Fibromyalgia is a chronic, nonfatal pain disorder1 that most often causes pain in muscles, ligaments, and tendons. Affecting 2% to 4% percent of the U.S. popu­lation,2 fibromyalgia is often accompanied by fatigue, sleep issues, and fibro fog, a term that encompasses difficulties with focus, memory, judgment, and performance of straightforward mental tasks.1 Memory and thinking symp­toms may fluctuate but are more common with increased stress and fatigue levels.1

Researchers hypothesize that people with fibromyalgia have stronger reactions than others to pressure, heat, sound, and light because their central nervous systems experience pain signals more acutely,1 result­ing in amplified pain.

The ​Pain ​Event

The cause of fibromyalgia is unknown, but researchers speculate that certain events may contribute to the disorder3:

  • Stressful or traumatic events
  • Repetitive injuries
  • Illness
  • Certain diseases

Researchers are also exploring poten­tial connections to sleep issues; stress; and immune, endocrine, and biochemical prob­lems.2 Those with autoimmune diseases are predisposed to developing fibromyalgia,1 which also seems to run in families.3

Symptoms usually become evident in adults between the ages of 30 and 55, although they can appear in children, par­ticularly adolescent girls.1 Women are more likely than men to develop fibromyalgia.3

The ​Phantom ​Menace

“There’s no single laboratory test or diagnos­tic test that will confirm that [fibromyalgia is] what people have,” says Charles Kodner, MD, a physician in Louisville, Kentucky, and author of a review on fibromyalgia published in American Family Physician. “One of the biggest frustrations that people might have … is that there’s never any way to be abso­lutely sure that someone has fibromyalgia. It’s a constellation of symptoms.”

In the past, the tender point examina­tion was typically used to diagnose fibromy­algia. For this test, physicians would press firmly on 18 particular points1 on a person’s body to see which were painful.4

More recently, the American College of Rheumatology updated its diagnostic criteria for fibromyalgia to include widespread pain for a minimum of three months in at least four of five areas of the body4:

  • Left upper region
  • Right upper region
  • Left lower region
  • Right lower region
  • Axial region

The upper regions include the shoulders, arms, and jaw, while the lower regions include the hips, buttocks, and legs. The axial region entails the neck, back, chest, and abdomen.4

Additionally, the widespread pain index (WPI) lists 19 areas of the body where those with fibromyalgia are likely to experience pain or tenderness.1 The symptom severity (SS) score uses a scale of zero to 3 to rate symptoms1:

  • Fatigue
  • Sleep patterns
  • Problems with memory, thinking, focusing, and problem-solving
  • Physical symptoms (e.g., headache, numbness, and bowel issues)

“I separate tolerance and perception when I talk to people,” says Brett Smith, DO, a rheumatologist at Blount Memorial Hospital in Alcoa, Tennessee. “Tolerance is your psychological [ability to cope] with any degree of pain, whether you smash your hand with a hammer or you stub your toe. … [Increased] pain perception means that you do feel more pain than somebody [else with] a lower stimuli level.”

Much of a fibromyalgia diagnosis involves ruling out other conditions first, many of which are metabolic and autoim­mune issues, according to Dr. Smith.

For example, X-rays or blood tests (e.g., complete blood count or thyroid function tests) can help rule out other conditions with similar symptoms.1,4

Growing ​Pains

Whether a causal relationship exists between fibromyalgia and certain comorbidities is unclear, but several documented concurrent issues are possible1:

  • Restless legs syndrome, which may be related to sleep difficulties.
  • Depression or chronic anxiety, which can worsen pain and fatigue associated with fibromyalgia. Patients with fibro­myalgia are 20% more likely to have depression or chronic anxiety.
  • Migraines and headaches, including tension headaches and pain in the face and jaw.
  • Pelvic pain, particularly endometriosis (a condition in which endometrial tis­sue grows outside of the uterus, poten­tially causing painful and irregular menstrual cycles).
  • Somatization syndrome, which involves extreme anxiety about a physical symptom and may lead to emotional distress and difficulties functioning.
  • Overactive bladder, a condition that causes frequent urination.
  • Irritable bowel syndrome, a greater risk for people with fibromyalgia that may cause bloating, stomach pain, and cramping.

Painstaking ​Care

No cure is currently available for fibromy­algia.1 Still, patients can find relief through treatment. Managing the pain and accompa­nying symptoms typically involves a mix of medications and self-care.4 Understanding triggers and learning to manage them can be a helpful first step.1

Dr. Smith treats both adult and pediatric patients with fibromyalgia. One morning a week, he teams up with a pediatric psy­chologist who specializes in pain to address both physical and mental aspects of pain management. They hope to add a physi­cal therapist to their team so that they can offer desensitization treatment—which Dr. Smith finds particularly effective in treating fibromyalgia—to their therapeutic arsenal.

Useful medications include over-the-counter pain relievers, such as acetamin­ophen (Tylenol), ibuprofen (Advil), or naproxen sodium (Aleve).4 Three medica­tions approved specifically to ease fibromy­algia symptoms include pregabalin (Lyrica), which targets the brain chemicals regulating the degree of pain one feels, and duloxetine (Cymbalta) and milnacipran (Savella), which control the quantities of pain-controlling chemicals in the brain.1 Overall, certain antidepressants, anti-seizure medicines,4 anti-inflammatories, and sleep medicines can help with the pain, sleep, and mood disorders associated with fibromyalgia.1

Additionally, therapy can be an effec­tive tool for managing symptoms. Physical therapy can help improve strength, flexibility, and stamina, while occupational therapy helps to reduce stress to the body. Counseling can help patients deal with the stress and other effects of fibromyalgia.4

Stress-management is also key, as is eating well, maintaining good sleep habits, and exercising regularly.4

“One of the most beneficial things that [fibromyalgia patients] can do is get some form of regular exercise,” says Dr. Kodner. Still, patients’ fatigue and pain may make them resistant to following through. “I try to get them to recognize that even though it hurts [to move more], there’s nothing that’s broken in their body.” Patients should add exercises to their lifestyles gradually—and pace themselves—to decrease fibromyalgia symptoms.4

“Fibromyalgia is a real biological ill­ness,” affirms Dr. Kodner. “We can’t measure it, [and] we can’t point to an imaging study, but it clearly is a biological abnormality. I think reassuring patients that they really do have an illness … is very important.”