Fibromyalgia: Symptoms, Cause, & Treatment

By Edo Paz, MD
Medically reviewed checkmarkMedically reviewed
August 15, 2019

Fibromyalgia may be the reason why you’re feeling very tired, moody, and achy, but find it hard to sleep and have trouble remembering things. You may be in pain because your brain is not processing pain signals normally. Although there is no cure for fibromyalgia, it is very common, especially in women, and there are various medications that can effectively help you manage your symptoms. Read on to learn about the symptoms and causes of Fibromyalgia, how you can find relief, and when to see a doctor.

What Is Fibromyalgia?

Fibromyalgia is a long-term or chronic condition that can cause you to feel pain and tenderness in different parts of your body. Rest assured that fibromyalgia doesn’t cause any lasting damage to your body, and treatments do exist to help you feel better.

Fibromyalgia affects nearly 1 in every 25 people and can occur at any time in someone’s life, although it commonly develops between the ages of 30 and 50. Women are about 7 times more likely to be affected by fibromyalgia than men.

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Fibromyalgia Symptoms

People with fibromyalgia usually look fine. This can sometimes feel frustrating, since others may not be able to see how much the condition affects their quality of life. Unfortunately, fibromyalgia symptoms in women are often dismissed as being ‘all in your head.’ Despite this myth, fibromyalgia is a real condition caused by problems in the way a person’s nerves transmit pain signals.

Main symptoms

The main symptoms of fibromyalgia are:

If you suffer from fibromyalgia, you are likely to find that the fatigue is stifling and can cause you to have trouble thinking clearly and remembering things.This difficulty in concentrating is sometimes referred to as ‘brain fog’ or ‘fibro fog.’

Fibromyalgia can affect different people in different ways with symptoms that vary from day to day. It is quite common to have symptoms flare or become worse at certain times (such as during periods of stress or after an illness) or in particular weather conditions. Some people with fibromyalgia feel pain throughout their whole bodies, while others feel it only in some areas.

Additional Symptoms

Less common symptoms of fibromyalgia include:

  • Headaches
  • Irritability or feeling miserable
  • Feeling an urgent need to urinate, especially at night
  • Irritable or uncomfortable bowels, (diarrhea, constipation and abdominal pain) sometimes separately diagnosed as irritable bowel syndrome (IBS)

Causes of Fibromyalgia

Why fibromyalgia occurs is still a mystery despite a wealth of medical research into the causes of this painful condition. Studies suggest that fibromyalgia results from a myriad of abnormalities, which together cause the unpleasant symptoms. These include physical, neurological, and psychological factors.

One primary mechanism is a disorder of pain processing, in which a painful stimulus is interpreted by the brain as being more severe than it actually is. For example, physical pain from fibromyalgia can feel more severe than the same stimulus would for a person without the condition. This leads the person with fibromyalgia to feel low, worried or stressed. In turn, if you’re feeling depressed or anxious, your pain can feel worse. In other words, with this condition, the physical symptoms can lead to neurological and psychological symptoms and vice versa.

There is also evidence that people with fibromyalgia have different levels of neurotransmitters, the chemicals that transmit signals within the brain. Normally, someone will feel pain if they’ve suffered from a physical injury or if there is some damage to their body. In people with fibromyalgia, however, there may be no physical injury or damage. Rather, their pain results from a problem in the way the nerves in the brain process pain that’s happening within the body. These nerve pathways may become so sensitive that even a minor knock can cause someone with fibromyalgia to feel severe pain. Since there is no physical damage to treat, there is no easy way to stop the pain—and this pain can be long-lasting.

Another symptom of fibromyalgia is disturbed sleep, which can lead to severe fatigue. Studies have shown that people with fibromyalgia often lose deep sleep. What’s more, there is evidence that healthy people who are intentionally woken during each period of deep sleep can develop fibromyalgia.

While symptoms of fibromyalgia can start without any particular trigger event, there are many cases where people develop fibromyalgia after:

  • An illness such as arthritis or infection
  • An injury
  • A period of emotional stress or anxiety (from work or personal relationships)
  • Being depressed by illness or unhappy events

How Is Fibromyalgia Diagnosed?

As we have mentioned, the symptoms of fibromyalgia can vary among patients, and can worsen at different times. The symptoms are similar to those of other conditions, such as an underactive thyroid gland (hypothyroidism) or autoimmune conditions such as rheumatoid arthritis. For these reasons, fibromyalgia is often difficult to diagnose.

Your doctor may ask you to have some blood tests. These tests cannot say definitively if you have fibromyalgia because there are no such specific tests for this condition, but they can help your doctor rule out other conditions with similar symptoms.

Tender Points

Fibromyalgia may cause you to feel pain all over your body. In order to pinpoint this pain more specifically, your doctor may see how tender you are in 18 different parts of your body—from the back of your head to your inner knees. These are referred to as ‘tender points’ and are each the size of a penny. While you may have other pain points, these are the ones most common to people with fibromyalgia.

In diagnosing fibromyalgia, your doctor may press on these points with a finger or use a device called a dolorimeter, which can measure the exact amount of pressure applied. You will be asked if you feel pain and whether the pressure on these points triggers pain that spreads to other body parts of your body. Fibromyalgia is diagnosed if you experience pain in at least 11 of the 18 tender points, and have suffered widespread pain in all your body for at least three months.

New Diagnostic Evaluation

Since most patients with fibromyalgia do not feel pain at all times, it can be difficult to diagnose the condition using tender points. Therefore, medical guidelines for doctors say that a diagnosis can also be made if a patient has the following symptoms, regardless of the current pain level at the time of the examination:

  • Widespread pain lasting three or more months
  • Fatigue and/or waking up feeling unrefreshed
  • Cognitive symptoms including problems thinking, remembering, and understanding

To help assess these symptoms, your doctor might ask you to fill out one of the following questionnaires.

The Widespread Pain Index (WPI) is a questionnaire in which you are asked if you have experienced pain in any one of 19 parts of the body in the past week. Each “yes” response is given a score of 1 for a possible maximum score of 19.

The Symptom Severity Sale (SS) is a questionnaire used to rank the severity of four different symptoms (fatigue, unrefreshed sleep, cognitive symptoms, and physical symptoms) on a scale of 0 to 3 for a possible maximum score of 12.

To diagnose fibromyalgia, your doctor would need to confirm all of the following:

  • Either a WPI of 7 or more with an SS of 5 or more OR a WPI of 3 to 6 with an SS of 9 or more
  • Persistent symptoms at a similar level for at least three months
  • No other explanation for the symptoms


The International Classification of Diseases (ICD-10) lists fibromyalgia as a diagnosable disease under “Diseases of the musculoskeletal system and connective tissue” (code M79-7). Fibromyalgia is classified as a functional somatic syndrome which basically means having physical symptoms that are poorly explained. Fibromyalgia is not a mental disorder, despite the fact that patients often experience anxiety and depression.

Fibromyalgia Treatment Options

Current research has not yet found a cure for fibromyalgia, but there are many effective treatments to manage your symptoms and improve your quality of life. Treatments include medications, therapies, and self-care. No single treatment can alleviate all the symptoms, but you can work with your doctor to find a combination of treatments that is most effective for you.


Medications can help reduce the pain of fibromyalgia and improve sleep. Common medications prescribed for fibromyalgia include:

Pain relievers

These can be over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others). If these are not sufficient to help you with your pain, you doctor might suggest a prescription pain reliever such as tramadol (Ultram). Narcotics are not a good choice, since you can become dependent on them and they can become less effective with time.


Duloxetine (Cymbalta) and milnacipran (Savella) may help minimize your pain and fatigue, while amitriptyline or the muscle relaxant cyclobenzaprine can help with sleep.

Anti-seizure drugs

These medications were developed to treat epilepsy, but are also effective at reducing certain types of pain associated with fibromyalgia. Your doctor may prescribe gabapentin (Neurontin) or pregabalin (Lyrica).


There are various therapies that can help you manage fibromyalgia and improve your day-to-day life. These are often more effective than any medications a doctor can prescribe.

Physical therapy

A physical therapist can teach you exercises to improve your strength, flexibility, and stamina. Water-based exercises or ‘hydrotherapy’ may also provide you with relief.

Occupational therapy

An occupational therapist can reduce the stress on your body by helping you find different ways to perform daily tasks, including the way sit or move at work.


Talking with a counselor can help you reduce anxiety, alleviate depression, and give you confidence and coping strategies for dealing with stressful situations.

Alternative therapies

Some people find alternative therapies helpful at relieving the pain from fibromyalgia. These can include acupuncture and various massage therapies.

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What You Can Do at Home

It is important to practice self-care. This will help you reduce fibromyalgia flare-ups and live as normal a daily-life as possible.

Reduce stress

Without giving up your normal activities or work, do try to minimize or avoid overexertion and emotional stress. Often we find it hard to say ‘no’ without guilt, but now it is time to put your health first. You may find it helpful to practice stress management techniques such as deep-breathing exercises or meditation.

Get enough sleep

This is easier said than done, but getting sufficient, quality sleep will reduce your fatigue. Try to practice good sleep habits: Go to bed and get up at the same time each day, develop a relaxing night-time routine, and reduce your daytime naps.

Exercise regularly

Understandably, you may instinctively avoid exercise if you’re in pain. However, it’s important to keep active. Try to combine moderate aerobic activity such as swimming, walking, and cycling, with exercises that improve your flexibility. This will help prevent secondary problems such as weakened muscles, and it can also improve your sleep. To build up your stamina and fitness, exercise regularly and increase the intensity gradually over time.

Maintain a healthy lifestyle

Fibromyalgia can be hard to deal with, especially when you’re feeling very tired. Make it a goal to do something that you find enjoyable and fulfilling every day.

There is no specific fibromyalgia diet that has been proven to help the condition. You can try keeping a food diary to see if certain foods cause your symptoms to worsen so that you can avoid them in the future. Clearly, it is important to have a healthy, balanced diet and keep your weight under control. Proper nutrition will give you more energy, make you generally feel better, and will contribute to preventing other health issues.

Fibromyalgia is sometimes accompanied by other medical issues. So if you have been diagnosed with fibromyalgia, you may also have other problems, such as:

  • Headaches
  • Joint pain in various parts of your body
  • Spasms in either or both legs (Restless Leg Syndrome)
  • Dry eyes – sometimes your doctor may recommend tests to check whether this is caused by Sjögren’s Syndrome
  • Irritable Bowel Syndrome (IBS)
  • Problems with the joint connecting the jawbone to their skull, causing pain in the jaw and areas nearby (Temporomandibular Joint Disorder or TMJD)
  • Underactive thyroid (Hypothyroidism)

Chronic Fatigue Syndrome

The severe tiredness or fatigue that comes with fibromyalgia may be confused with the exhaustion that people have if they suffer from chronic fatigue syndrome (CFS), also called systemic exertion intolerance disease (SEID). You may have heard this previously called myalgic encephalomyelitis (ME). Talking to your doctor in detail about your symptoms and when they started will help in working out which syndrome you have and how to treat it. A practical way to differentiate fibromyalgia from CFS or SEID is that pain is the main symptom if you have fibromyalgia, whereas fatigue is the most difficult problem with CFS or SEID.

When to See a Doctor

If you are suffering from any of the symptoms of fibromyalgia such as widespread pain, fatigue, and sleep problems, and if they are severe enough to interfere with your work and daily activities, it is time to see a doctor. This is particularly important if your pain cannot be controlled by over-the-counter pain relievers, or if you have anxiety and depression that feel unmanageable.

Healthcare professionals, including those available 24/7 on the K Health app, are available to help you. They understand that fibromyalgia is difficult to diagnose, and that you may look perfectly well despite having symptoms that interfere with your normal life. The sooner you see a doctor, the sooner you can find a treatment plan that works for you.


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K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Edo Paz, MD

Edo Paz is the VP of Medical at K Health. Dr. Paz has two degrees in chemistry from Harvard and earned his medical degree from Columbia University. He did his medical training in internal medicine and cardiology at New York-Presbyterian. In addition to his work at K Health, Dr. Paz is a cardiologist at White Plains Hospital, part of the Montefiore Health System.