Fibromyalgia: Causes, Symptoms, Diagnosis, and Treatment

Fibromyalgia is characterized by symptoms of muscular or joint pain, fatigue, poor sleep, depression, and cognitive issues such as memory problems and difficulty concentrating. The areas of pain are widespread throughout the body. There is no cure for fibromyalgia — treatment is aimed at alleviating the symptoms.

What is fibromyalgia?

In the past, it was controversial whether the condition existed or was just in the minds of the patients. However, in the past 30 years, there has been much progress in identifying the condition. Nowadays, fibromyalgia is an accepted diagnosis and condition.

It is estimated that fibromyalgia affects 2–6% of the population, with females more often than males. Fibromyalgia is a disease of middle-aged people, usually between 25 and 55.

Causes of fibromyalgia

Although, the exact cause of fibromyalgia is currently unknown, it is believed to be related to trauma, such as physical trauma, psychological stress, or certain infections.

The pain from fibromyalgia is augmented by our central nervous system (brain and spinal cord) due to imbalances in our neurochemical (small organic molecules that participate in neural activity) system. In other words, our brains may sense more pain than should be present in the area, either by increased sensitization or decreasing the inhibitory pain fibers. Studies are currently being done to verify this theory.

Symptoms of fibromyalgia

Fibromyalgia consists of widespread feelings of pain through the body. The symptoms differ from person to person but generally include:

  • Pain. Joint and muscle aches in various locations around the body.
  • Low quality of sleep. Poor sleep is often reported in those with fibromyalgia.
  • Fatigue. Tiredness and a general lack of energy is often associated with this condition.
  • Depression. Feelings of sadness, anger and mood swings are common.
  • Cognition. Cognitive issues such as impacted memory or poor concentration are sometimes linked with fibromyalgia'.
  • IBS. Irritable Bowel Syndrome (IBS) presents in some cases.
  • TMD and TMJ. Temporomandibular disorder (TMD) and it's subtype temporomandibular joint disorder (TMJ) have been associated with fibromyalgia.

How is fibromyalgia diagnosed?

The history can elicit multiple areas of pain in addition to a recent history of physical or psychological trauma. Let your physician know if you've been under any recent significant psychological stressors. A history of symptoms for three or more months is needed to make the diagnosis.

Physical exam

A physical exam will check for areas of tenderness in the muscles and joints. In the past, a certain number of tender areas was needed, but nowadays, only widespread tenderness or pain is required for diagnosis.

Even though there is no specific laboratory test for fibromyalgia, it is essential to do bloodwork to help rule out other conditions that cause similar types of pain:

  1. Test of erythrocyte sedimentation rate (ESR) for inflammatory conditions;
  2. Test of antinuclear body (ANA) for rheumatoid arthritis;
  3. Test of the blood calcium level (muscle cramps can result from low calcium levels);
  4. Test of a rheumatoid factor (RF) for rheumatoid arthritis and other inflammatory conditions.

Imaging studies

Even though there are no specific fibromyalgia findings on imaging studies, they can help identify other conditions that cause pain.

  • Plain x-rays. X-rays allow the physician to view the underlying bones. It is first necessary to rule out any underlying bony abnormalities such as a fracture (break), spur (bony prominence), or osteoporosis (thinning of the bones). In cases of osteoarthritis and rheumatoid arthritis, the joints could show x-ray findings of narrowing, spurs, bony cysts, or sclerosis (hardening of the bones). Metastatic cancer that has spread to the bone can appear as "punched-out" lesions on x-rays. These lesions resemble raindrops hitting a surface and splashing.
  • CT and MRI scans. Computed tomography (CT) and magnetic resonance imaging (MRI) evaluate soft tissue structures not seen on x-rays, including the muscles, tendons, and ligaments. Both produce computer-generated three-dimensional views for the reviewing physician.

Fibromyalgia treatment options

Once it is determined that the diagnosis is fibromyalgia, it can be treated as such. Since there is no cure for fibromyalgia, the treatment aims to alleviate the symptoms with medications, lifestyle changes, and cognitive-behavioral help.


  • Over-the-counter (OTC) analgesics. For example, acetaminophen (Tylenol), can help with the pain, although caution must be used since liver disease can result from excessive use.
  • Non-steroidal anti-inflammatory drugs (NSAIDs). Fibromyalgia is not considered an inflammatory disease; thus, prescription nonsteroidal anti-inflammatory drugs (NSAIDs) are not indicated as a treatment. However, many over-the-counter NSAIDs can help with the pain, including aspirin, ibuprofen, and naproxen. Prolonged use of OTC NSAIDs is not recommended since they can cause conditions like stomach ulcers and stroke. Other side effects include nausea, vomiting, diarrhea, and constipation.
  • Antidepressants. Several classes of antidepressants can help with the pain and fatigue of fibromyalgia, including tricyclics like Elavil (amitriptyline). Newer antidepressants include Cymbalta (duloxetine) and milnacipran (Savella), which increase the levels of neurotransmitters serotonin and norepinephrine.
  • Muscle relaxers. These can help but have a common side effect of drowsiness. Commonly used muscle relaxers include Flexeril (cyclobenzaprine), Soma (carisoprodol), and Robaxin (methocarbamol).
  • Anti-seizure medications. These can help reduce the nerve pain associated with fibromyalgia. Neurontin (gabapentin) and Lyrica (pregabalin) are examples; however, like muscle relaxers, they can produce drowsiness.
  • Opioids. Narcotic pain medicines (opioids) will help with the pain but should not be used in the long term; these medicines are considered addictive, meaning you need a higher and higher dose to get the same pain relief.

Lifestyle changes

Combining cardiovascular exercise with weight training is ideal. In addition, we recommend you lightly stretch before exercise and moderately after exercise; however, don't overdo the stretching since it could lead to injury.

  • Cardio. Walking, running, biking, hiking, and using elliptical machines are excellent activities for cardiovascular exercise. For those that cannot tolerate the activities mentioned above, pool exercises can be beneficial. These can include lap swimming or water aerobics.
  • Weight training. Bodyweight exercises and free-weights are great for building strength.
  • Smoking. Avoid cigarette smoking.
  • Doctor. See your doctor regularly.
  • Diet. Eat a healthy diet.
  • Sleep. Get enough rest and sleep.

All these lifestyle changes will improve a person's overall health, especially in the long term.

Wearing a mouth guard, especially at night, can help treat the TMD and TMJ conditions. Numerous types are available, including custom, pre-made, soft, or firm.

Cognitive behavioral therapy (CBT)

A mental health counselor may be needed to deal with the psychological issues associated with fibromyalgia, including chronic fatigue, depression, insomnia, and other mental health issues.

Even though there is no cure for fibromyalgia, there are options for treating the symptoms.

Key takeaways:

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