David Ozeri, MD, is a board-certified rheumatologist. He is based in Tel Aviv, Israel, where he does research at Sheba Medical Center. Previously, he practiced at New York-Presbyterian Hospital.
Fibromyalgia is a chronic condition characterized by widespread pain, fatigue, sleep disturbance, cognitive impairment, depression, environmental sensitivities, and digestive symptoms.
In this illness, experts believe that pain signals are exaggerated by the brain and nerves, amplifying the sensation of pain you experience. This disordered signal processing leads to several abnormal types of pain.
No objective blood or imaging tests can identify it, so fibromyalgia is diagnosed with subjective criteria and by excluding other possible causes of symptoms.
Treatment may involve antidepressants to target abnormal brain chemistry, physical therapy, massage, lifestyle changes, cognitive behavioral therapy, and medications specifically approved to treat fibromyalgia, such as Lyrica (pregabalin).
No one knows for certain. Symptoms are believed to be caused by a dysfunctional nervous system. The condition itself is believed to be caused by some combination of multiple factors, including:
Risk factors include being female and between the ages of 20 and 50.
Many people with fibromyalgia are disabled. However, symptom severity varies greatly from one person to another, and may include flares (times when it’s especially bad) and remissions (when symptoms are light or absent.) It can also get better or worse over time.
Fibromyalgia may qualify you for Social Security Disability Insurance, depending on how severe it is.
Fibromyalgia might be an autoimmune disease, but experts don’t know for sure yet. Some evidence suggests an overactive immune system, and the condition may be associated with damage to certain nerve structures, including the optic nerve. Many people with fibromyalgia have autoimmune diseases (e.g., lupus, rheumatoid arthritis, Sjögren’s syndrome), which could point to a common pathophysiology.
Fibromyalgia involves many types of pain, so it can feel achy, stabbing, burning, tingling, and/or like electrical “zings.” People commonly talk about how their skin hurts to the touch, almost like a sunburn. In addition, there’s usually fatigue, lack of energy, and a foggy or dull feeling in the brain. It’s common for people with fibromyalgia to feel anxious or depressed as well.
Fibromyalgia can run in families, but it’s not hereditary in the sense that certain genes mean you will develop the condition. Rather, experts believe people who are genetically predisposed to fibromyalgia may develop it if other conditions arise, including:
Together, many factors may combine to trigger fibromyalgia.
To diagnose fibromyalgia, doctors rely on symptoms, tests to exclude similar illnesses, and two questionnaires called the Widespread Pain Index (WPI) and Symptom Severity Scale (SS). A high enough combined score indicates fibromyalgia. Some doctors may still use a tender point exam, which is a measurement of widespread pain, but this method has generally been replaced with the WPI and SS.
Allodynia is pain from stimuli that shouldn’t be painful. For example, a cold breeze brushing against your skin or the waistband of loose-fitting pants shouldn’t cause pain, but when you have allodynia, they do. This is a hallmark symptom of fibromyalgia and may be thermal (temperature related), mechanical (caused by movement against your skin), and/or tactile (caused by pressure or touch).
Also called “fibro fog,” cognitive dysfunction is an array of problems involving concentration, learning, math, spatial perception, and memory. This is one of the most common symptoms of fibromyalgia and is often one of the more disabling aspects of the condition.
Hyperalgesia is pain that’s amplified (made more intense) by your body. This central feature of fibromyalgia is caused by nerves that send too many pain messages to the brain, and a brain that over-responds to those signals. It’s essentially like “turning up the volume” of your pain. The heightened reaction can be in response to heat, cold, pressure, and touch.
Neurotransmitters are chemical messengers in your brain. They carry nerve signals (“messages”) from one brain cell to another. Fibromyalgia is believed to involve dysregulation of multiple neurotransmitters, including:
The term pain disorder describes pain associated with certain psychological factors. Pain disorders are a type of complex somatic symptom disorder (CSSD). To be diagnosed with CSSD, you must have both unexplained physical symptoms and cognitive distortions. Some doctors label fibromyalgia a CSSD but that view is highly controversial in the medical community and considered invalid by some.
Paresthesias are abnormal nerve sensations. They may feel tickly, tingly, itchy, zingy, crawling, or like pins and needles. Sometimes these sensations are simply annoying, but they can also be painful—which is often the case in fibromyalgia.
Rheumatoid arthritis (RA) is a type of autoimmune arthritis in which the immune system attacks and degrades the lining of the joints. Many people with RA eventually develop fibromyalgia as a secondary condition, possibly because of the impact chronic pain has on the pain-processing regions of the brain.
TMJ disorder is pain or tenderness in or around the temporomandibular joints, which connect your jaw to your skull. It may also cause clicking, popping, and reduced range of motion when opening your mouth. A lot of people with fibromyalgia also have TMJ, but the precise reason for this overlap isn’t yet understood.
Bellato E, Marini E, Castoldi F, et al. Fibromyalgia syndrome: Etiology, pathogenesis, diagnosis, and treatment. Pain Res Treat. 2012;426130. doi:10.1155/2012/426130
Wolfe F, Walitt BT, Katz RS, Häuser W. Symptoms, the Nature of Fibromyalgia, and Diagnostic and Statistical Manual 5 (DSM-5) Defined Mental Illness in Patients with Rheumatoid Arthritis and Fibromyalgia. Assassi S, ed. PLoS ONE. 2014; 9(2): e88740. https://doi.org/10.1371/journal.pone.0088740