Fibromyalgia is a chronic pain condition believed to strike around 10 million people in the U.S. It mostly affects young to middle-aged women but can occur at any age and is found in men as well.
Called the quintessential pain syndrome, fibromyalgia is characterized by widespread pain, fatigue, unrefreshing and poor sleep, “fibro-fog” (cognitive problems), mood issues, problems with stimuli, and other symptoms. Fibromyalgia causes so many symptoms that some researchers believe it’s essentially a sensory condition.
The Central Nervous System Sensory Disorders: Dr. Clauw on Fibromyalgia, ME/CFS and Long COVID
For many years, fibromyalgia was thought to be triggered most often by physical trauma such as an accident, injury, or infection. Recent studies suggest that this is not so for most people. Having any chronic pain condition, however, dramatically increases one’s risk of coming down with fibromyalgia. It’s believed that constant streams of pain signals to the brain cause changes in the nervous system, which result in a state of widespread pain sensitization known as fibromyalgia.
Health Rising’s Quickie Summer Donation Drive is On!While studies have uncovered numerous physiological abnormalities in FM, some doctors still dismiss it. Check out ten ways you can prove that FM is a real and serious disease.
Ten Ways to Prove That Fibromyalgia is a Real and Serious Disease
Symptoms
Fibromyalgia’s core characteristic is a widespread pain that can occur in a variety of flavors. Some of the terms used to describe the various kinds of pain encountered include burning, stabbing, throbbing and aching. Allodynia – when touch becomes painful – and nerve-associated pain, such as numbness, tingling, and burning, are commonly found. The pain is often worse in the morning and can be severe enough to significantly limit a person’s ability to work and socialize.
The widespread nature of the pain is a critical part of the diagnosis, but many other symptoms are often present. They can include fatigue, post-exertional malaise, sleep problems, cognitive problems (e.g, “fibrofog” – difficulty concentrating, poor short-term memory, slowed information processing, problems multi-tasking), muscle spasms, rashes, problems standing, irritable bowel symptoms, muscle weakness, myoclonic twitches, pelvic pain, poor coordination, and hypoglycemia.
Diagnosis
Because many doctors are not familiar with FM getting a diagnosis can sometimes be a drawn out and costly process. Diagnosis depends upon assessing symptoms and ruling out other diseases. (A diagnostic blood test has possibly been developed which is covered by Medicare and some insurance companies. Find more about it here.)
The American College of Rheumatology (ACR) criteria, which was developed in 1990s and focused on widespread pain affecting four quadrants of the body and tender pointsis no longer considered accurate.
A controversial 2010 ACR criteria uses a widespread pain index (WPI – 19 areas of the body) and a symptom severity (SS) scale to assess pain and many other symptoms. According to the 2010 ACR criteria, fibromyalgia is diagnosed when
- WPI ≥ 7 and SS ≥ 5 OR WPI 3–6 and SS ≥ 9,
- Symptoms have been present at a similar level for at least three months, and
- No other diagnosable disorder otherwise explains the pain
Several conditions that mimic fibromyalgia’s symptoms can result in a misdiagnosis.
Doctors familiar with fibromyalgia, however, say the constellation of symptoms found in FM makes it easily recognizable.
Prognosis
Fibromyalgia often causes severe distress, which impedes patients’ ability to work, socialize, and exercise as they did before. While no cures exist, many people – usually using a multidimensional treatment approach – experience improvement over time, and a few people do overcome it.
No evidence suggests that FM results in early death or that it resolves over time into a more serious neurological condition. Fibromyalgia can, however, cause the most severely afflicted to become house or even bedbound.
Cause
Fibromyalgia is probably a heterogeneous condition that can be produced in several ways. It’s clear that a process called central sensitization, in which activity in pain-producing pathways in the brain/spinal cord is upregulated and activity in pain-inhibiting pathways is downregulated, is present.
Wound up, Overheated and Tweaked: A Look at the Fibromyalgia Brain and Nervous System.
The first large GWAS genetics study pointed overwhelmingly at the brain.
Increased glutamate and reduced dopamine, serotonin, and opioid signaling in the brain have been found. The sympathetic (fight-or-flight) and parasympathetic (rest-and-digest) nervous systems are affected. The involvement of the immune cells in the brain, called the microglia, is suspected. Damage to small nerve fibers may also contribute.
Small Fiber Neuropathy (SFN) Fibromyalgia and ME/CFS Resource Page
Recent passive transfer studies suggest that an autoimmune process may be tweaking the nerves in at least a subset of FM patients.
Treatment
Fibromyalgia is best treated using a multidimensional approach that incorporates pharmaceutical drugs, supplements, alternative medicine approaches and/or behavioral approaches. Treatment is aimed at symptom management not a cure.
FDA-Approved Drugs
Three drugs, Lyrica (pregabalin), Cymbalta (duloxetine), and Savella (milnacipran HCl) were approved by the FDA between 2007 and 2009 to treat fibromyalgia. While these drugs can be helpful for some, side effects and lack of efficacy prevent many from using them.
In 2025, the FDA approved the first new drug, Tomnya, for FM in 16 years. By improving sleep, Tomnya was shown to reduce pain and improve other symptoms.
Tonmya is FDA Approved to Treat Fibromyalgia: CEO Seth Lederman Talks
Opioids
The consensus regarding the use of opioids in FM, and indeed in chronic pain conditions in general, is that they are not particularly effective. Long-term opioid use (more than a couple of months) can cause increased pain sensitization (hyperalgesia), addiction, and other side effects. Many people with FM struggle, as well, with the side effects of opioids.
While opioids are not generally recommended for FM, for a subset of FM patients, they provide an important means of pain relief. When opioids are used, weaker opioids with low addiction potential, such as tramadol (Ultram) with or without acetaminophen, may be particularly helpful.
The next generation of opioid drugs being developed may provide better pain relief with fewer side effects.
Under The Radar and Alternative Medicine Treatments
Low-dose naltrexone and medical marijuana are two under-the-radar treatments that have failed to attract significant amounts of research but are often very helpful in fibromyalgia. Patient surveys put them at the top of the list regarding effectiveness. Other alternative treatments include trigger point injections, hyperbaric oxygen therapy, herbal remedies, various supplements, dietary changes, massage, myofascial release, acupuncture, yoga, and Tai Chi.
Non-Pharmacological Approaches
Non-drug approaches to fibromyalgia can play a significant role in a well-balanced treatment regimen. Pacing, stress reduction, exercise, and movement therapies can all be helpful.
Many people with fibromyalgia are well acquainted with the negative impacts stress can have on their pain and sleep. Several of the approaches outlined below seek to reduce pain levels by reducing the emotional and mental stresses associated with having a chronic illness. Studies suggest they are moderately successful at doing so and, as such, provide another element of an effective treatment regimen.
The Amygdala and Insula Retraining Program, ANS Rewired, cognitive behavioral therapy, mindfulness-based stress reduction (MBSR), and other neuroplasticity programs have helped some people with fibromyalgia.
New and Emerging Treatments
Five drugs may be approved for use in the U.S. over the next two to five years, and new approaches to treating pain are being developed. New approaches to chronic pain include GLP-1 agonists, transcranial magnetic stimulation, ketamine derived drugs, and vagus nerve stimulation. Ion channel blockers, the next generation of opioid drugs.
- GLP-1 Agonists
- Four New Drugs for Fibromyalgia?
- Ketamine Derived Drugs
- Vagus Nerve Stimulation
- Ion Channel Blockers
- The Next Generation of Opioid Drugs
Female Predominance
Both men and women can have fibromyalgia but it occurs most commonly in females – a finding also found in chronic fatigue syndrome, migraine, irritable bowel syndrome (IBS), interstitial cystitis (IC), temporal mandibular disorder (IBS), most autoimmune illnesses and other chronic pain conditions.
Why females are at greater risk of coming down with fibromyalgia is not clear but their complex hormonal and immune systems may play a role. Some studies suggest that testosterone plays a protective role in men.
Co-occurring Disorders
Fibromyalgia is similar to and commonly co-occurs with other pain and fatigue-causing disorders, such as chronic fatigue syndrome (ME/CFS), long COVID, migraine, irritable bowel syndrome (IBS), interstitial cystitis (IC), and Gulf War Syndrome (GWS).
Other common co-morbid disorders include myofascial pain syndrome, restless leg syndrome, osteo and rheumatoid arthritis and lupus. Studies suggest that people with any painful condition are at increased risk of coming down with fibromyalgia at some point.
Mood Disorders and Fibromyalgia
The name fibromyalgia implies problems with the muscles and joints, but until recently, researchers found few problems in these areas. The inability to correlate the pain FM patients experience in a joint, for instance, with problems in that joint lead many medical professionals to take a dismissive approach to what they assumed was a psychological disorder.
Many studies now indicate fibromyalgia is primarily a central nervous system disorder caused by dysregulated pain pathways in the brain and spinal cord that cause the brain to interpret normal stimuli as pain.
All chronic illnesses are associated with increased rates of depression and anxiety, but the rate of mood disorders in fibromyalgia may be higher than in most chronic illnesses. Several factors may contribute to this, including the unusually widespread problems (pain, fatigue, poor sleep, reduced cognition) that the disease causes, and the poor reception that many patients receive in the doctor’s office. Another factor may be common physiological pathways fibromyalgia shares with mood disorders.
Triggering Events
One of the more intriguing aspects of fibromyalgia are the events that trigger it. While a significant number of people with fibromyalgia do not experience a trigger, others do. (Recent studies suggest that most people with FM do not experience an obvious triggering event.)
Stressful events ranging from automobile accidents to infections to vaccinations to emotional stressors have all been known to abruptly trigger fibromyalgia. Researchers have been able to trigger fibromyalgia-like conditions in the laboratory by subjecting laboratory animals to prolonged and/or unexpected periods of stress.
How this abrupt shift occurs is unclear, but it may involve immune cells in the brain and spinal cord, called glia, that become suddenly and permanently activated. These cells then may produce inflammatory products that cause symptoms such as pain, fatigue, sensory, cognitive, and mood problems we commonly associate with having colds.
The Future
Like other disorders that are common, cause high rates of disability, and mostly affect women but do not kill them, the main medical funder in the U.S. (and the world) – the National Institutes of Health – virtually ignores FM. The NIH provides about $1 per patient per year for FM research, making fibromyalgia one of the poorest funded diseases.
While the HEAL effort, which is funded by Congressional appropriations, does not focus on fibromyalgia and has funded little fibromyalgia research, it does present a major effort to understand and find treatments for chronic pain. As of 2022, HEAL had produced 20 investigational new drug applications (INDs) to the FDA.
Healing Chronic Pain? An Update on the NIH’s $2 Billion HEAL Project to End Chronic Pain
