 18 specific spots on the body,
or tender points. You may also hear these called trigger points. Before the diagnosis, your 
			 doctor will make sure that you don't have other conditions that
			 cause pain. These include
			 rheumatoid arthritis,
			 polymyalgia rheumatica,
			 lupus, and other
			 autoimmune diseases. How is it treated? Treatment is focused on
		  managing pain, fatigue, depression, and other symptoms. You may be able to control your
			 symptoms by: Getting regular exercise. This is one of the best ways to manage the pain.Taking medicine, if your symptoms bother you.Going to counseling.  This can  help you cope with long-term (chronic) pain. Taking care of yourself. Good self-care includes finding better ways to handle stress, having   good sleep habits, and talking to your doctor if you have symptoms of depression.
 Some
			 people with fibromyalgia also find
			 complementary therapies helpful. These include
			 tai chi, acupuncture, massage, behavioral therapy, and relaxation techniques. Frequently Asked Questions| Learning about fibromyalgia: |  |  | Being diagnosed: |  |  | Getting treatment: |  |  | Living with fibromyalgia: |  | 
CauseFibromyalgia is a syndrome-a set of symptoms that occur together. Experts have ideas about what may cause it, but there is
		  not enough evidence to support any one idea.  Some ideas include: Nerve cells may be too sensitive.Chemicals in the brain
			 (neurotransmitters) may be out of balance.The  deep phase of sleep may be disrupted and affect the amount of hormones that your body releases. 
 Many people connect the beginning of their symptoms to a certain event, such as the
		  flu, an injury or surgery, or emotional trauma and stress. An event of this type combined with other things, such as
		  increased sensitivity to pain and   sleep problems, may lead to
		  fibromyalgia in some people.SymptomsThe symptoms of
		  fibromyalgia vary from person to person. Symptoms can last from days to months or years.  The most common symptoms are:  Widespread deep or burning pain above and below your waist and on
		  the right and left sides of your body. Pain is more common in the
		  trunk, neck, low back, hips, and shoulders. It usually gets worse gradually and can interfere
		  with even simple daily activities.Tender points (or trigger points)  on the body that hurt when pressed. 
 Other symptoms that can occur
		  along with pain include: Fatigue that interferes with work and daily
			 activities.Sleep problems, such as trouble falling asleep or staying asleep, or
			 waking up feeling tired.Morning stiffness lasting less than an
			 hour.Headaches.Constipation or diarrhea related to
			 irritable bowel syndrome.Memory problems
			 and trouble concentrating.Anxiety or depression.
  People
		  with fibromyalgia have times when their symptoms get worse and other times
		  when they have milder or no symptoms. Flare-ups of fatigue and muscle and joint
		  aches are common, especially following physical or emotional stress. Many
		  people with fibromyalgia say that cold or damp weather, poor sleep, fatigue,
		  stress, or being too active makes their pain worse. What HappensFor most people,
		  fibromyalgia seems to involve a cycle of muscle pain,
		  increased sensitivity to pain, and inactivity that may be made worse by sleep
		  problems and fatigue.  Increasing pain causes a person to be less
			 physically active.Muscles that aren't exercised regularly are
			 more likely to be irritated during activity. And it may be that people
			 with fibromyalgia are more sensitive to pain or have muscles that are more
			 easily irritated.The irritated muscles are painful. Some doctors
			 think that the muscles of people with fibromyalgia stay sore because they don't repair themselves as well as they should.Muscle pain, sometimes occurring with disrupted
			 sleep and daytime fatigue, leads to less and less activity.
 Although fibromyalgia is a long-lasting (chronic) condition
		  with no cure, it can be controlled. It doesn't damage the muscles, joints, or
		  internal organs. Most people adjust to their symptoms and are able to keep working and
		  doing their daily activities. For more information about managing fibromyalgia, see the Treatment Overview.What Increases Your RiskCertain things may make you more likely to have
		  fibromyalgia. Things that increase your risk (risk factors) include:  Being female.  Having certain health problems, such as rheumatoid arthritis, lupus, Lyme disease,
		  mononucleosis, or depression. Having been through a traumatic event (such as a car
		  accident).Having a family history of fibromyalgia.
When To Call a DoctorIf not diagnosedCall your doctor if you have
		  had the following symptoms for more than 6 weeks without an obvious cause. They
		  may be signs of
		  fibromyalgia, especially if they have developed
		  gradually. Widespread muscle tenderness and pain,
			 particularly on both sides of the body and both above and below the
			 waistDisturbed sleep (tossing, turning, waking up frequently
			 during the night) and waking up feeling tired and unrestedMuscle
			 and joint stiffness that doesn't get better when you move around
 If diagnosedIf you have fibromyalgia, call your doctor if you have:   Symptoms of
		  depression, such as a loss of interest in things you
		  usually enjoy or changes in eating and sleeping habits. These can often be
		  treated if you tell your doctor about them. New symptoms  or  existing
			 symptoms get worse. Your doctor may need
			 to reassess your treatment, such as adjust your medicines or
			 prescribe different ones.  
 Who to seeHealth professionals who may be able to help you
			 with fibromyalgia include: You may need to see a specialist who has experience with fibromyalgia. These include: Pain management programs can be helpful too. These
			 typically include a team of doctors, counselors, physical therapists, nurses, and pharmacists who
			 can help you develop a strategy for pain management. Your personal program may
			 include medicines, complementary therapies, diet, exercise, and counseling.
			  To prepare for your appointment, see the topic Making the Most of Your Appointment.Exams and Tests There are no specific tests that can
		  confirm a diagnosis of
		  fibromyalgia. You will likely have
		  lab tests to make sure that you don't have another condition causing your symptoms. Your doctor will  also ask questions about your
		  medical history and do a
		  physical exam.    Doctors use a set of criteria 
		  to diagnose fibromyalgia. These include: Widespread pain. Pain is considered to be widespread if it is above and below your waist and on the right
and left sides of your body.Other symptoms such as fatigue, trouble sleeping or feeling unrefreshed in the
morning, and trouble thinking. If these symptoms are severe, widespread pain may not be as important in the
diagnosis.Symptoms that have lasted for at least 3 months.No other medical explanation for why you
feel this way (for example, another health condition or disease).
 Fibromyalgia is sometimes diagnosed or described using pain and tenderness at 18 specific spots on the body,
or tender points. You may also hear these called trigger points. A person may not meet these criteria but may still
		  have fibromyalgia. That is why diagnosis can be so difficult. Treatment OverviewThere are many steps you can take to
		  manage your symptoms. Treatment is focused on
		  managing pain, fatigue, depression, and other symptoms common in fibromyalgia. The goal is to  break the cycle of increased sensitivity to pain and decreased
		  physical activity.   The  treatment you need or want may be based on: How bad your symptoms are.Whether the condition is disrupting your daily
				life.What kinds of changes in your life you are willing and able
				to make.
 ExerciseGetting consistent exercise, especially
				cardiovascular exercise, is one of the best ways to manage fibromyalgia. Pool
				exercise is a good example. It's important to build up your exercise program slowly so
				you don't get sore muscles that cause you to want to stop exercising. Working
				with a physical therapist familiar with fibromyalgia may be helpful. For more information, see Exercise and Fibromyalgia. MedicinesMedicines are part of the long-term treatment of fibromyalgia. Medicines can help you sleep better, relax
			 your muscles, or relieve muscle and joint pain.  Your doctor may suggest
			 prescription medicines, such as antidepressants, muscle relaxants, and anticonvulsants. Or he or she may suggest nonprescription pain relievers. Not all people with fibromyalgia will need, want, or benefit from
		  medicines.   You might need to try one medicine before finding
		  one that works best for you. You may also find that a medicine that has been
		  helping your symptoms seems to not work as well over time.
		    CounselingCognitive-behavioral therapy and other
				forms of counseling, including relaxation therapy and biofeedback, have been
			 shown to help people who have fibromyalgia.footnote 1 Counseling has been shown to help with the pain of fibromyalgia. It can also help with sleep problems and fatigue. And it can help improve your mood.footnote 1 Chronic Pain: Using Healthy Thinking
 Taking care of yourself over time Taking care of yourself  is a vital part of managing
		  fibromyalgia. For example you can:  Identify  sleep problems, if you have them. Then learn  about
				ways to get more restful sleep.Relieve
				pain and stiffness with medicines and heat.Identify  "triggers"
				that seem to make your symptoms worse. Then you can learn to avoid or manage them. Triggers
				may be a change in the weather, certain activities, stress, or a lack of
				sleep.Talk to your doctor if you have signs of
			 depression or
			 anxiety. 
 With help, you will be able to
			 start working on most of these goals at home.  You may have a team of health
			 professionals to help you. To learn more, see Home Treatment.  Because the symptoms of fibromyalgia can come and go, you
			 may find it hard to judge whether a particular treatment is really
			 working. Different people may respond differently to each type of treatment.  Many people with fibromyalgia have other joint or muscle diseases (such as rheumatoid arthritis or lupus) that need to be treated too.  Finding a treatment
			 can take time. You may have to try several different treatments to find an
			 approach that works for you.PreventionFibromyalgia can't be prevented or cured. But
		  treating symptoms may help reduce how long a flare-up lasts. For more information, see the Treatment Overview.Home TreatmentHome treatment is the most
		  important part of treating fibromyalgia. There are many things you can
		  do over time to treat your symptoms: Exercise regularly. Of all the
			 treatments for fibromyalgia, cardiovascular (aerobic) exercise may have the
			 most benefit in reducing pain and other symptoms and in improving your overall
			 condition. Work with a physical therapist or other professional who has
			 expertise with fibromyalgia to build an exercise program that works for you. And then stay with it.Try to avoid or limit your
			 exposure to "triggers" or "stressors" that make your symptoms worse. Common triggers include cold or
			 damp weather, poor sleep, fatigue, physical or emotional stress, and
			 being too active.  Improve sleep. Sleep disturbances seem
			 to both cause and result from some of the other symptoms of fibromyalgia, such
			 as pain. Learn good sleep habits. And try to get enough sleep each
			 night.Relieve pain. Heat therapy, massage, gentle exercise,
			 and short-term use of nonprescription pain relievers may be
			 helpful.Reduce stress. Finding healthy ways to cope with stress may help reduce your pain.
Learn about fibromyalgia. The more you know about fibromyalgia, the more control you
			 will have over your symptoms. People who feel more in control also tend to be
			 more active and report less pain and other symptoms.Learn ways to manage your
			 memory problems. Feeling as though you are not
			 thinking clearly-sometimes called "fibro fog"-increases stress and can make
			 memory problems worse. Simple things like writing yourself notes can help you
			 feel more in control.Have a
			 good-health attitude, along with these other healthy
			 habits. It's hard to stay positive when you don't feel well. But a good
			 attitude helps you focus less on your challenges and feel more healthy.
 The best results occur when you take an active, committed
		  role in your own treatment. You may need to adjust your lifestyle to fit home
		  treatment, especially regular exercise, into your daily routine. It may take time
		  to find an approach that works for you. Try to be patient. And keep in mind
		  that consistent home treatment usually can help relieve or control symptoms of
		  fibromyalgia.MedicationsMedicines are part of the long-term treatment of fibromyalgia. They may help break the
			 cycle of pain and sleep problems when symptoms flare up. Not all people with fibromyalgia will need, want, or benefit from
		  medicines. People with more severe pain, sleep problems, or
		  depression that disturbs their daily life may find
		  medicines helpful. Fibromyalgia symptoms in different people respond to
		  different medicines. Your doctor may try more than one medicine before finding
		  one that works best for you. You may also find that a medicine that has been
		  helping your symptoms seems to become less effective over time.
		  Talk with your doctor if you are not getting relief. He or
		  she may try a different medicine or make suggestions for helping find new ways to modify your activity, sleep, and stress. Medicine choices Certain types of medicines may be used to
			 improve sleep, relieve pain and fatigue, and, in some cases, treat depression. These
			 improvements in symptoms may allow you to feel better and to be more active. Medicines used
			 for fibromyalgia include: Cyclobenzaprine (Amrix).Antidepressants,  such
				as fluoxetine (Prozac), milnacipran (Savella), bupropion
				(Wellbutrin), and amitriptyline.Anticonvulsants (seizure medicines), such as pregabalin (Lyrica).
 Often medicines may be combined (such as fluoxetine and
			 amitriptyline) for the most effective treatment of symptoms of pain and sleep
			 disruptions. Prescription pain medicines, such as tramadol (Ultram), are sometimes used. And they are sometimes combined
				with acetaminophen. Nonprescription pain relievers, such as acetaminophen
			 (for example, Tylenol) or
			 nonsteroidal anti-inflammatory drugs (NSAIDS, such as
			 ibuprofen or aspirin) usually aren't very helpful in treating day-to-day
			 symptoms of fibromyalgia. But they may be useful in reducing severe pain caused
			 by a flare-up of symptoms. Check with your doctor if you need to
			 keep taking these medicines, because they may harm your stomach, kidneys,
			 or in rare cases, your liver. Your doctor may want to monitor you if you take
			 acetaminophen or NSAIDs daily.Other TreatmentCounselingThe pain and other symptoms of fibromyalgia can get worse during stressful times. The good news is that there are a lot of things you can do to lower your stress. For example, research shows that you can change how you think. And how you think affects how you feel.  Here are some techniques you can try on your own or with help from a therapist or counselor trained in muscle relaxation, meditation, biofeedback, or cognitive-behavioral therapy: Complementary therapyComplementary  treatments that have been used to treat
			 fibromyalgia include:   Talk with your doctor about the
				safety and potential side effects of the treatment. Remember that fibromyalgia
				doesn't physically harm you or damage your body. A treatment that could be
				harmful may not be worth the risk, especially when its benefits are unproven.
				Avoid treatments that may be harmful, such as unusual diets or excessive
				vitamin or mineral supplements. (A daily multiple vitamin-mineral supplement is
				okay. Try to avoid taking more than 100% of the recommended daily allowance for
				any vitamin or mineral unless your doctor prescribes a special
				supplement.) Most mind and body practices-such as acupuncture, meditation, and yoga-are  safe when used under the care of a well-trained professional. Choose an instructor or practitioner as carefully as you would choose a doctor.Other Places To Get HelpOrganizationNational Institute of Arthritis and Musculoskeletal and Skin Diseases (U.S.) www.niams.nih.govReferencesCitationsGlombiewski JA, et al. (2010). Psychological treatments for fibromyalgia. Pain, 151(2): 280-295.
 Other Works ConsultedArnold LM, et al. (2008). Patient perspectives on the impact of fibromyalgia. Patient Education and Counseling, 73(1): 114-120.Häuser W, et al. (2009). Treatment of fibromyalgia syndrome with antidepressants. JAMA, 301(2): 198-209.U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/guidelines/default.aspx.Wolfe F, et al. (2010). The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care and Research, 62(5): 600-610.Wolfe F, et al. (2013) Fibromyalgia. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 9th ed., Vol. 1, pp 733-751. Philadelphia: Saunders.
CreditsByHealthwise StaffPrimary Medical ReviewerAnne C. Poinier, MD - Internal Medicine
 Kathleen Romito, MD - Family Medicine
 Adam Husney, MD - Family Medicine
 E. Gregory Thompson, MD - Internal Medicine
 Martin J. Gabica, MD - Family Medicine
 Specialist Medical ReviewerMartin J. Gabica, MD - Family Medicine
Current as ofOctober 14, 2016Current as of:
                October 14, 2016Glombiewski JA, et al. (2010). Psychological treatments for fibromyalgia. Pain, 151(2): 280-295. Last modified on: 8 September 2017  |  |