Fibromyalgia (FM) is a long-term condition characterised by widespread chronic pain. Other symptoms can include fatigue, trouble thinking or remembering, waking up tired (unrefreshed), pain or cramps in the lower abdomen, depression, or headache. The causes of fibromyalgia are unknown, with several pathophysiologies proposed.
Fibromyalgia is estimated to affect 2 to 4% of the population. Women are affected at a higher rate than men. Rates appear similar across areas of the world and among varied cultures. Fibromyalgia was first recognised in the 1950s, and defined in 1990, with updated criteria in 2011, 2016, and 2019.
The treatment of fibromyalgia is symptomatic and multidisciplinary. Aerobic and strengthening exercise is recommended. Duloxetine, milnacipran, and pregabalin can give short-term pain relief to some people with FM. Symptoms of fibromyalgia persist long-term in most patients.
Fibromyalgia is associated with a significant economic and social burden, and it can cause substantial functional impairment among people with the condition. People with fibromyalgia can be subjected to significant stigma and doubt about the legitimacy of their symptoms, including in the healthcare system. FM is associated with relatively high suicide rates.
Terminology The term "fibromyalgia" was derived from Neo-Latin (meaning 'fibrous tissues'), Greek (, 'muscle'), and Greek (, 'pain'). Thus, the term literally means "muscle and fibrous connective tissue pain". Thus, this term is inaccurate and misleading, as it only reflects a part of the symptom set. The term "FM" is increasingly used.
Classification ICD-11 Fibromyalgia is not listed as a code in the ICD-11.
"Fibromyalgia syndrome" is listed as an inclusionInclusions in ICD-11 are terms or conditions which are judged important or commonly used in relation to a code. in the ICD-11 code of "Chronic widespread pain" (CWP) (code MG30.01). (No other signs or symptoms of fibromyalgia are mentioned.)(In ICD-10, FM had been given its own code under soft tissue disorders.
Other classifications Research seeing FM as a subset of chronic widespread pain has estimated the population prevalence of chronic widespread pain as 11% and of fibromyalgia as 2–6%.
FM has been seen as a functional somatic syndrome condition, although this term does not appear in the ICD-11.
Subgroups or clusters within FM There may be clusters of symptom characteristics within fibromyalgia. A 2024 systematic review found that fibromyalgia could be clustered according to symptom severity, adjustment to the condition, thermal pain sensitivity, personality, and response to treatment. However it stated there was a need for more objective measures, and for more validation and replication of clusters. Clustering has also been undertaken based on psychological and coping characteristics of FM people.
Signs and symptoms The characteristic symptom of fibromyalgia is chronic widespread pain. The current prevalent diagnosis method also requires an above-threshold severity score from among six other symptoms: fatigue, trouble thinking or remembering, waking up tired (unrefreshed), pain or cramps in the lower abdomen, depression, and headache. Many other symptoms can be present. The key symptoms of fibromyalgia often present concurrently, in varying severity, and are intertwined with and influence each other.
Chronic pain Chronic pain continues to be regarded as the core characteristic of fibromyalgia. According to the NHS, widespread pain is a major symptom, which could feel like an ache, a burning sensation, or a sharp, stabbing pain. Patients are also susceptible to pain, and the slightest touch can cause pain. Pain also tends to linger for a longer period when a patient experiences it. The pain associated with fibromyalgia is often a constant dull ache that has lasted for at least three months, occurring on both sides of the body and above and below the waist.
Pain in fibromyalgia may include contributions from central pain, peripheral musculoskeletal pain generators, neuropathic pain, and other pathways.
Men may be affected by FM pain differently to women.
Fatigue Fatigue is a common symptom of fibromyalgia. Patients may experience physical or mental fatigue. Physical fatigue can present as a feeling of exhaustion after exercise or limitation in daily activities. Fibromyalgia fatigue can range from feeling mildly tired to flu-like exhaustion. Severe fatigue may come on suddenly, making it difficult to be active at all. The impact of fatigue can be severe and pose more of a problem than the pain. Fatigue is a complicated, multifactorial, and vexing symptom that is highly prevalent (76%) and stubbornly persistent, as evidenced by longitudinal studies over 5 years. Fatigue does not improve with sleep or rest. Medication seems to have little impact on FM fatigue.
Sleep problems Sleep disturbances are extremely common in fibromyalgia and may occur in up to 90% of patients. These disturbances frequently include non-restorative sleep, morning tiredness, and daytime somnolence. Although patients often report poor sleep quality, insomnia itself is not considered a typical or defining feature of fibromyalgia. Instead, individuals may obtain a normal duration of sleep but still wake feeling unrefreshed due to abnormalities in sleep architecture and pain-related disruptions in restorative sleep stages.
A meta-analysis compared quantitative and qualitative sleep metrics in people with fibromyalgia and healthy people. Individuals with fibromyalgia reported lower sleep quality and efficiency, longer wake time after sleep onset, shorter sleep duration, lighter sleep, and greater difficulty initiating sleep, both quantitatively and qualitatively.
Improving sleep quality can help people with fibromyalgia manage pain.
Cognitive problems ("fibro fog") Many people with fibromyalgia experience cognitive problems often known as "fibro fog". The CDC and the American Pain Society recognize these problems as a major feature of fibromyalgia.
About 75% of people with fibromyalgia report significant problems with concentration, memory, and multitasking. A 2018 meta-analysis found that the largest differences between people with fibromyalgia and healthy subjects were in inhibitory control, memory, and processing speed. A 2023 scoping review grouped effects into subjective cognitive dysfunction, perceived variability, changes in functional activities, and participation limitations.
A 2017 review found that the neuropsychological mechanisms underlying brain fog may be similar to those in isolated functional cognitive disorders. One hypothesis is that chronic pain in fibromyalgia compromises attention systems, resulting in cognitive problems.
Other signs and symptoms People with fibromyalgia may experience hyperalgesia (abnormally increased sensitivity to pain) and allodynia (pain from a stimulus that does not normally elicit pain). People with FM may be intolerant to bright lights, loud noises, perfumes, and cold. Other symptoms may be musculoskeletal stiffness, environmental sensitivity, hypervigilance, sexual dysfunction, and visual symptoms. Nocturnal myoclonus can be present in people with fibromyalgia. A 2021 review found that fibromyalgia can also cause ocular discomfort (foreign body sensation and irritation) and visual disturbances (blurred vision).
Comorbidity Fibromyalgia as a stand-alone diagnosis is uncommon, as most fibromyalgia patients often have other chronic overlapping pain problems, mental disorders or other medical conditions. Comorbidities may be associated with more intense pain and other symptoms.
Fibromyalgia is associated with mental health issues, including anxiety, post-traumatic stress disorder (PTSD), bipolar disorder, alexithymia, and depressive disorders. Approximately one-third of patients presenting with an FM diagnosis also meet the criteria for PTSD, and are five times more likely to have major depressive disorder than the general population.
The pain and limited energy of fibromyalgia often leads to less activity, leading to social isolation and increased stress levels—both of which tend to cause anxiety and depression. Separation of depression symptoms from those of fibromyalgia is difficult.
Chronic pain conditions are often comorbid with fibromyalgia, including neuropathic pain, chronic tension headaches, myofascial pain syndrome, and temporomandibular joint dysfunction. Neurological disorders that have been linked to pain or fibromyalgia include multiple sclerosis, post-polio syndrome, and Parkinson's disease.
Fibromyalgia may share pathogenetic overlap with other syndromes, including myalgic encephalomyelitis/chronic fatigue syndrome and irritable bowel syndrome (IBS).
Fibromyalgia has been reported to occur as a comorbidity in 20–30% of individuals with rheumatic diseases, including rheumatoid arthritis (RA). It has also been reported in people with noninflammatory musculoskeletal disorders.
The prevalence of fibromyalgia in gastrointestinal disease has been described mostly for celiac disease and irritable bowel syndrome. IBS and fibromyalgia may share similar pathogenic mechanisms involving mast cell abnormalities, inflammatory biomarkers, hormones, and neurotransmitters such as serotonin. Dysbiosis alters serotonin transmission, leading to autonomic nervous system hyperstimulation.
Other conditions that are associated with fibromyalgia include obesity, connective tissue disease, cardiovascular autonomic abnormalities, obstructive sleep apnea (hypopnea syndrome), restless legs syndrome, and overactive bladder.
Causal and risk factors The cause of fibromyalgia is unknown. However, several risk factors, genetic and environmental, have been identified.
Fibromyalgia may have a variety of causal factors, including disease, trauma, psychological and social emotional factors. Thus more than one pathophysiological state may cause fibromyalgia.
Genetics Genetics plays a major role in fibromyalgia and may explain up to 50% of disease susceptibility. Fibromyalgia is potentially associated with polymorphisms of genes in the serotonergic, dopaminergic and catecholaminergic systems. Several genes have been suggested as candidates for susceptibility to fibromyalgia. These include a coding variation in Huntingtin, SLC6A4, TRPV2, MYT1L, NRXN3, and the 5-HT2A receptor 102T/C polymorphism. The heritability of fibromyalgia is estimated to be higher in patients younger than 50.
Nearly all the genes suggested as potential risk factors for fibromyalgia are associated with neurotransmitters and their receptors.
Stress and adverse life experiences Stress may be a precipitating factor in the development of fibromyalgia. A 2018 systematic review found low quality evidence supporting an association between fibromyalgia and traumatic events, and noted a lack of prospective studies. A 2021 meta-analysis of case-control studies found abuse and other lifetime stressors to be strongly associated with fibromyalgia. People with fibromyalgia had approximately three times the odds of reporting any type of abuse, and approximately twice the odds of reporting medical trauma or other stressors. A 2024 review of violence and chronic pain in women found "strong associations between an adult history of violent victimization and chronic pain" and that "the impact of violence on fibromyalgia was significant." A 2014 review argued that existing evidence entailed too many methodological limitations, such as reliance on recollections and confounding, to support that physical trauma could cause fibromyalgia.
Some of the other FM risk markers below may include stress elements.
Other risk markers FM prevalence rates appear higher when COVID-19 infections have occurred.