Fibromyalgia Overview from the Mayo Clinic


Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that Fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals.

Symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event.

Women are much more likely to develop Fibromyalgia than are men. Many people who have Fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression.

While there is no cure for Fibromyalgia, a variety of medications can help control symptoms. Exercise, relaxation and stress-reduction measures also may help.


The pain associated with Fibromyalgia often is described as a constant dull ache, typically arising from muscles. To be considered widespread, the pain must occur on both sides of your body and above and below your waist.

Fibromyalgia is characterized by additional pain when firm pressure is applied to specific areas of your body, called tender points. Tender point locations include:

  • Back of the head
  • Between shoulder blades
  • Top of shoulders
  • Front sides of neck
  • Upper chest
  • Outer elbows
  • Upper hips
  • Sides of hips
  • Inner knees

Fatigue and sleep disturbances
People with Fibromyalgia often awaken tired, even though they report sleeping for long periods of time. Sleep is frequently disrupted by pain, and many patients with Fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea, that further worsen symptoms.

Coexisting conditions
Many people who have Fibromyalgia also may have:

  • Fatigue
  • Anxiety
  • Depression
  • Endometriosis
  • Headaches
  • Irritable bowel syndrome


In 1990, the American College of Rheumatology (ACR) established two criteria for the diagnosis of fibromyalgia:

  • Widespread pain lasting at least three months
  • At least 11 positive tender points — out of a total possible of 18

But fibromyalgia symptoms can come and go. And many doctors were uncertain about how much pressure to apply during a tender point exam. While the 1990 guidelines may still be used by researchers studying fibromyalgia, less stringent guidelines have been developed for doctors to use in general practice.

These newer diagnostic criteria include:

  • Widespread pain lasting at least three months
  • No other underlying condition that might be causing the pain

Blood tests
While there is no lab test to confirm a diagnosis of fibromyalgia, your doctor may want to rule out other conditions that may have similar symptoms. Blood tests may include:

  • Complete blood count
  • Erythrocyte sedimentation rate
  • Thyroid function tests


Doctors don't know what causes fibromyalgia, but it most likely involves a variety of factors working together. These may include:

  • Genetics. Because fibromyalgia tends to run in families, there may be certain genetic mutations that may make you more susceptible to developing the disorder.
  • Infections. Some illnesses appear to trigger or aggravate fibromyalgia.
  • Physical or emotional trauma. Post-traumatic stress disorder has been linked to Fibromyalgia.

Why does it hurt?
Current thinking centers around a theory called central sensitization. This theory states that people with fibromyalgia have a lower threshold for pain because of increased sensitivity in the brain to pain signals.

Researchers believe repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain that signal pain (neurotransmitters). In addition, the brain's pain receptors seem to develop a sort of memory of the pain and become more sensitive, meaning they can overreact to pain signals.


Risk factors for fibromyalgia include:

  • Your sex. Fibromyalgia is diagnosed more often in women than in men. Female reproductive hormones may play a part in how women experience pain.
  • Family history. You may be more likely to develop fibromyalgia if a relative also has the condition.
  • Rheumatic disease. If you have a rheumatic disease, such as rheumatoid arthritis or lupus, you may be more likely to develop Fibromyalgia.


Fibromyalgia generally doesn't lead to other conditions or diseases. But the pain and lack of sleep associated with fibromyalgia can interfere with your ability to function at home or on the job. The frustration of dealing with an often-misunderstood condition also can result in depression and health-related anxiety.


In general, treatments for fibromyalgia include both medication and self-care. The emphasis is on minimizing symptoms and improving general health.

Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include:

  • Analgesics. Acetaminophen (Tylenol, others) may ease the pain and stiffness caused by fibromyalgia. However, its effectiveness varies. Tramadol (Ultram) is a prescription pain reliever that may be taken with or without acetaminophen. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) — such as ibuprofen (Advil, Motrin, others) or naproxen sodium (Aleve, others) — in conjunction with other medications.
  • Antidepressants. Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia. Your doctor may prescribe amitriptyline or fluoxetine (Prozac) to help promote sleep.
  • Anti-seizure drugs. Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin) is sometimes helpful in reducing fibromyalgia symptoms, while pregabalin (Lyrica) was the first drug approved by the Food and Drug Administration to treat fibromyalgia.

Talking with a counselor can help strengthen your belief in your abilities and teach you strategies for dealing with stressful situations.


Self-care is critical in the management of Fibromyalgia.

  • Reduce stress. Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. But try not to change your routine completely. People who quit work or drop all activity tend to do worse than those who remain active. Try stress management techniques, such as deep-breathing exercises or meditation.
  • Get enough sleep. Because fatigue is one of the main characteristics of fibromyalgia, getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping.
  • Exercise regularly. At first, exercise may increase your pain. But doing it gradually and regularly often decreases symptoms. Appropriate exercises may include walking, swimming, biking and water aerobics. A physical therapist can help you develop a home exercise program. Stretching, good posture and relaxation exercises also are helpful.
  • Pace yourself. Keep your activity on an even level. If you do too much on your good days, you may have more bad days. Moderation means not "overdoing it" on your good days, but likewise it means not self-limiting or doing "too little" on the days when symptoms flare.
  • Maintain a healthy lifestyle. Eat healthy foods. Limit your caffeine intake. Do something that you find enjoyable and fulfilling every day.


Complementary and alternative therapies for pain and stress management aren't new. Some, such as meditation and yoga, have been practiced for thousands of years. But their use has become more popular in recent years, especially with people who have chronic illnesses, such as fibromyalgia.

Several of these treatments do appear to safely relieve stress and reduce pain, and some are gaining acceptance in mainstream medicine. But many practices remain unproved because they haven't been adequately studied.

  • Acupuncture. Acupuncture is a Chinese medical system based on restoring normal balance of life forces by inserting very fine needles through the skin to various depths. According to Western theories of acupuncture, the needles cause changes in blood flow and levels of neurotransmitters in the brain and spinal cord. Some studies indicate that acupuncture helps relieve fibromyalgia symptoms, while others show no benefit.
  • Massage therapy. This is one of the oldest methods of health care still in practice. It involves use of different manipulative techniques to move your body's muscles and soft tissues. Massage can reduce your heart rate, relax your muscles, improve range of motion in your joints and increase production of your body's natural painkillers. It often helps relieve stress and anxiety.
  • Yoga and tai chi. These practices combine meditation, slow movements, deep breathing and relaxation. Both have been found to be helpful in controlling fibromyalgia symptoms.


Besides dealing with the pain and fatigue of fibromyalgia, you may also have to deal with the frustration of having a condition that's often misunderstood. In addition to educating yourself about fibromyalgia, you may find it helpful to provide your family, friends and co-workers with information.

It's also helpful to know that you're not alone. Organizations such as the National Fibromyalgia Association and the American Chronic Pain Association can help put you in touch with others who have had similar experiences and can understand what you're going through.

Courtesy of the Mayo Clinic

I certainly agree that Fibro amplifies painful sensations!

Here I have a problem understanding, "No other underlying condition that could cause pain" So that goes against what my Rheumn the asst professor told me about Fibro being a condition CAUSED by chronic pain that changes the brain, and they even attribute this to injury, trauma! So they also contradict themselves!

PTSD, now there's a factor seldom discussed, but very real if you were traumatised by a car accident, being in a war (there are a considerable number of vets who are members here), or a thousand other things.

Good they mentioned alternative therapy, as many cannot tolerate the AMA meds, many cannot tolerate the PT or the exercise!

All in all I think it's a pretty fair explaination. Not too much to pick apart, I do like the fact that they tell you that this condition is misunderstood, but seem to think that giving people info will change the way they act toward you! ha!

Thank you, very good information, I enjoyed reading it xxx

Very good, detailed description. I do agree that there are a couple of contradictions it it, but overall very good.

I think what they are saying SK is that there is not any condition like compressed disks or upper thoracic syndrome ect. However it can be caused by an acute cause such as you were in a car accident and you broke your collar bone with the seat belt. Those can be treated in mo. And are not chronic. I hope I didn’t just talk in circles. Lol. I’m tired and just woke up for a bit lol

Yes, I have read this and fit it to a tee. It is almost scary.

I read it but forgot what I read....rotfLOL! I've been up for too long and need someone to knock me in the head so I can sleep...

SK, that's the new criteria for a definite diagnosis. If there is "No other underlying condition that could cause pain", then they feel it HAS to be fibro. If there IS finding of a possible underlying condition, then they would consider that it was THAT condition causing pain, and NOT diagnose fibro immediately.

IMO, emotional stress alone is enough to trigger it too. PTSD without physical injuries. Anything that taxes the system in any way can cause it to react as if it's a trauma, although unsuccessfully. Even vaccine shots have been known to cause fibro to surface. Anything abnormal introduced can cause the body to respond inappropriately.

I also think this is the first article I've read that offers reasonable advice on exercise!

This analysis is sooo incomplete. Over 26 years with chronic fatigue / ME, and fibro, I can tell you that they have minimized the pain, the depression/bi-polar that can result from brain changes, fatigue and other issues that arise from fibro or CFS.

If you have pain that cannot be bearable with ibuprofen DO NOT think you’re stuck with your pain. I fortunately found a rheumatologist that believes in not leaving me in pain, or at least with minimal pain. I’m on narcotic pain relief that allows me to function. Do Not feel guilty or hesitate to treat your pain. You won’t get a “buzz”, it will just allow your body to dull the pain to the point where you can have a better quality of life. Your doctor will get you on the minimal amount of meds to get you out of pain. Don’t hesitate to take care of yourself.

Also, make sure to find a doctor who does a complete blood work up. Look at your thyroid, adrenal function, gluten sensitivity, hormones, and everything they can test for. Treating some of these can also help improve your quality of life if they need treating.

Lastly, see a psychiatrist and see a therapist, my therapist started by telling me that I was being tortured everyday with no end in sight and that we needed to support me in this area, then I was able to deal with other issues, such as family that doesn’t understand your disease and how unsupportive friends and family may be. Utilize this resource. Fibro being a disease of the Central Nervous System can change the brain chemistry. You may need support from drugs other than the 2 drugs most doctors prescribe for fibro.

Don’t be afraid to need psychiatric, therapy support. We need many outlets to treat this horrible disease that affects the body in many other ways.

Amen to that. All we want is to feel some relief from this chronic pain. If it has to be a narcotic then I chose to take it, otherwise I would be in bed all day just wasting my life away.

Only "Dull" pain?? I thought FM can cause all types of pain. Mine are not dull - it's like the horrible deep muscle pain when you have flu accompanied by extreme fatigue. I feel almost like my cells are being squeezed very tight and they are disintegrating. I feel like my body is dying.

Other times I have other types of pain on top of that - it can be sharp, stabbing, throbbing, dull electric buzzing, sharp electric-like shocks. Sometimes I feel like knives are scraping my flesh off.

Do most FM patients have chronic "dull" pain? Am I one of the few with many types of pain? I don't think so. They need to add that to their definition of FM. There are other symptoms (cognitive problem) to go with FM, too.

Thanks for the information. It's nice that they recognize fibromylgia. I guess we are making progress. It's about time.

To FibroChou

I have different types of pain like you. Mine is primarily flu like and I have horrible fatigue so it’s exactly like being in the bed with the flu. I don’t have sharp pains much, but I can have deep pain that feels like you worked out 3 days straight at the gym and now everything hurts like that, like you’ve way overdone it.

When I get sharp pain, it’s in my lower back after running the sweeper or if its cold and rainy and I have to walk any distance. Sometimes have to push hard in pain to walk to my car.

Oh you may also have chronic fatigue syndrome as well as fibro. You should have that checked out.


I thought chronic fatigue was just a part of major FM symptoms. Is there any reason to get a diagnosis for CFS?

I am afraid of getting any new diagnosis - more reason for insurance company to deny me (Blue Cross denied my application because of FM).

Yes horrible fatigue does go along with fibro and you don’t have to get another diagnosis. If it is a detriment don’t even go there medically. However, you may want to keep up with CFS research just because it may help with fibro as well.

It’s just from my experience only, I had CFS prior to the fibro and the flu symptoms with extreme fatigue is what I experienced for years, the fibro started later and the pain intensified and was in more places on my body. That’s the only reason it made the CFS comment.

Take care

I think chronic fatigue started before Fm symptoms for me, too. Chronic fatigue also came with Multiple Chemical Sensitivity.

I have found a doc who also believes in narcotic pain relief. I spent 11 years being “treated” with ibu’s and flexeril. Then a spinal specialist pointed me towards Dr. B and he was a god send. Eventhough I am still in quite a bit of pain I can still go to work.

Isn’t it funny how we can be on these heavy medications but not have a “high” it’s weird.