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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.
No one knows for sure what causes fibromyalgia. But experts have some ideas, such as:
The main symptoms of fibromyalgia are:
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.
Doctors diagnose fibromyalgia based on:
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.
Treatment is focused on managing pain, fatigue, depression, and other symptoms. You may be able to control your symptoms by:
Some people with fibromyalgia also find complementary therapies helpful. These include tai chi, acupuncture, massage, behavioural therapy, and relaxation techniques.
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Fibromyalgia 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:
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.
The symptoms of fibromyalgia vary from person to person. Symptoms can last from days to months or years.
The most common symptoms are:
Other symptoms that can occur along with pain include:
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.
For 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.
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.
Certain things may make you more likely to have fibromyalgia. Things that increase your risk (risk factors) include:
Call 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.
If you have fibromyalgia, call your doctor if you have:
Ask your family doctor or general practitioner about checking chronic pain, fatigue, and other symptoms of fibromyalgia. You may be referred to specialists, such as:
Pain management programs can be helpful too. These typically include a team of doctors, counsellors, 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 counselling.
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 examination.
Doctors use a set of criteria to diagnose fibromyalgia. These include:
A person may not meet these criteria but may still have fibromyalgia. That is why diagnosis can be so difficult.
There 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:
Getting 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 physiotherapist familiar with fibromyalgia may be helpful.
For more information, see Exercise and Fibromyalgia.
Medicines 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 non-prescription 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.
Cognitive-behavioural therapy and other forms of counselling, including relaxation therapy and biofeedback, have been shown to help people who have fibromyalgia.footnote 1
Counselling 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
Taking care of yourself is a vital part of managing fibromyalgia. For example you can:
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.
Fibromyalgia 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 treatment is the most important part of treating fibromyalgia. There are many things you can do over time to treat your symptoms:
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.
Medicines 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.
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:
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.
Non-prescription pain relievers, such as acetaminophen (for example, Tylenol) or non-steroidal 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.
The 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 counsellor trained in muscle relaxation, meditation, biofeedback, or cognitive-behavioural therapy:
Complementary 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.
CitationsGlombiewski 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.
Current as of: March 28, 2019
Author: Healthwise StaffMedical Review: Anne C. Poinier, MD - Internal MedicineDonald Sproule, MDCM, CCFP - Family MedicineAdam Husney, MD - Family MedicineE. Gregory Thompson, MD - Internal MedicineMartin J. Gabica, MD - Family MedicineKathleen Romito, MD - Family MedicineKarin M. Lindholm, DO - Neurology
Current as of: March 28, 2019
Author: Healthwise Staff
Medical Review:Anne C. Poinier, MD - Internal Medicine & Donald Sproule, MDCM, CCFP - Family Medicine & Adam Husney, MD - Family Medicine & E. Gregory Thompson, MD - Internal Medicine & Martin J. Gabica, MD - Family Medicine & Kathleen Romito, MD - Family Medicine & Karin M. Lindholm, DO - Neurology
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