What is fibromyalgia?


Fibromyalgia: Overview

Fibromyalgia is a painful condition that is not completely understood by medical experts. The cause of fibromyalgia is not known. It can make you feel tired and ache all over. It causes tender spots at specific points of the body that hurt only when you press on them. You may have trouble sleeping, as well as other symptoms. These problems can upset your work and home life.

Symptoms tend to come and go, although they may never go away completely. Fibromyalgia does not harm your muscles, joints, or organs.


Fibromyalgia is a condition that causes widespread pain in the muscles and soft tissues. People who have it feel pain, tenderness, or both even when there is no injury or inflammation.

Depression, stress, and sleep problems are common in people who have fibromyalgia. These problems may make fibromyalgia symptoms worse.

What happens when you have fibromyalgia?

Fibromyalgia involves a cycle of muscle pain and sensitivity to pain. Pain causes a person to become less active. This causes muscles to become more painful during activity. More pain then leads to even less activity. But symptoms can be controlled. And most people adjust to their symptoms and can keep doing daily activities.

What are the symptoms of fibromyalgia?

The main symptoms of fibromyalgia are:

  • Deep or burning pain in your muscles or joints. Pain can be in many places in your body.
  • Tender points (or trigger points) on the body that hurt when pressed.

People with fibromyalgia may have other problems along with pain, such as:

  • Anxiety or depression.
  • Fatigue that gets in the way of work and daily activities.
  • Sleep problems, such as trouble falling asleep or staying asleep, or waking up feeling tired.
  • Headaches.
  • Morning stiffness.
  • Trouble thinking clearly.
  • Irritable bowel syndrome.

Symptoms tend to come and go. You may have times when you hurt more, followed by times when symptoms happen less often, are milder, or are absent (remission). 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.

How is fibromyalgia treated?

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.

There are many steps you can take to manage your symptoms. The treatment you need or want may be based on:

  • How bad your symptoms are.
  • Whether the condition is disrupting your daily life.
  • What kinds of changes in your life you are willing and able to make.

Because the symptoms of fibromyalgia can come and go, you may find it hard to judge whether a certain 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.

Try to be patient. Finding the right treatment can take time. You may have to try several different treatments to find an approach that works for you.


Getting regular exercise, especially cardiovascular exercise, is one of the best ways to manage fibromyalgia. Pool exercise, like water aerobics or swimming, is a good example.

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.


Medicines are part of the long-term treatment of fibromyalgia. They may 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 your doctor may suggest nonprescription pain relievers.

Not all people with fibromyalgia will need, want, or benefit from medicines. You might need to try more than one medicine before you find 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.


Cognitive behavioral therapy and other forms of counseling, including relaxation therapy and biofeedback, can help people who have fibromyalgia. Counseling can help with the pain of fibromyalgia. It can also help with sleep problems and fatigue. And it may improve your mood.


Taking care of yourself is an important part of managing fibromyalgia. For example, you can:

  • Identify sleep problems, if you have them. Then learn about ways to get more restful sleep.
  • Relieve pain and stiffness with medicines and heat.
  • Identify "triggers" that seem to make your symptoms worse. Then you can learn to avoid or manage them. Triggers may be a change in the weather, certain activities, stress, or a lack of sleep.
  • Talk to your doctor if you have signs of depression or anxiety.

With help, you can start working on most of these goals at home. You may have a team of health professionals to help you.

How is fibromyalgia diagnosed?

There are no specific tests that can confirm a diagnosis of fibromyalgia. You will probably have lab tests to make sure that you don't have other conditions that cause pain. These include rheumatoid arthritis, polymyalgia rheumatica, lupus, and other autoimmune diseases. Your doctor will also ask questions about your medical history and do a physical exam.

Doctors use a set of guidelines to diagnose fibromyalgia. You may be diagnosed with fibromyalgia if you have:

  • Widespread pain. Pain is widespread if it's above and below your waist and on the right and left sides of your body.
  • Other symptoms such as fatigue, trouble sleeping, and trouble thinking.
  • Symptoms that have lasted for at least 3 months.
  • No other medical explanation for why you feel this way. (For example, you don't have another health condition or disease.)

Fibromyalgia is sometimes diagnosed or described using pain and tenderness at 18 specific spots on the body. These spots are called tender points. You may also hear these called trigger points.

How are medicines used to treat fibromyalgia?

Medicines are often part of the long-term treatment of fibromyalgia. They may help when symptoms flare up. But not all people with fibromyalgia will benefit from medicines.

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:

  • Cyclobenzaprine (Amrix).
  • Antidepressants, such as duloxetine (Cymbalta), milnacipran (Savella), and amitriptyline (Elavil).
  • Anticonvulsants (seizure medicines), such as pregabalin (Lyrica) and gabapentin (Neurontin).

Tramadol (Ultram) is sometimes used for pain. Sometimes it is combined with acetaminophen.

Your doctor may try more than one medicine before finding one that works best for your symptoms. Sometimes a medicine that has been helping your symptoms doesn't seem to work as well over time. Talk with your doctor if you aren't getting relief.

Who can diagnose and treat fibromyalgia?

Health professionals who may be able to help you with fibromyalgia include:

  • Family medicine physicians.
  • Internists.
  • Nurse practitioners.
  • Physician assistants.

You may need to see a specialist who has experience with fibromyalgia. These include:

  • Rheumatologists, who have the most experience with diagnosing fibromyalgia.
  • Pain management specialists, who have experience with treatment.

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.

How can you care for yourself when you have fibromyalgia?

  • Exercise often. Walk, swim, or bike to help with pain and sleep problems and to make you feel better.
  • Try to get a good night's sleep. Go to bed and get up at the same time each day, whether you feel rested or not. Make sure you have a good mattress and pillow.
  • Reduce stress. Avoid things that cause you stress, if you can. If not, work at making them less stressful. Learn to use biofeedback, guided imagery, meditation, or other methods to relax.
  • Make healthy changes. Eat a balanced diet, quit smoking, and limit alcohol and caffeine.
  • Use a heating pad set on low or take warm baths or showers for pain. Using cold packs for up to 20 minutes at a time can also relieve pain. Put a thin cloth between the cold pack and your skin. A gentle massage might help too.
  • Be safe with medicines. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. Your doctor may talk to you about taking antidepressant medicines. These medicines may improve sleep, relieve pain, and in some cases treat depression.
  • Learn about fibromyalgia. This makes coping easier. Then, take an active role in your treatment.
  • Think about joining a support group with others who have fibromyalgia to learn more and get support.

What increases your risk for fibromyalgia?

Certain things may make you more likely to have fibromyalgia. Things that increase your risk (risk factors) include:

  • Being female.
  • Having certain health problems, such as rheumatoid arthritis, lupus, mononucleosis, or depression.
  • Having been through a traumatic event (such as a car accident).
  • Having problems with sleep.
  • Having a family history of fibromyalgia.

Why is exercise important when you have fibromyalgia?

Exercise is one of the most important treatments for fibromyalgia. Regular exercise will strengthen your muscles, increase blood flow to the muscles, and increase your endurance. It also may reduce the risk of tiny injuries to the muscles that may cause more pain. Exercise may also help you sleep better and improve your overall sense of well-being.

Mild to moderate exercise is appropriate for most people with this condition. A balanced exercise program should include:

  • Low-impact aerobic exercise, such as walking, swimming, biking, or water aerobics. This is the most helpful type of exercise for people who have fibromyalgia. That is because it builds general strength and endurance.
  • Stretching exercises. This can help relax tight muscles and ease spasms.
  • Strengthening exercises to build stronger muscles.

Moderate activity is safe for most people. But it's always good to talk to your doctor before you start an exercise program.

How is counseling used to treat fibromyalgia?

The pain and other symptoms of fibromyalgia can get worse during stressful times. The good news is that there are a lot of things you can do to lower your stress. For example, research shows that you can change how you think. And how you think affects how you feel.

Here are some techniques you can try on your own or with help from a therapist or counselor trained in muscle relaxation, meditation, biofeedback, or cognitive behavioral therapy:

  • Biofeedback
  • Breathing exercises for relaxation
  • Cognitive behavioral therapy for pain management
  • Guided imagery to relax
  • Progressive muscle relaxation
  • Mindfulness-based stress reduction
  • Reframing negative thoughts

Fibromyalgia Tender Points

Fibromyalgia tender points

Tender points are specific sites on the body that cause pain when pressed. The pain may spread when a tender point is pressed and causes pain in a larger area (for example, down the leg, arm, or back).

There are 9 pairs of tender points. Each pair has one point on each side of the body, for a total of 18 points. These pairs are located:

  • At the back of the neck behind the ear, where the neck muscles attach to the base of the skull.
  • About halfway between the base of the neck and the tip of the shoulder.
  • At the spot where the back muscles attach to the shoulder blade.
  • On the front of the neck above the collarbone.
  • Just to the right and left of the breastbone (sternum) about 2 in. (5 cm) below the collarbone.
  • On each forearm just below and to the outside of the crease of the elbow.
  • Just above and to the outside of each buttock.
  • On the outer upper leg just behind the bony part of the hip (this point is easier to find when standing).
  • On the inside of each knee.

Experts call these tender points, but you may also hear them called trigger points.

What types of complementary therapy are used to treat fibromyalgia?

Complementary treatments that have been used to treat fibromyalgia include:

  • Acupuncture.
  • Chiropractic therapy.
  • Dietary supplements, herbal products, and vitamins.
  • Massage therapy.
  • Meditation.
  • Tai chi and qi gong.
  • Yoga.

Most mind and body practices—such as acupuncture, tai chi, and yoga—are safe when used under the care of a well-trained professional. Choose an instructor or practitioner as carefully as you would choose a doctor.

Talk with your doctor about the safety and potential side effects of the treatment. Remember that fibromyalgia doesn't physically harm you or damage your body. A treatment that could be harmful may not be worth the risk, especially when its benefits are unproven. Avoid treatments that may be harmful, such as unusual diets or excessive vitamin or mineral supplements. (A daily multiple vitamin-mineral supplement is okay. Try to avoid taking more than 100% of the recommended dietary allowance for any vitamin or mineral unless your doctor prescribes a special supplement.)

What causes fibromyalgia?

No one knows for sure what causes fibromyalgia. But experts have some ideas. For example, nerve cells may be too sensitive. Or chemicals in the brain (neurotransmitters) may be out of balance.

What is fibromyalgia?

Fibromyalgia is a condition that causes widespread pain in the muscles and soft tissues. This pain is felt 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. The pain can be long-lasting (chronic). But fibromyalgia isn't life-threatening, and it doesn't damage the muscles, joints, or internal organs.

Fibromyalgia is a syndrome or a set of symptoms that occur together. It has no cure. When it's not controlled, you may not have any energy. Or you may feel depressed or have trouble sleeping. But with treatment, most people with fibromyalgia are able to work and do their regular activities.

Managing fibromyalgia cognitive problems

"Fibro fog" is the name commonly given to the cognitive problems that can go along with fibromyalgia syndrome. These problems with concentration and memory can lead to confusion, losing your train of thought, or forgetting or mixing up words or details.

You can take steps to manage fibro fog. Try some of the following tips.

  • Write it down.

    Making a note helps you get a thought more firmly in your mind. You might want to keep a calendar or notebook with you so you can write things down while you're thinking of them.

  • Get treated.

    Other symptoms that commonly go along with fibromyalgia-including depression, pain, and lack of sleep-can also make it harder to concentrate and remember. Medical treatment for these other problems may also help your memory.

  • Stay active—mind and body.

    Keep your mind working by doing puzzles, reading, or seeing a play to get yourself thinking. Moderate physical activity can increase your energy and help clear the fibro fog. Talk with your doctor or physical therapist about an exercise program that is right for you.

  • Find ways to help you focus.

    Try breaking tasks up into small steps. Don't take on more than you can comfortably manage, so you're not trying to do too much at once. When you do start a task, avoid distractions that can keep you from concentrating. A loud radio or TV, or trying to work where other people are talking, can make it hard for you to focus on what you're doing. Try working in a quiet place when you are trying to concentrate or remember, so you can give the task your full attention.

Fibromyalgia: When to call

Watch closely for changes in your health, and be sure to contact your doctor if:

  • You feel sad, helpless, or hopeless; lose interest in things you used to enjoy; or have other symptoms of depression.
  • Your fibromyalgia symptoms get worse.

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