4-Patient education_ Fibromyalgia (Beyond the Basics) - UpToDate

Patient education: Fibromyalgia (Beyond the Basics) - UpToDate 7/9/24, 5:30 PM
Official reprint from UpToDate®

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Patient education: Fibromyalgia (Beyond the Basics)

author: Don L Goldenberg, MD
section editor: Daniel J Wallace, MD
deputy editor: Siobhan M Case, MD, MHS
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Jun 2024.

This topic last updated: Aug 11, 2023.
Please read the Disclaimer at the end of this page.
FIBROMYALGIA OVERVIEW
Fibromyalgia is one of a group of chronic pain disorders or syndromes that affect connective
tissues, including the muscles, ligaments (the tough bands of tissue that bind together the
ends of bones), and tendons (which attach muscles to bones). It is a chronic condition that
causes widespread muscle pain (known as "myalgia") and extreme tenderness in many areas
of the body. Many patients also experience fatigue, sleep disturbances, headaches, and
mood disturbances such as depression and anxiety. Despite ongoing research, the cause,
diagnosis, and optimal treatment of fibromyalgia are not clear.
In the United States, fibromyalgia affects about 2 percent of people by age 20, which
increases to approximately 8 percent of people by age 70; it is the most common cause of
generalized musculoskeletal pain in women between 20 and 55 years. It is more common in
women than men.
FIBROMYALGIA CAUSES
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The cause of fibromyalgia is unknown. Various physical or emotional factors (such as

infection, injury, or stress) may play a role in triggering symptoms, although many patients
report a lifelong history of chronic pain.
In people with fibromyalgia, the muscles and tendons are excessively irritated by various
painful stimuli. This is thought to be due to a heightened perception of pain, a phenomenon
called "central sensitization." Other conditions may also develop as a result of central
sensitization, including irritable bowel syndrome (IBS); chronic fatigue syndrome (CFS), also
known as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS); chronic headaches;
chronic pelvic and bladder pain; and chronic jaw and facial pain.
There is no generally agreed-upon explanation for how or why central sensitization develops
in some people. The most plausible theory suggests that there is a genetic component,
meaning that some people are predisposed to having a heightened sense of pain. People
with a parent or sibling with fibromyalgia have a higher chance of developing it themselves.
In some cases, various stressors, including infection (eg, Lyme disease or viral illness),
diseases that involve joint inflammation (eg, rheumatoid arthritis or systemic lupus
erythematosus), physical or emotional trauma, or sleep disturbances appear to trigger the
development of fibromyalgia. Some people who have coronavirus disease 19 (COVID-19)
infection have fatigue, muscle pain, and joint pain that last for months. This condition is
called "long COVID" and shares many similarities with fibromyalgia. (See "Patient education:
Long COVID (The Basics)".)
Brain imaging studies in people with fibromyalgia and related chronic pain disorders have
shown changes in brain function and connections between different parts of the brain. As
research continues, the factors that lead to chronic pain in fibromyalgia will be better
understood, hopefully allowing for the development of better treatments.
FIBROMYALGIA SYMPTOMS
Muscle and soft tissue pain — The primary symptom of fibromyalgia is widespread (or
"diffuse"), chronic, and persistent pain. Although the pain is felt in muscles and soft tissues,
there are no visible abnormalities in these areas. The pain may be described as a deep
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muscular aching, soreness, stiffness, burning, or throbbing. Patients may also feel
numbness, tingling, or unusual "crawling" sensations in the arms and legs. Although some
degree of muscle pain is always present, it varies in intensity and is aggravated by certain
conditions, such as anxiety or stress, poor sleep, exertion, or exposure to cold or damp
conditions. People often describe their muscle symptoms as feeling like they always have the
flu.
The pain may be confined to specific areas, often the neck or shoulders, early in the course
of the disease. Multiple regions are eventually involved, with most patients experiencing pain
in the neck, middle and lower back, arms and legs, and chest wall. Areas called "tender
points" can feel painful with even mild to moderate pressure. Many patients with
fibromyalgia feel that their joints are swollen, although there is no visible inflammation of
the joints (as would be found in forms of arthritis).
Other pain symptoms — Patients with fibromyalgia are often affected by other pain-related
symptoms, including:
● Repeated headaches, including migraines (see "Patient education: Headache causes

and diagnosis in adults (Beyond the Basics)")
● Symptoms of irritable bowel syndrome (IBS), including frequent abdominal pain and
episodes of diarrhea, constipation, or both (see "Patient education: Irritable bowel
syndrome (Beyond the Basics)")
● Interstitial cystitis/painful bladder syndrome, in which bladder pain and urinary urgency
and frequency are typically present without an infection (see "Patient education:
Diagnosis of interstitial cystitis/bladder pain syndrome (Beyond the Basics)"); and
chronic, unexplained pelvic pain
● Temporomandibular joint (TMJ) syndrome, which can involve limited jaw movement;
clicking, snapping, or popping sounds while opening or closing the mouth; pain within
facial or jaw muscles in or around the ear; or headaches
Fatigue and sleep disturbances — Persistent fatigue occurs in more than 90 percent of
people with fibromyalgia. Most people complain of unusually light, unrefreshing, or
nonrestorative sleep. Difficulties falling asleep, awakening repeatedly during the night, and
feeling exhausted upon awakening are also common problems.
People with fibromyalgia may also have sleep apnea (when the person stops breathing for a
few moments while sleeping) or restless legs syndrome (when there is an uncontrollable
urge to move the legs). Like some painful conditions, these sleep problems might also be
triggers of fibromyalgia. If you have one or both of these problems, your doctor will likely
recommend a formal sleep evaluation to confirm the diagnosis. (See "Patient education:
Sleep apnea in adults (Beyond the Basics)".)
There appears to be a close relationship between fibromyalgia and chronic fatigue syndrome
(CFS), also known as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which is
primarily characterized by chronic, debilitating fatigue. Most patients with CFS meet the
"tender point" criteria for fibromyalgia (meaning that they have pain in many of the areas
commonly affected in people with fibromyalgia), and up to 70 percent of those with
fibromyalgia meet the criteria for CFS ( table 1). A better understanding of both conditions
is needed to clarify how they may be related. (See "Patient education: Myalgic
encephalomyelitis/chronic fatigue syndrome (Beyond the Basics)".)
Depression and anxiety — Many people with fibromyalgia also have depression and/or
anxiety at the time of diagnosis, or develop one or both later in life. However, this is true of
most chronic pain conditions, and fibromyalgia is not simply a physical manifestation of
depression. (See "Patient education: Depression in adults (Beyond the Basics)".)
FIBROMYALGIA DIAGNOSIS
There are no specific laboratory or imaging tests used to diagnose fibromyalgia. Thus, the
diagnosis is typically based upon a thorough patient history, a complete physical
examination, and a limited number of blood tests, which are used to exclude conditions with
similar symptoms.
Different diagnostic guidelines have been used, and different health care providers may vary
in their process, but all approaches involve evaluating your pain, fatigue, and other
symptoms that may be related.
● The American College of Rheumatology (ACR) developed classification criteria for

fibromyalgia in 1990 that have often been used to help make the diagnosis. According
to these criteria, a person can be diagnosed with fibromyalgia if he or she has
widespread musculoskeletal pain and excess tenderness in at least 11 of 18 specific
"tender points" (based on clinician examination).
● The ACR released updated diagnostic criteria in 2010. These criteria do not require a
tender point examination but use a numerical scoring system based on how
widespread and severe a person describes their pain to be. They also consider other
symptoms such as fatigue, cognitive problems (eg, trouble thinking clearly), and other
pain-related issues such as headache or digestive problems.
● Diagnostic criteria proposed by the Addiction Clinical Trial Translations, Innovations,

Opportunities, and Networks (ACTTION)-American Pain Society (APS) Pain Taxonomy
(AAAPT) include multisite pain (defined as at least six out of nine possible sites) and
moderate to severe sleep problems or fatigue, present for at least three months.
If you have symptoms of fibromyalgia, your doctor should obtain a medical history and do a
physical exam to rule out arthritis, other connective tissue problems, neurologic conditions,
and other disorders that may be causing your symptoms (see 'Conditions that can be similar
to fibromyalgia' below). Routine laboratory tests may be recommended to help exclude
certain conditions, such as inflammatory arthritis, thyroid disease, and disorders of the
muscles. Results of these tests are normal in most people with fibromyalgia.
Because people with fibromyalgia frequently have symptoms besides muscle pain, including
persistent fatigue, headache, additional pain symptoms, and sleep and mood disturbances,
your doctor may also suggest the following:
● Informal or formal evaluation of mood problems such as depression or anxiety – If you

have symptoms of depression or anxiety, you may be referred to a mental health
specialist for further evaluation or treatment.
● A thorough sleep history – If your sleep history suggests a sleep disturbance such as
restless legs syndrome or sleep apnea, you will be referred to a sleep specialist for
additional evaluation and treatment. (See "Patient education: Sleep apnea in adults
(Beyond the Basics)".)
Conditions that can be similar to fibromyalgia — The process of determining whether a

person's signs and symptoms are related to fibromyalgia or to another condition can be
lengthy and complex in some cases. Many illnesses can cause generalized muscle aches,
fatigue, and other common symptoms of fibromyalgia.
It is important to note that fibromyalgia can occur in people with rheumatoid arthritis,
systemic lupus erythematosus, osteoarthritis, and other conditions (see below). If this is the
case, it may be difficult to determine whether your symptoms of chronic pain and fatigue are
caused by fibromyalgia or your other condition. Often this will require consultation with a
rheumatologist.
The following is a sample of disorders that your doctor may consider during the diagnostic
process:
● Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) – RA is a chronic

disease that causes inflammation of joints, resulting in pain, swelling, and potential
deformity of the affected joints. SLE is also a chronic, inflammatory disorder of
connective tissue that can affect multiple organs.
Although both RA and SLE share many symptoms with fibromyalgia, they have other
features that are not usually seen in people with fibromyalgia, including inflammation
of the synovial membranes (connective tissue that lines the spaces between bones and
joints). (See "Patient education: Systemic lupus erythematosus (Beyond the Basics)" and
"Patient education: Rheumatoid arthritis symptoms and diagnosis (Beyond the
Basics)".)
● Osteoarthritis (OA) – OA causes stiffness, tenderness, pain, and potential deformity of

affected joints, and it most commonly occurs in older individuals. Doctors can
differentiate OA from fibromyalgia based upon a person's medical history, physical
examination, and x-ray results (in OA, x-rays can show degenerative joint changes that
are not present in fibromyalgia). (See "Patient education: Osteoarthritis symptoms and
diagnosis (Beyond the Basics)".)
● Ankylosing spondylitis (AS) – AS is a chronic, progressive, inflammatory disease

involving joints of the spine. This condition leads to stiffness, pain, and decreased
movement of the spine. AS also causes characteristic findings that can be seen on x-ray,
which are absent in people with fibromyalgia. By contrast, spinal motion and x-rays are
usually normal in people with fibromyalgia. (See "Patient education: Axial
spondyloarthritis, including ankylosing spondylitis (Beyond the Basics)".)
● Polymyalgia rheumatica (PMR) – PMR is a chronic, inflammatory condition that causes

stiffness and pain in the shoulders, hips, or other areas of the body. The disorder, which
primarily affects people older than 50, is frequently associated with inflammation of
certain large arteries. PMR is differentiated from fibromyalgia based upon a person's
medical history, physical examination, and blood tests. (See "Patient education:
Polymyalgia rheumatica and giant cell arteritis (Beyond the Basics)".)
● Sjogren’s syndrome – These patients are often tired and achy but are usually over the
age of 50 and have dry eyes and dry mouth.
● Hypothyroidism and other endocrine disorders – Decreased activity of the thyroid

gland, known as hypothyroidism, can cause fatigue, sleep disturbances, and
generalized aches, similar to those in fibromyalgia. Blood tests to measure thyroid
function are routinely conducted to help exclude hypothyroidism. Other endocrine
disorders, including increased activity of the parathyroid glands (hyperparathyroidism),
can also cause symptoms similar to fibromyalgia. (See "Patient education:
Hypothyroidism (underactive thyroid) (Beyond the Basics)" and "Patient education:
Primary hyperparathyroidism (Beyond the Basics)".)
● Muscle inflammation (myositis) or muscle disease due to metabolic abnormalities

(metabolic myopathy) – These conditions cause muscle fatigue and weakness, but not
the widespread pain seen in fibromyalgia. In addition, patients with myositis typically
have abnormal levels of muscle enzymes. (See "Patient education: Polymyositis,
dermatomyositis, and other forms of idiopathic inflammatory myopathy (Beyond the
Basics)".)
● Neurologic disorders – These may include disorders of the brain and spinal cord
(central nervous system or CNS) or of nerves outside the CNS (peripheral nervous
system) such as myasthenia gravis or multiple sclerosis. A thorough neurologic
examination can assist in differentiating fibromyalgia from neurologic disease. A subset
of people with fibromyalgia may have evidence of nerve damage and should be
referred to a neurologist.
FIBROMYALGIA TREATMENT
Ideally, the treatment of fibromyalgia should involve you and your doctor, as well as (in many
cases) a physical therapist, mental health expert, and other health care professionals.
It may help to keep the following in mind:
● Fibromyalgia is a real illness, and your pain is not "all in your head."
● Fibromyalgia is not a degenerative or deforming condition, nor does it result in life-

threatening complications. However, treatment of chronic pain and fatigue is
challenging, and there are no "quick cures."
● Treatments are available. Medications may be helpful in relieving pain, improving your
quality of sleep, and improving your mood. Exercise, stretching programs, and other
activities are also important in helping to manage symptoms. An approach that involves
combining multiple different types of intervention into an organized treatment
program is usually best. Being physically active will not cause harm or long-term muscle
damage, and it can help improve pain and function.
● Understanding fibromyalgia, and accepting that its cause is not well understood, may
help to improve your response to treatment. As an example, some people believe that
their illness is due to an undiagnosed or persistent infection; however, there is no
evidence that this is true. Learning about fibromyalgia as well as some of the common
myths may help you to cope better with your symptoms.
● It is important to try to have realistic expectations about your fibromyalgia and how
much it can be managed. Symptoms often increase and decrease over time, but some
degree of muscle pain and fatigue generally persist. Nevertheless, most people with
fibromyalgia improve, and most people lead full, active lives.
Medications — In addition to exercise and coping techniques to help manage symptoms,

many people with fibromyalgia benefit from medication. The medications that have been
most effective in relieving symptoms of fibromyalgia in clinical trials are drugs that target
chemicals in the brain and spinal cord that are important in processing pain. These include
some of the medications usually used to treat depression (antidepressants) and epilepsy
(anticonvulsants). By contrast, medications and techniques that work to decrease symptoms
of pain locally, such as antiinflammatory drugs and analgesics, are less effective.
The best medication for you will depend on your symptoms, preferences, and cost concerns,
as well as which drugs are available in your area. Your doctor can talk to you about options
and how to begin medication therapy. In general, medication is usually started at a low dose
and then increased slowly as needed.
Antidepressants — There are several different classes of drugs used to treat depression
(see "Patient education: Depression treatment options for adults (Beyond the Basics)"). Some
of these can be effective in treating fibromyalgia symptoms as well.
● Tricyclic antidepressants (TCAs) – These drugs are often used first in treating
fibromyalgia. Examples include amitriptyline and nortriptyline. Cyclobenzaprine, a
closely related medication, may help in treating fibromyalgia but is not effective for
depression. Taking TCAs before bedtime may promote deeper sleep and may alleviate
muscle pain. Lower doses are usually used in fibromyalgia than the doses needed to
treat depression, but even when taken at low doses, side effects are common; they may
include dry mouth, fluid retention, weight gain, constipation, or difficulty concentrating.
● Dual-reuptake inhibitors – These drugs, also called serotonin-norepinephrine reuptake

inhibitors (SNRIs), can help with symptoms of fibromyalgia as well. They include
duloxetine and milnacipran. The most common side effects are nausea and dizziness,
but these are generally more tolerable if the dose is started at a low level and is
increased very slowly.
● Selective serotonin-reuptake inhibitors – Selective serotonin-reuptake inhibitors (SSRIs)
such as fluoxetine and paroxetine may also be effective in fibromyalgia. However, they
are not as effective for pain reduction as the tricyclic or dual-reuptake medications.
SSRIs are not typically used as initial treatment of fibromyalgia, but doctors might try
them in some situations. These are a group of antidepressant drugs that work to
increase the concentration of serotonin in the brain. Serotonin is a naturally produced
chemical that regulates the delivery of messages between nerve cells.
Anticonvulsants — Certain anticonvulsants (drugs used primarily for treating epilepsy)

may help to relieve pain and improve sleep. They include pregabalin and gabapentin and are
thought to relieve pain by blocking certain chemicals that increase pain transmission. The
most common side effects of these drugs include feeling sedated or dizzy, gaining weight, or
developing swelling in the lower legs; however, most people tolerate these medications well.
Often, more than one class of these drugs are used together. For example, a low dose of a
serotonin-norepinephrine reuptake inhibitor would be taken in the morning and a low dose
of a tricyclic antidepressant or another drug would be taken at bedtime.
Other drugs — You may wonder about other medications for treating your symptoms.
However, evidence is limited, and it's important to talk with your doctor about your situation
and what approach is most likely to help.
Fibromyalgia does not cause tissue inflammation; thus, neither nonsteroidal

antiinflammatory drugs (NSAIDs) such as ibuprofen (sample brand names: Advil, Motrin) or
naproxen (sample brand name: Aleve) nor glucocorticoids (steroids) are effective in relieving
fibromyalgia symptoms. Analgesics or antiinflammatory drugs may be useful for concurrent
osteoarthritis or localized musculoskeletal pain. (See "Patient education: Nonsteroidal
antiinflammatory drugs (NSAIDs) (Beyond the Basics)".)
Analgesics (pain-relieving medications) are sometimes added to fibromyalgia medications for

people who need additional short-term pain relief. They include acetaminophen (sample
brand name: Tylenol) and the prescription medication tramadol (sample brand name:
Ultram), which may be used alone or in combination. Tramadol is an opioid, although it is
weaker than other opioid drugs and less likely to result in addiction. It may cause dizziness,
diarrhea, or sleep disturbances in some people.
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There is no evidence that long-term opioids are effective in treating fibromyalgia symptoms,
and these drugs come with potentially serious side effects as well as a risk of addiction.
There is some evidence that fibromyalgia can worsen when opioids are given (opioid-induced
hyperalgesia). Some people with fibromyalgia have reported that cannabis products,
particularly cannabidiol (CBD), are helpful; however, this has not been studied sufficiently to
confirm benefit and safety of these compounds. The Arthritis Foundation has urged the US
Food and Drug Association (FDA) to expedite the study and regulation of cannabis for the
treatment of fibromyalgia.
Non-medication treatments
Exercise — Regular exercise, such as walking, swimming, or biking, is helpful in reducing

muscle pain and improving muscle strength and fitness in fibromyalgia. If you are beginning
an exercise program for the first time, it's best to start slowly and gradually increase your
level of activity. Over time, exercise typically improves fibromyalgia symptoms. Muscle
strengthening programs also appear to improve pain, and improve muscle strength. Water
exercise is often a helpful way to initiate a very low-impact exercise program.
It can also help to work with a physical therapist to develop an appropriate, individualized
exercise program that will be of most benefit to you. Eventually, a good goal is to exercise for
at least 30 minutes three times weekly. A separate topic review discusses exercise and
arthritis; some of these approaches may also help people with fibromyalgia. (See "Patient
education: Arthritis and exercise (Beyond the Basics)".)
Relaxation therapies — In some cases, participating in stress-reduction programs,

learning relaxation techniques, or participating in hypnotherapy (hypnosis), biofeedback, or
cognitive behavioral therapy (CBT) may help to relieve certain symptoms. Remedies that
focus upon the mind-body connection are an important adjunct in the management of
fibromyalgia. Of these approaches, the most is known about CBT.
● CBT is based on the concept that people's perceptions of themselves and of their
surroundings affect their emotions and behavior. The goal of CBT is to change the way
you think about pain and to deal with illness more positively. CBT has been especially
effective when combined with patient education and information, ie, learning about
your disease and how to manage it.
● Mind-body stress reduction (MBSR) programs have been effective in fibromyalgia. MBSR
may be individual or as part of a group and may involve discussion, meditation, and
other techniques, such as hypnosis and biofeedback. During biofeedback, patients use
information about typically unconscious bodily functions, such as muscle tension or
blood pressure, to help gain conscious control over such functions.
Tai chi, Pilates, and yoga — Some people with fibromyalgia benefit from a traditional
Chinese exercise called tai chi (which combines mind-body practice with gentle, flowing
movement exercises) or yoga.
Tai chi, yoga, and Pilates strengthen and stretch the muscles and decrease pain.
Acupuncture — Acupuncture involves inserting hair-thin, metal needles into the skin at
specific points on the body. It causes little to no pain. In some cases, a mild electric current is
applied to the needle, termed electroacupuncture. Most studies have found acupuncture to
be helpful but there has been little difference found between traditional and "sham"
acupuncture.
Multidisciplinary therapy — Fibromyalgia typically responds best to an integrated

management program, combining medications, exercise, and cognitive approaches. This
works best if a team of health care professionals is involved.
LIVING WITH FIBROMYALGIA
While fibromyalgia is not a life-threatening disorder, many people worry that their symptoms
represent the "early stages" of a more serious condition, such as systemic lupus
erythematosus. However, long-term studies do not indicate that people with fibromyalgia
have an increased risk of developing other rheumatic diseases or neurologic conditions.
Most people with fibromyalgia continue to have chronic pain and fatigue throughout their
lives. However, most people are able to work and do normal activities. The degree to which
fibromyalgia impacts a person's day-to-day life varies, and everyone's situation is unique.
Working with your doctors (and other health care providers) to understand your condition
and manage your symptoms, learning effective coping techniques, and having strong family
and social support can really help improve and maintain your quality of life.
It is important for patients with fibromyalgia to be as active as possible. Most patients are
able to continue to work, although workplace modifications may be helpful. Alternating
periods of activity with periods of rest is advised.
WHERE TO GET MORE INFORMATION
Your healthcare provider is the best source of information for questions and concerns related
to your medical problem.
This article will be updated as needed on our web site ( www.uptodate.com/patients).

Related topics for patients, as well as selected articles written for healthcare professionals,
are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a
patient might have about a given condition. These articles are best for patients who want a
general overview and who prefer short, easy-to-read materials.
Patient education: Fibromyalgia (The Basics)

Patient education: Myalgic encephalomyelitis/chronic fatigue syndrome (The Basics)
Patient education: Complex regional pain syndrome (The Basics)
Patient education: Sjögren's disease (The Basics)
Beyond the Basics — Beyond the Basics patient education pieces are longer, more
sophisticated, and more detailed. These articles are best for patients who want in-depth
information and are comfortable with some medical jargon.
Patient education: Headache causes and diagnosis in adults (Beyond the Basics)
Patient education: Irritable bowel syndrome (Beyond the Basics)
Patient education: Diagnosis of interstitial cystitis/bladder pain syndrome (Beyond the Basics)
Patient education: Sleep apnea in adults (Beyond the Basics)

Patient education: Myalgic encephalomyelitis/chronic fatigue syndrome (Beyond the Basics)
Patient education: Depression in adults (Beyond the Basics)
Patient education: Lyme disease symptoms and diagnosis (Beyond the Basics)
Patient education: Systemic lupus erythematosus (Beyond the Basics)
Patient education: Rheumatoid arthritis symptoms and diagnosis (Beyond the Basics)
Patient education: Osteoarthritis symptoms and diagnosis (Beyond the Basics)
Patient education: Axial spondyloarthritis, including ankylosing spondylitis (Beyond the
Basics)
Patient education: Polymyalgia rheumatica and giant cell arteritis (Beyond the Basics)
Patient education: Hypothyroidism (underactive thyroid) (Beyond the Basics)
Patient education: Primary hyperparathyroidism (Beyond the Basics)
Patient education: Polymyositis, dermatomyositis, and other forms of idiopathic
inflammatory myopathy (Beyond the Basics)
Patient education: Depression treatment options for adults (Beyond the Basics)
Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (Beyond the Basics)
Patient education: Arthritis and exercise (Beyond the Basics)
Professional level information — Professional level articles are designed to keep doctors
and other health professionals up-to-date on the latest medical findings. These articles are
thorough, long, and complex, and they contain multiple references to the research on which
they are based. Professional level articles are best for people who are comfortable with a lot
of medical terminology and who want to read the same materials their doctors are reading.
Clinical manifestations and diagnosis of fibromyalgia in adults

Differential diagnosis of fibromyalgia
Pathogenesis of fibromyalgia
Fibromyalgia: Treatment in adults
The following organizations also provide reliable health information.
● National Library of Medicine

( https://medlineplus.gov/healthtopics.html)
● National Institute of Arthritis, Musculoskeletal, and Skin Diseases

( www.niams.nih.gov/, search for "fibromyalgia")
● American College of Rheumatology

( www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-
Conditions/Fibromyalgia)
● National Fibromyalgia Association

( https://www.fmaware.org/)
● The Arthritis Foundation

( www.arthritis.org)
Use of UpToDate is subject to the Terms of Use.
Disclaimer: This generalized information is a limited summary of diagnosis, treatment,

and/or medication information. It is not meant to be comprehensive and should be used as
a tool to help the user understand and/or assess potential diagnostic and treatment
options. It does NOT include all information about conditions, treatments, medications,
side effects, or risks that may apply to a specific patient. It is not intended to be medical
advice or a substitute for the medical advice, diagnosis, or treatment of a health care
provider based on the health care provider's examination and assessment of a patient's
specific and unique circumstances. Patients must speak with a health care provider for
complete information about their health, medical questions, and treatment options,
including any risks or benefits regarding use of medications. This information does not
endorse any treatments or medications as safe, effective, or approved for treating a
specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to
this information or the use thereof. The use of this information is governed by the Terms of
Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms.
2024© UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.
Topic 703 Version 33.0
GRAPHICS
Clinical similarities between fibromyalgia and chronic fatigue syndrome

(CFS), also known as systemic exertion intolerance disease (SEID)
80 to 90% women, usual age 20 to 55 years
Myalgias and fatigue in more than 90%
Associated common symptoms
Neurocognitive and mood disturbances
Headaches
Sleep disturbances
No identifiable cause
Testing not helpful
Physical examination usually normal except for tender points which are present in most patients
with both conditions
Normal laboratory and radiologic tests
Chronic symptoms, no highly effective therapy
Graphic 62764 Version 6.0
Contributor Disclosures
Don L Goldenberg, MD No relevant financial relationship(s) with ineligible companies to
disclose. Daniel J Wallace, MD Grant/Research/Clinical Trial Support: Eli Lilly and Company [Lupus];
Exagen Diagnostics [Lupus]; GlaxoSmithKline [Lupus]. Consultant/Advisory Boards: Amgen [Vasculitis];
Eli Lilly and Company [Lupus]; GlaxoSmithKline [Lupus]; Horizon [Sjögren's syndrome, lupus]; Kyverna
[Sjögren's syndrome, lupus]; Merck Serono [Lupus]; Nektar [Sjögren's syndrome, lupus]; Novartis
[Sjögren's syndrome, lupus]. Speaker's Bureau: AstraZeneca [Lupus]; Aurinia [Lupus]; GlaxoSmithKline
[Lupus]. All of the relevant financial relationships listed have been mitigated. Siobhan M Case, MD,
MHS No relevant financial relationship(s) with ineligible companies to disclose.
Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these
are addressed by vetting through a multi-level review process, and through requirements for
references to be provided to support the content. Appropriately referenced content is required of all
authors and must conform to UpToDate standards of evidence.
Conflict of interest policy

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Patient education: Fibromyalgia (Beyond the Basics) - UpToDate 7/9/24, 5:30 PM

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Patient education: Fibromyalgia (Beyond the Basics)

Literature review current through: Jun 2024.

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The cause of fibromyalgia is unknown. Various physical or emotional factors (such as

● Repeated headaches, including migraines (see "Patient education: Headache causes

● The American College of Rheumatology (ACR) developed classification criteria for

● Diagnostic criteria proposed by the Addiction Clinical Trial Translations, Innovations,

● Informal or formal evaluation of mood problems such as depression or anxiety – If you

(Beyond the Basics)".)

Conditions that can be similar to fibromyalgia — The process of determining whether a

● Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) – RA is a chronic

● Osteoarthritis (OA) – OA causes stiffness, tenderness, pain, and potential deformity of

● Ankylosing spondylitis (AS) – AS is a chronic, progressive, inflammatory disease

● Polymyalgia rheumatica (PMR) – PMR is a chronic, inflammatory condition that causes

● Hypothyroidism and other endocrine disorders – Decreased activity of the thyroid

● Muscle inflammation (myositis) or muscle disease due to metabolic abnormalities

It may help to keep the following in mind:

● Fibromyalgia is not a degenerative or deforming condition, nor does it result in life-

Medications — In addition to exercise and coping techniques to help manage symptoms,

● Dual-reuptake inhibitors – These drugs, also called serotonin-norepinephrine reuptake

● Selective serotonin-reuptake inhibitors – Selective serotonin-reuptake inhibitors (SSRIs)

Anticonvulsants — Certain anticonvulsants (drugs used primarily for treating epilepsy)

Fibromyalgia does not cause tissue inflammation; thus, neither nonsteroidal

Analgesics (pain-relieving medications) are sometimes added to fibromyalgia medications for

Exercise — Regular exercise, such as walking, swimming, or biking, is helpful in reducing

Relaxation therapies — In some cases, participating in stress-reduction programs,

your disease and how to manage it.

Multidisciplinary therapy — Fibromyalgia typically responds best to an integrated

LIVING WITH FIBROMYALGIA

WHERE TO GET MORE INFORMATION

This article will be updated as needed on our web site ( www.uptodate.com/patients).

Patient education: Fibromyalgia (The Basics)

Patient education: Sleep apnea in adults (Beyond the Basics)

Clinical manifestations and diagnosis of fibromyalgia in adults

The following organizations also provide reliable health information.

● National Library of Medicine

● National Institute of Arthritis, Musculoskeletal, and Skin Diseases

● American College of Rheumatology

● National Fibromyalgia Association

● The Arthritis Foundation

Use of UpToDate is subject to the Terms of Use.

Disclaimer: This generalized information is a limited summary of diagnosis, treatment,

Topic 703 Version 33.0

Clinical similarities between fibromyalgia and chronic fatigue syndrome

80 to 90% women, usual age 20 to 55 years

Myalgias and fatigue in more than 90%

Associated common symptoms

Neurocognitive and mood disturbances

Testing not helpful

Normal laboratory and radiologic tests

Chronic symptoms, no highly effective therapy

Graphic 62764 Version 6.0

Conflict of interest policy

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