Fibromyalgia (FM)

What Is Fibromyalgia (FM)?

Fibromyalgia (FM), also known as Fibromyalgia Syndrome (FMS) is a condition with symptoms that include widespread, pervasive and chronic pain and tenderness in the body, and muscle stiffness, often accompanied by fatigue (hence a relationship with ME/CFS), cognitive disturbance/difficulties and emotional distress. Like ME/CFS, symptoms of FM can vary from mild to severe.

FM affects between 2 and 10% of the population, and like ME/CFS, is mostly women although men and adolescents do acquire it. It tends to develop during middle adulthood.

Symptoms of FM

As well as the chronic pain, including skeletal pain, and tenderness, some or all of the following symptoms might be present:

  • Neurological: dysfunctions of muscles, ligaments and joints – numbness, tingling; abnormal  muscle  twitch response, muscle cramps, muscle  weakness; headaches, generalised weakness, dizziness, and sensory overload.
  • Neurocognitive: These are usually present and include: impaired concentration and short-­term memory problems, impaired speed of performance, inability to multi-­task, one is easily distracted, and/or cognitive overload.
  • Sleep disturbances: Like ME/CFS sufferers, most people with FM experience nonrefreshing sleep. This is usually accompanied by insomnia, frequent nocturnal awakenings, nocturnal muscle twitching, and/or restless leg syndrome.
  • Autonomic and/or neuroendocrine: These include but are not limited to: cardiac arrhythmias, neuraly medicated hypotension, vertigo, temperature instability, hot/cold intolerance (intolerance to very hot or very cold weather), respiratory disturbances, irritable bowel or bladder dysfunction, dysmenorrhea, loss of adaptability and tolerance for stress, reactive depression.
  • Stiffness: Generalized or even regional stiffness that is most severe upon awakening and typically lasts for hours. Stiffness can return during periods of inactivity during the day.

As with ME/CFS, symptoms can vary over time with the waxing and waning over periods of hours, days, weeks, months and so on. An increase in stress can cause a worsening of symptoms.

What Causes FM?

The cause and/or causes (known in the scientific literature as the aetiology or etiology) of FM are unclear. Like ME/CFS the trigger for FM may be different for different people. Before the onset of FM, most people enjoyed an otherwise healthy active lifestyle.

There is evidence that a physical trauma, such as a spinal injury or whiplash can trigger FM in some people. Other associated physical traumas include surgery, repetitive  strain, childbirth, viral infections and chemical exposures. Emotional stress may also trigger the illness. Some people may be genetically predisposed to FM, especially when more than one family member is affected. Some cases of FM have a gradual onset with no obvious cause.

The result is a change in the way the body “talks” with the spinal cord and brain. Levels of brain chemicals and proteins may change. For the person with FM, it is as though the “volume control” is turned up too high in the brain’s pain processing centres.

How Is FM Diagnosed?

A doctor will suspect FM based on your symptoms. As with ME/CFS there are no diagnostic tests (such as X-rays or blood tests) for this illness (neither are MS, ALS, Parkinson’s and Alzheimer’s Disease diagnosed by bio-marker). Yet, you may need tests to rule out another health problem that can be confused with FM.

A physical exam will be required to detect tenderness and to exclude other causes of muscle pain.

Signs that suggest a diagnosis of FM are:

  • Widespread pain for three months or longer;
  • Abnormal tenderness at particular points around the neck, shoulder, chest, hip, knee and elbow;
  • You may have one or more of the additional symptoms listed above.

How Is FM Treated?

At this point in time there is no known cure for FM. However, symptoms can be treated with both medication and non-drug treatments. An effective management program should be designed to suit the needs of the individual.

Generally, management of FM will involve a combination of:

  • Education – people with FM need to understand as much as is practicable about the condition in order to decide which management approach will help them. Keep yourself informed.
  • Medication – combined with other strategies, medication may be used to manage pain, reduce stress or promote sleep. Please also see our page on Sleep – including sleep hygiene.
  • Exercise – a gentle aerobic exercise program, such as walking, tai chi or water-based exercise, can help to manage symptoms such as pain, fatigue and sleep disturbance. Please see our page on Exercise (Graded Exercise Therapy).
  • Relaxation – stress may aggravate symptoms. Skills that can help manage stress include planning, relaxation, assertiveness and emotional management.
  • Pacing – balancing rest and activity, plan your activities to make the most of your energy by alternating periods of activity with rest. Break large jobs down into small achievable tasks so that you do not overdo things. Please see our page on Pacing.
  • Massage of one form or another – this can aid muscle relaxation and stress management.
  • Nutrition – eating a balanced diet can help provide you with better energy levels, help to maintain your weight, give you a greater sense of wellbeing, and give you a sense of control over your life. Identify any potential food intolerances. Please see our page on Nutrition And ME/CFS.
  • Support from others – You can Contact Us or contact Arthritis and Osteoporosis Victoria for information about support group locations and contact details.

Living With FM

You should find as your pain symptoms decrease due to drug treatments you are able to increase your activity levels and thus increase your mood, and hence correspondingly decrease your overall illness burden.

Hopefully with the help of your treating physician with some of the treatments and advice from above and the links to useful resources below you can find a meaningful life and some contentment despite the illness.

Websites And Online Resources

Fibromyalgia Support Australia is on Facebook, check it out here.

The Victorian Government’s Better Health Channel page on Fibromyalgia.

Arthritis Victoria’s page on Fibromyalgia.

Western Australia’s Fibromyalgia Support Network.

Health.Com (US): Guide to the eight best fibromyalgia blogs and websites.

Men with Fibro.

American College of Rheumatology (US): Fibromyalgia fact sheet page. Here it is in pdf.

Fibromyalgia Information Foundation (US): Guidance for Fibromyalgia patients who are having elective surgery. Here’s a pdf version.

Fibromyalgia Network (US).

National Institute of Arthritis and Musculoskeletal and Skin Diseases (US).

National Fibromyalgia Association (US).

National Fibromyalgia Partnership, Inc. (US).

The American Fibromyalgia Syndrome Association, Inc. (US).

Online News Articles

Dellwo, A (2013) ‘Early Menopause & Fibromyalgia’ February 19.

Dellwo, Adrienne (2011) ‘Finding footware with fibromyalgia‘, About.Com, 2nd March.

Barrow, Kate (2011) ‘Patient voices: Fibromyalgia‘, The New York Times, February.

Dellwo, Adrienne (2010) ‘Problems showering with Fibromyalgia and CFS‘, About.Com, 16th November.

Dellwo, Adrienne (2010) ‘Small fiber neuropathy in fibromyalgia‘, About.Com, 11th October.

Belluck, Pam (2010) ‘Tai Chi reported to ease fibromyalgia‘, New York Times, 18th August.

Pellegrino, J (2010) ‘Fibromyalgia in Children and Teens – Risk Factors, Symptoms, and Treatment‘, Feb 24, Prohealth.

Pellegrino, J (2010) ‘Dizziness on Rising – Dealing with a Common Symptom of Fibromyalgia and ME/CFS‘, Feb 19, Prohealth.

Oregon Fibromyalgia Research and Treatment Team (2008) ‘Guidance for fibromyalgia patients who are having elective surgery – an update‘, Prohealth, [Full text, November 18].

Lapp, C (2008) ‘Recommendations for persons with Chronic Fatigue Syndrome (or Fibromyalgia) who are anticipating surgery‘, January 8th, ProHealth.

References & Journal Articles

The Canadian Fibromyalgia Clinical Case Definition and Guidelines for Medical Practitioners (Overview). Bruce M. Carruthers and Marjorie I. van de Sande, 2005.

Gavi, M. B. R. O., et al. “Strengthening exercises improve symptoms and quality of life but do not change autonomic modulation in fibromyalgia: a randomized clinical trial.” PLoS One, 2014, 9(3): e90767/90761-e90767/90768.

Ablin, J. N. and D. Buskila. “Predicting fibromyalgia, a narrative review: are we better than fools and children?” Eur J Pain, 2014, 18(8): 1060-1066.

Dubin, R. “Keep it simple: easing the care burden of fibromyalgia.” Can Fam Physician, 2014, 60(7): 599-601.

Hauser, W., et al. “Review of pharmacological therapies in fibromyalgia syndrome.” Arthritis Res Ther, 2014, 16(1): 201.

Jin, H., et al. “Topical review: the enigma of fibromyalgia.” J Oral Facial Pain Headache, 2014, 28(2): 107-118.

Clauw, D. J. “Fibromyalgia: a clinical review.” JAMA, J. Am. Med. Assoc., 2014, 311(15): 1547-1555.

Wiffen, P. J., et al. “Antiepileptic drugs for neuropathic pain and fibromyalgia – an overview of Cochrane reviews.” Cochrane Database Syst Rev, 2013, 11: CD010567.

Gaskell, H., et al. “Oxycodone for neuropathic pain and fibromyalgia in adults.” Cochrane Database Syst Rev, 2014, 6: CD010692.

Garza-Villarreal, E. A., et al. “Music reduces pain and increases functional mobility in fibromyalgia.” Front Psychol, 2014, 5: 90.

Wepner, F., et al. “Effects of vitamin D on patients with fibromyalgia syndrome: a randomized placebo-controlled trial.” Pain, 2014, 155(2): 261-268.

Wiffen, P. J., et al. “Carbamazepine for chronic neuropathic pain and fibromyalgia in adults.” Cochrane Database Syst Rev, 2014, 4: CD005451.

Younger, J., et al. “The use of low-dose naltrexone (LDN) as a novel anti-inflammatory treatment for chronic pain.” Clin Rheumatol, 2014, 33(4): 451-459.

Wolfe, F., et al. “Symptoms, the nature of fibromyalgia, and diagnostic and statistical manual 5 (DSM-5) defined mental illness in patients with rheumatoid arthritis and fibromyalgia.” PLoS One, 2014, 9(2): e88740.

Wallace, D., et al. “Cytokine and chemokine profiles in fibromyalgia, rheumatoid arthritis and systemic lupus erythematosus: a potentially useful tool in differential diagnosis.” Rheumatology International, 2014,: 1-6.

Vural, M., et al. “Evaluation of the effectiveness of an aerobic exercise program and the personality characteristics of patients with fibromyalgia syndrome: a pilot study.” J Phys Ther Sci, 2014, 26(10): 1561-1565.

Vincent, A., et al. “OMERACT-based fibromyalgia symptom subgroups: an exploratory cluster analysis.” Arthritis Res Ther, 2014, 16(5): 463.

Vincent, A., et al. “Decreased physical activity attributable to higher body mass index influences fibromyalgia symptoms.” PM R, 2014, 6(9): 802-807.

Torgrimson-Ojerio, B., et al. “Preliminary evidence of a blunted anti-inflammatory response to exhaustive exercise in fibromyalgia.” J. Neuroimmunol., 2014, 277(1-2): 160-167.

Verma, V., et al. “Pregabalin in Neuropathic Pain: Evidences and Possible Mechanisms.” Curr. Neuropharmacol., 2014, 12(1): 44-56.

Sturgill, J., et al. “Unique cytokine signature in the plasma of patients with fibromyalgia.” J Immunol Res, 2014, 2014: 938576.

Staud, R., et al. “Slow temporal summation of pain for assessment of central pain sensitivity and clinical pain of fibromyalgia patients.” PLoS One, 2014, 9(2): e89086/89081-e89086/89088.

Garcia-Leiva, J. M., et al. “Celiac symptoms in patients with fibromyalgia: a cross-sectional study.” Rheumatol Int, 2014.

Schmidt-Wilcke, T., et al. “Resting state connectivity correlates with drug and placebo response in fibromyalgia patients.” Neuroimage Clin, 2014, 6: 252-261.

Rivera, J., et al. “Classifying fibromyalgia patients according to severity: the combined index of severity in fibromyalgia.” Rheumatol Int, 2014, 34(12): 1683-1689.

Marlow, N. M., et al. “Efficacy of transcranial direct current stimulation and repetitive transcranial magnetic stimulation for treating fibromyalgia syndrome: a systematic review.” Pain Pract, 2013, 13(2): 131-145.

Okifuji, A. and B. D. Hare. “Management of fibromyalgia syndrome: review of evidence.” Pain Ther, 2013, 2(2): 87-104.

Meeus, M., et al. “Heart rate variability in patients with fibromyalgia and patients with chronic fatigue syndrome: a systematic review.” Semin Arthritis Rheum, 2013, 43(2): 279-287.

Lauche, R., et al. “A systematic review and meta-analysis of qigong for the fibromyalgia syndrome.” Evid Based Complement Alternat Med, 2013, 2013: 635182.

Lauche, R., et al. “A systematic review and meta-analysis of mindfulness-based stress reduction for the fibromyalgia syndrome.” J Psychosom Res, 2013, 75(6): 500-510.

Langhorst, J., et al. “Efficacy and safety of meditative movement therapies in fibromyalgia syndrome: a systematic review and meta-analysis of randomized controlled trials.” Rheumatol. Int., 2013, 33(1): 193-207.

Cao, H., et al. “Acupoint stimulation for fibromyalgia: a systematic review of randomized controlled trials.” Evid Based Complement Alternat Med, 2013, 2013: 362831.

Busse, J. W., et al. “Systematic review and network meta-analysis of interventions for fibromyalgia: a protocol.” Syst Rev, 2013, 2: 18.

Alcocer-Gomez, E., et al. “Effect of coenzyme Q10 evaluated by 1990 and 2010 ACR Diagnostic Criteria for Fibromyalgia and SCL-90-R: Four case reports and literature review.” Nutrition (N. Y., NY, U. S.), 2013, 29(11-12): 1422-1425.

McCarberg, B. H. “Clinical overview of fibromyalgia.” Am J Ther, 2012, 19(5): 357-368.

Light, A. R., et al. “Gene expression alterations at baseline and following moderate exercise in patients with Chronic Fatigue Syndrome, and Fibromyalgia Syndrome.” Journal of internal medicine, 2012, 271(1): 64-81.

Behm, F. G., et al. “Unique immunologic patterns in fibromyalgia.” BMC Clin. Pathol., 2012, 12: 25.

Brooks, L., et al. “The relationship between performances on neuropsychological symptom validity testing and the MCMI-III in patients with fibromyalgia.” Clin Neuropsychol, 2012, 26(5): 816-831.

Schweinhardt, P., et al. “Fibromyalgia as a disorder related to distress and its therapeutic implications.” Pain Res Treat, 2012, 2012: 950602.

Sanudo, B., et al. “Effects of exercise training and detraining in patients with fibromyalgia syndrome: a 3-yr longitudinal study.” Am J Phys Med Rehabil, 2012, 91(7): 561-569.

Munguia-Izquierdo, D. and A. Legaz-Arrese. “Reliability and validity of a low load endurance strength test for upper and lower extremities in patients with fibromyalgia.” Arch Phys Med Rehabil, 2012, 93(11): 2035-2041.

Tort, S., et al. “Monoamine oxidase inhibitors (MAOIs) for fibromyalgia syndrome.” Cochrane Database Syst Rev, 2012, 4: CD009807.

Mohammad, A., et al. “Prevalence of fibromyalgia among patients with chronic hepatitis C infection: relationship to viral characteristics and quality of life.” J Clin Gastroenterol, 2012, 46(5): 407-412.

Wierwille, L. “Fibromyalgia: diagnosing and managing a complex syndrome.” J Am Acad Nurse Pract, 2012, 24(4): 184-192.

Craggs, J. G., et al. “Effective connectivity among brain regions associated with slow temporal summation of C-fiber-evoked pain in fibromyalgia patients and healthy controls.” J Pain, 2012, 13(4): 390-400.

Ramanathan, S., et al. “Is fibromyalgia an endocrine/endorphin deficit disorder? Is low dose naltrexone a new treatment option?” Psychosomatics, 2012, 53(6): 591-594.

de, M. L. F. and S. L. Da-Silva. “Neuropsychological assessment of cognitive disorders in patients with fibromyalgia, rheumatoid arthritis, and systemic lupus erythematosus.” Rev Bras Reumatol, 2012, 52(2): 181-188.

Fraga, B. P., et al. “Signs and symptoms of temporomandibular dysfunction in fibromyalgic patients.” J Craniofac Surg, 2012, 23(2): 615-618.

Suk, J. H., et al. “Association between thyroid autoimmunity and fibromyalgia.” Exp. Clin. Endocrinol. Diabetes, 2012, 120(7): 401-404.

Ceko, M., et al. “Neurobiology underlying fibromyalgia symptoms.” Pain Res Treat, 2012, 2012: 585419.

Fitzcharles, M.-A. and M. B. Yunus. “The clinical concept of fibromyalgia as a changing paradigm in the past 20 years.” Pain Res Treat, 2012, 2012: 184835.

Holton, K. F., et al. “The effect of dietary glutamate on fibromyalgia and irritable bowel symptoms.” Clin Exp Rheumatol, 2012, 30(6 Suppl 74): 10-17.

Light, A. R., et al. “Gene expression alterations at baseline and following moderate exercise in patients with Chronic Fatigue Syndrome, and Fibromyalgia Syndrome.” Journal of internal medicine, 2012, 271(1): 64-81.

Robinson, M. E., et al. “Gray matter volumes of pain-related brain areas are decreased in fibromyalgia syndrome.” J Pain, 2011, 12(4): 436-443.

Auvinet, B., et al. “The interest of gait markers in the identification of subgroups among fibromyalgia patients.” BMC Musculoskelet Disord, 2011, 12: 258.

Kim, Y.-S., et al. “Women with fibromyalgia have lower levels of calcium, magnesium, iron and manganese in hair mineral analysis.” J. Korean Med. Sci., 2011, 26(10): 1253-1257.

Thomas, R. J. “Sleep as a Window into the World of Fibromyalgia Syndrome.” The Journal of Rheumatology, 2011, 38(12): 2499-2500.

Matsumoto, S., et al. “Effects of thermal therapy combining sauna therapy and underwater exercise in patients with fibromyalgia.” Complement Ther Clin Pract, 2011, 17(3): 162-166.

Lamb, J. J., et al. “A program consisting of a phytonutrient-rich medical food and an elimination diet ameliorated fibromyalgia symptoms and promoted toxic-element detoxification in a pilot trial.” Altern Ther Health Med, 2011, 17(2): 36-44.

Feraco, P., et al. “Metabolic abnormalities in pain-processing regions of patients with fibromyalgia: a 3T MR spectroscopy study.” AJNR Am J Neuroradiol, 2011, 32(9): 1585-1590.

McDonald, M., et al. “Musculoskeletal pain in the workforce: the effects of back, arthritis, and fibromyalgia pain on quality of life and work productivity.” J Occup Environ Med, 2011, 53(7): 765-770.

Walitt, B., et al. “The longitudinal outcome of fibromyalgia: a study of 1555 patients.” J Rheumatol, 2011, 38(10): 2238-2246.

Juuso, P., et al. “Living with a double burden: Meanings of pain for women with fibromyalgia.” Int J Qual Stud Health Well-being, 2011, 6(3).

Wang, F., et al. “Early improvement in pain predicts pain response at endpoint in patients with fibromyalgia.” J Pain, 2011, 12(10): 1088-1094.

Short, E. B., et al. “Ten sessions of adjunctive left prefrontal rTMS significantly reduces fibromyalgia pain: a randomized, controlled pilot study.” Pain, 2011, 152(11): 2477-2484.

Olivares, P. R., et al. “Tilting Whole Body Vibration improves quality of life in women with fibromyalgia: a randomized controlled trial.” J Altern Complement Med, 2011, 17(8): 723-728.

Busch, A. J., et al. “Exercise therapy for fibromyalgia.” Curr Pain Headache Rep, 2011, 15(5): 358-367.

Fitzgerald, C. T. and L. P. Carter. “Possible role for glutamic acid decarboxylase in fibromyalgia symptoms: A conceptual model for chronic pain.” Med. Hypotheses, 2011, 77(3): 409-415.

Ang, D. C., et al. “MCP-1 and IL-8 as pain biomarkers in fibromyalgia: a pilot study.” Pain Med, 2011, 12(8): 1154-1161.

Bennett, R. M. and D. L. Goldenberg. “Fibromyalgia, myofascial pain, tender points and trigger points: splitting or lumping?” Arthritis Research & Therapy, 2011, 13(3): 117-117.

Mahdi, A. A., et al. “Abnormality of circadian rhythm of serum melatonin and other biochemical parameters in fibromyalgia syndrome.” Indian J. Biochem. Biophys., 2011, 48(2): 82-87.

Ge, H. Y., et al. “Reproduction of overall spontaneous pain pattern by manual stimulation of active myofascial trigger points in fibromyalgia patients.” Arthritis Res Ther, 2011, 13(2): R48.

Winkelmann, A., et al. “Impact of fibromyalgia severity on health economic costs: results from a European cross-sectional study.” Appl Health Econ Health Policy, 2011, 9(2): 125-136.

Smith, H. S., et al. “Fibromyalgia: an afferent processing disorder leading to a complex pain generalized syndrome.” Pain Physician, 2011, 14(2): E217-245.

Wolfe, F., et al. “Fibromyalgia criteria and severity scales for clinical and epidemiological studies: a modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia.” J Rheumatol, 2011, 38(6): 1113-1122.

Sperber, A. D., et al. “Validation of New Symptom-Based Fibromyalgia Criteria for Irritable Bowel Syndrome Co-morbidity Studies.” J Neurogastroenterol Motil, 2011, 17(1): 67-72.

Wolfe, F., et al. “Mortality in fibromyalgia: a study of 8,186 patients over thirty-five years.” Arthritis Care Res (Hoboken), 2011, 63(1): 94-101.

Castro-Sanchez, A. M., et al. “Benefits of massage-myofascial release therapy on pain, anxiety, quality of sleep, depression, and quality of life in patients with fibromyalgia.” Evid Based Complement Alternat Med, 2011, 2011: 561753.

Okifuji, A., et al. “Sequential analyses of daily symptoms in women with fibromyalgia syndrome.” J Pain, 2011, 12(1): 84-93.

Lavergne, M. R., et al. “Functional impairment in chronic fatigue syndrome, fibromyalgia, and multiple chemical sensitivity.” Can Fam Physician, 2010, 56(2): e57-65.

Viola-Saltzman, M., et al. “High prevalence of restless legs syndrome among patients with fibromyalgia: a controlled cross-sectional study.” J Clin Sleep Med, 2010, 6(5): 423-427.

Napadow, V., et al. “Intrinsic brain connectivity in fibromyalgia is associated with chronic pain intensity.” Arthritis Rheum, 2010, 62(8): 2545-2555.

Kayiran, S., et al. “Neurofeedback intervention in fibromyalgia syndrome; a randomized, controlled, rater blind clinical trial.” Appl Psychophysiol Biofeedback, 2010, 35(4): 293-302.

Smith, H. S. and R. L. Barkin. “Fibromyalgia syndrome: a discussion of the syndrome and pharmacotherapy.” Am J Ther, 2010, 17(4): 418-439.

Kranzler, J. D. and R. M. Gendreau. “Role and rationale for the use of milnacipran in the management of fibromyalgia.” Neuropsychiatr Dis Treat, 2010, 6: 197-208.

Branco, J. C., et al. “A European multicenter randomized double-blind placebo-controlled monotherapy clinical trial of milnacipran in treatment of fibromyalgia.” J. Rheumatol., 2010, 37(4): 851-859.

Vallejo, M. A., et al. “Development of a self-reporting tool to obtain a combined index of severity of fibromyalgia (ICAF).” Health Qual Life Outcomes, 2010, 8: 2.

Mannerkorpi, K., et al. “Pool exercise for patients with fibromyalgia or chronic widespread pain: a randomized controlled trial and subgroup analyses.” J Rehabil Med, 2009, 41(9): 751-760.

Bazzichi, L., et al. “Detection of potential markers of primary fibromyalgia syndrome in human saliva.” Proteomics: Clin. Appl., 2009, 3(11): 1296-1304.

Mease, P. J. “Further strategies for treating fibromyalgia: the role of serotonin and norepinephrine reuptake inhibitors.” Am J Med, 2009, 122(12 Suppl): S44-55.

Feng, J., et al. “Missense mutations in the MEFV gene are associated with fibromyalgia syndrome and correlate with elevated IL-1beta plasma levels.” PLoS One, 2009, 4(12): e8480.

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Staud, R., et al. “Brain activity associated with slow temporal summation of C-fiber evoked pain in fibromyalgia patients and healthy controls.” Eur J Pain, 2008, 12(8): 1078-1089.


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