Fibromyalgia is a chronic pain disorder that is expressed through pain in various parts of the body. Those affected may find that their skin, muscles or joints are painful. The measures that help with fibromyalgia differ greatly from person to person.
At a glance
- Fibromyalgia is a chronic pain disorder that is expressed in various parts of the body.
- In people with fibromyalgia, the brain’s ability to process pain is disrupted. Those affected may find that their skin, muscles or joints are painful.
- Other typical symptoms include sleep disorders, fatigue and concentration problems.
- It often takes several years for fibromyalgia to be diagnosed as the clinical picture is very difficult to comprehend.
- The condition is usually diagnosed between the ages of 40 and 60, with women more commonly affected than men.
Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.
What is fibromyalgia?
Fibromyalgia is a chronic pain disorder. It manifests as pain in various parts of the body.
Those affected may find that their skin, muscles or joints are painful. Other symptoms, such as sleep disorders, fatigue and concentration problems, may also occur.
Fibromyalgia is also known as fibromyalgia syndrome or FMS. The condition is not life-threatening, as the organs remain healthy and life expectancy is not affected.
Important: Fibromyalgia has been recognized as a disease since the 1990s. However, people with fibromyalgia are still sometimes accused of simply imagining their symptoms. Part of the reason for this is that very few people are familiar with the condition and the symptoms are difficult to investigate and measure. This often causes additional stress. Those affected are sometimes told that their pain cannot be treated, yet studies have shown that there are indeed treatments that can alleviate the typical symptoms. Many people also learn to cope more effectively with the pain over time. They determine which activities they can handle – and what can be too much for them.
What are the symptoms of fibromyalgia?
Fibromyalgia primarily causes chronic, dull muscle pain in various parts of the body. The pain often feels like a pulled muscle or intense muscle ache.
It is frequently unpredictable and can change from one day to the next. For example, the intensity of the pain can vary or it can occur in different parts of the body. This makes it difficult for people with fibromyalgia to make plans – including for everyday activities like shopping or day trips.
Some people find that the pain recedes for a few hours each day, enabling them to get things done during that time.
Other typical symptoms are poor-quality, unrestorative sleep, fatigue and exhaustion. Many people with fibromyalgia also sometimes struggle to think clearly, remember things, find their words or concentrate. This is known as brain fog or “fibro fog”.
What causes fibromyalgia?
If people have fibromyalgia, their brain’s ability to process pain is disrupted. This means that their threshold for perceiving stimuli as pain is lower than in other people.
The condition is thought to be caused by multiple factors. It is suspected that fibromyalgia is triggered by both genetic and physical or psychological factors. These lead to the body processing pain differently.
Fibromyalgia is often referred to as soft-tissue rheumatism but this term is misleading, as the pain does not originate in soft tissue, such as muscles, and is not caused by a rheumatic condition. What’s more, soft-tissue rheumatism is a generic term for various health conditions and not a condition in its own right.
More detailed information about the development of fibromyalgia can be found at gesundheitsinformation.de.
How common is fibromyalgia?
According to a representative study, about 2 percent of adults in Germany suffer from fibromyalgia.
The condition is usually diagnosed between the ages of 40 and 60, with women more commonly affected than men. However, it is also possible for children, adolescents and young adults to show symptoms of fibromyalgia.
What is the outlook for fibromyalgia?
Fibromyalgia usually begins inconspicuously and develops over a long period. Many people have diffuse pain or other pain disorders for a long time before being diagnosed with fibromyalgia.
Potential symptoms include irritable bowel syndrome, back, neck and jaw pain as well as headaches. Women can also experience severe period pain, endometriosis or interstitial cystitis – a chronic type of bladder inflammation.
Some people affected had frequent headaches, stomach aches, muscle ache or joint pain as children or adolescents.
The symptoms of fibromyalgia and the way it progresses can differ greatly. Phases of severe pain can alternate with almost symptom-free ones.
A large study of people with fibromyalgia that lasted for more than ten years found that the symptoms improved slightly in 25 percent of the participants and significantly in 10 percent. However, most people’s symptoms remained unchanged over the long term.
How is fibromyalgia diagnosed?
It often takes several years for fibromyalgia to be diagnosed as the clinical picture is extremely complex.
As the pain begins gradually or even only affects a single area of the body, doctors often initially think that it is something else. In addition, many doctors are reluctant to give this diagnosis because fibromyalgia cannot be confirmed by either laboratory tests or x-rays. This can lead to misdiagnosis and a lack of understanding.
People with fibromyalgia often feel that they are not being taken seriously. Many also feel that their doctor believes they are imagining the pain. Fibromyalgia is often only diagnosed in a rheumatological practice or pain management clinic.
A diagnosis requires a detailed doctor-patient consultation and a physical examination – for example, to determine vitamin levels.
If pain has occurred in at least 7 out of 19 defined areas of the body in the three months prior to the examination, this could indicate fibromyalgia. The body areas in question include the chest and abdomen, back, jaw, shoulders, upper and lower arms, hips, thighs and calves – on both sides of the body.
A “fibromyalgia symptom questionnaire” can help document the symptoms. Other symptoms must also occur, such as:
- concentration problems
- feeling tired first thing
- stomach pain or cramps
To be considered a sign of fibromyalgia, these additional symptoms have to reach a certain level of severity and must have persisted alongside the pain for at least three months.
To determine whether the symptoms are actually caused by something else, medical societies recommend a thorough analysis of the person’s medical history, various blood tests and a physical examination. This allows other possible causes to be ruled out, such as rheumatoid arthritis, hypothyroidism, muscle disorders and mental health conditions.
How is fibromyalgia treated?
Many people with fibromyalgia refrain from physical activity for fear of exacerbating the pain or overdoing things. However, studies have shown that exercise and low-intensity sports like cycling or walking can be good for people, strengthen the body and alleviate the pain somewhat. This explains why exercise is an important aspect of the treatment. There are also indications that exercise can reduce anxiety about pain becoming more intense.
Medication can significantly alleviate fibromyalgia pain for some people. Studies have proven the efficacy of amitriptyline, duloxetine, milnacipran and pregabalin. Conventional painkillers such as diclofenac, ibuprofen and paracetamol are usually advised against.
Certain physical therapies, in particular thermal baths, are often found to be pleasant. Some people with fibromyalgia also find sauna sessions or gentle massages beneficial.
Multimodal pain therapy can sometimes be helpful, especially in the case of severe symptoms. This treatment combines exercise, relaxation and pain management techniques used in cognitive behavioral therapy (CBT).
CBT and other psychotherapeutic approaches can help people with fibromyalgia to deal more effectively with their condition. Multimodal pain treatment can also include the use of medication.
What is life like with fibromyalgia?
What people with fibromyalgia find beneficial and how they deal with their condition can differ greatly from person to person. It is therefore important to develop personal strategies for managing the condition. This primarily means finding ways to cope with the symptoms instead of putting all your strength into fighting the condition itself.
Helpful advice includes the following:
- Think about which aspects of everyday life are really important to you.
- Let go of perfectionism.
- Establish and respect your own limits.
This may mean:
- giving yourself more time for strenuous activities from the outset
- taking regular breaks
- trying various stress management techniques – for example, autogenic training or progressive muscle relaxation
Many things are possible despite fibromyalgia and people can still do lots of things that bring them joy. This also applies to social contact and activities. It is important not to be discouraged from these activities. Talking to other people with fibromyalgia can also be extremely helpful in this regard because they are familiar with the problems that the condition brings with it. This can be done by attending a self-help group, for example.
Real-life stories about people with fibromyalgia can be found at gesundheitsinformation.de.
- Aaron LA, Buchwald D. A review of the evidence for overlap among unexplained clinical conditions. Ann Intern Med 2001; 134(9 Pt 2): 868-881. doi: 10.7326/0003-4819-134-9_part_2-200105011-00011.
- Adams EH, McElroy HJ, Udall M et al. Progression of fibromyalgia: results from a 2-year observational fibromyalgia and chronic pain study in the US. J Pain Res 2016; 9: 325-336. doi: 10.2147/JPR.S100043.
- Arnold LM, Crofford LJ, Mease PJ et al. Patient perspectives on the impact of fibromyalgia. Patient Educ Couns 2008; 73(1): 114-120. doi: 10.1016/j.pec.2008.06.005.
- Bidonde J, Busch AJ, Schachter CL et al. Mixed exercise training for adults with fibromyalgia. Cochrane Database Syst Rev 2019; (5): CD013340. doi: 10.1002/14651858.CD013340.
- Clauw DJ. Fibromyalgia: a clinical review. JAMA 2014; 311(15): 1547-1555. doi: 10.1001/jama.2014.3266.
- Dennis NL, Larkin M, Derbyshire SW. "A giant mess" – making sense of complexity in the accounts of people with fibromyalgia. Br J Health Psychol 2013; 18(4): 763-781. doi: 10.1111/bjhp.12020.
- Derry S, Cording M, Wiffen PJ et al. Pregabalin for pain in fibromyalgia in adults. Cochrane Database Syst Rev 2016; (9): CD011790. doi: 10.1002/14651858.CD011790.pub2.
- Deutsche Schmerzgesellschaft e.V. Definition, Pathophysiologie, Diagnostik und Therapie des Fibromyalgiesyndroms. S3-Leitlinie. Kurzfassung. AWMF-Registernummer 145-004. 03.2017.
- Fitzcharles MA, Ste-Marie PA, Goldenberg DL et al. 2012 Canadian Guidelines for the Diagnosis and Management of Fibromyalgia Syndrome: Executive Summary. Pain Res Manag 2013; 18(3): 119-126. doi: 10.1155/2013/918216.
- Lunn MP, Hughes RA, Wiffen PJ. Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. Cochrane Database Syst Rev 2014; (1): CD007115. doi: 10.1002/14651858.CD007115.pub3.
- Martinez-Calderon J, Flores-Cortes M, Morales-Asencio JM et al. Intervention Therapies to Reduce Pain-Related Fear in Fibromyalgia Syndrome: A Systematic Review of Randomized Clinical Trials. Pain Med 2021; 22(2): 481-498. doi: 10.1093/pm/pnaa331.
- Moore RA, Derry S, Aldington D et al. Amitriptyline for fibromyalgia in adults. Cochrane Database Syst Rev 2015; (7): CD011824. doi: 10.1002/14651858.CD011824.
- Skelly AC, Chou R, Dettori JR et al. Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update. (AHRQ Comparative Effectiveness Reviews; No. 227). 04.2020.
- Walitt B, Fitzcharles MA, Hassett AL et al. The Longitudinal Outcome of Fibromyalgia: A Study of 1555 Patients. J Rheumatol 2011; 38(10): 2238-2246. doi: 10.3899/jrheum.110026.
- Wolfe F, Brähler E, Hinz A et al. Fibromyalgia Prevalence, Somatic Symptom Reporting, and the Dimensionality of Polysymptomatic Distress: Results From a Survey of the General Population. Arthritis Care Res (Hoboken) 2013; 65(5): 777-785. doi: 10.1002/acr.21931.
In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG).As at: