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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 two things:
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, behavioral therapy, and relaxation techniques.
Learning about fibromyalgia:
Living with fibromyalgia:
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.1 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:
Health 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.
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. Your doctor will look for:
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 has been found to work well for many people.2
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.1
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 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.
Counseling can help you learn to manage your pain, learn to relax, and reduce stress. These can help decrease pain and fatigue. And it can improve your mood and help you function.2
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.
Other medicines are being studied and used for treating fibromyalgia, including:
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.
Most people with fibromyalgia try some type of alternative therapy.4 They may relieve stress, ease muscle tension, and help you feel better and healthier. Some of these therapies have been shown to be effective for many people. But for other therapies, such as tender point injections, there is no evidence that they help.
Therapies that have been shown to be effective for many people include the following:
Other treatments that have been used to treat fibromyalgia include:
You may find one or more complementary or alternative therapies to be helpful in relieving some of your symptoms. Keep in mind that there is only limited information about how well these treatments (and others you may have heard about) work for treating fibromyalgia.
If you have fibromyalgia and are thinking about trying a complementary therapy, get the facts before you begin. Consider these questions with your doctor:
With a hard-to-treat condition like fibromyalgia, it can be tempting to jump at the promise of an effective treatment. Be careful. Avoid products that claim to have a secret ingredient or that claim to cure fibromyalgia. Avoid those that encourage unhelpful behaviors such as excessive resting or avoiding activity.
Also make sure you know how much a treatment is going to cost before you agree to it. An expensive, unproven treatment that may or may not help you may not be worth the high cost. Beware of treatment providers or products that require a large financial investment at the start or a series of costly treatments.
|National Fibromyalgia Association|
|2121 South Towne Centre Place|
|Anaheim, CA 92806|
The National Fibromyalgia Association was founded to support people who have fibromyalgia and other chronic pain illnesses. This group has an educational website and publishes an international magazine called Fibromyalgia AWARE. The group also helps develop continuing medical education programs and provides a means for fibromyalgia experts to share their research and expertise with patients and health care professionals.
|American College of Rheumatology|
|2200 Lake Boulevard NE|
|Atlanta, GA 30319|
The American College of Rheumatology (ACR) and the Association of Rheumatology Health Professionals (ARHP, a division of ACR) are professional organizations of rheumatologists and associated health professionals who are dedicated to healing, preventing disability from, and curing the many types of arthritis and related disabling and sometimes fatal disorders of the joints, muscles, and bones. Members of the ACR are physicians; members of the ARHP include research scientists, nurses, physical and occupational therapists, psychologists, and social workers. Both the ACR and the ARHP provide professional education for their members.
The ACR website offers patient information fact sheets about rheumatic diseases, about medicines used to treat rheumatic diseases, and about care professionals.
|P.O. Box 7669|
|Atlanta, GA 30357|
The Arthritis Foundation provides grants to help find a cure, prevention methods, and better treatment options for arthritis. It also provides a large number of community-based services nationwide to make living with arthritis easier, including self-help courses; water- and land-based exercise classes; support groups; home study groups; instructional videotapes; public forums; free educational brochures and booklets; the national, bimonthly consumer magazine Arthritis Today; and continuing education courses and publications for health professionals.
|National Center for Complementary and Alternative Medicine (NCCAM), National Institutes of Health|
|9000 Rockville Pike|
|Bethesda, MD 20892|
The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) explores complementary and alternative healing practices in the context of rigorous science, trains complementary and alternative medicine researchers, and gives out authoritative information.
|National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health|
|1 AMS Circle|
|Bethesda, MD 20892-3675|
|Phone:||1-877-22-NIAMS (1-877-226-4267) toll-free|
The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is a governmental institute that serves the public and health professionals by providing information, locating other information sources, and participating in a national federal database of health information. NIAMS supports research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases and supports the training of scientists to carry out this research.
The NIAMS website provides health information referrals to the NIAMS Clearinghouse, which has information packages about diseases.
- Bradley LA, Alarcon GS (2005). Fibromyalgia section of Miscellaneous rheumatic diseases. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 2, pp. 1869–1910. Philadelphia: Lippincott Williams and Wilkins.
- Goldenberg DL, et al. (2004). Management of fibromyalgia syndrome. JAMA, 292(19): 2388–2395.
- Nielson WR, Jensen MP (2004). Relationship between changes in coping and treatment outcome in patients with fibromyalgia syndrome. Pain, 109(3): 233–41.
- Wahner-Roedler DL, et al. (2004). Use of complementary and alternative medical therapies by patients referred to a fibromyalgia treatment program at a tertiary care center. Mayo Clinic Proceedings, 80(1): 55–60.
- Wang C, et al. (2010). A randomized trial of tai chi for fibromyalgia. New England Journal of Medicine, 363(8): 743–754.
Other Works Consulted
- Afshar B (2002). Clearing the fog section of Relieving symptoms. In Good Living with Fibromyalgia, pp. 18–19. Atlanta: Arthritis Foundation.
- Arnold LM, et al. (2007). Gabapentin in the treatment of fibromyalgia. Arthritis and Rheumatism, 56(4): 1336–1344.
- Arnold LM, et al. (2008). Patient perspectives on the impact of fibromyalgia. Patient Education and Counseling, 73(1): 114–120.
- Busch A, et al. (2007). Exercise for treating fibromyalgia syndrome. Cochrane Database of Systematic Reviews (4).
- Carville SF, et al. (2007). EULAR evidence based recommendations for the management of fibromyalgia syndrome. Annals of the Rheumatic Diseases, 67(4): 536–541.
- Crofford LJ, Appleton BE (2001). Complementary and alternative therapies for fibromyalgia. Current Rheumatology Reports, 3(2): 147–156.
- Crofford LJ, et al. (2005). Pregabalin for the treatment of fibromyalgia syndrome. Arthritis and Rheumatism, 52(4): 1264–1273.
- Häuser W, et al. (2009). Treatment of fibromyalgia syndrome with antidepressants. JAMA, 301(2): 198–209.
- Meisler JG (2000). Toward optimal health: The experts discuss fibromyalgia. Journal of Women's Health and Gender-Based Medicine, 9(10): 1055–1060.
- Richards SCM, Scott DL (2002). Prescribed exercise in people with fibromyalgia: Parallel group randomised controlled trial. BMJ, 325(7357): 185.
- Taylor AG, et al. (2003). Fibromyalgia section of Pain. In JW Spencer, JJ Jacobs, eds., Complementary and Alternative Medicine: An Evidence-Based Approach, pp. 384–395 . St. Louis: Mosby.
- 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, Rasker JJ (2009). Fibromyalgia. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology, 8th ed., vol. 1, pp. 555–569. Philadelphia: Saunders Elsevier.
|Primary Medical Reviewer||Anne C. Poinier, MD - Internal Medicine|
|Specialist Medical Reviewer||Karin M. Lindholm, DO - Neurology|
|Last Revised||June 11, 2012|
Last Revised: June 11, 2012
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