The word fibromyalgia means pain (algia) coming from the muscles (my) and fibrous tissues (fibro) such as tendons and ligaments. Most people with fibromyalgia also have other symptoms in addition to the pains - see below. Therefore, fibromyalgia is sometimes called fibromyalgia syndrome (FMS). It is a chronic (persistent) condition. Fibromyalgia does not affect the joints, and so is not an arthritis.
The cause of fibromyalgia is not known. However, research has shown that people with fibromyalgia have certain subtle changes in some chemicals in the brain and nervous system. For example, there seems to be a minor change in the level of certain brain chemicals called neurotransmitters. These are the chemicals responsible for transmitting messages between nerves and between brain cells. Research studies have also shown that people with fibromyalgia tend to have an increased amount of a chemical called substance P in the fluid that bathes the brain and spinal cord (the cerebrospinal fluid (CSF)). This substance may be involved in the way pain messages are transmitted.
A current main theory is that people with fibromyalgia have an oversensitivity to pain signals in the brain. This is called central sensitisation. This may be due to various minor changes in brain chemicals. What triggers or causes these changes is not known.
Note: the term fibromyalgia has been used for a long time. However, because the cause is now thought to be due to the processes described above in the brain and spinal cord, the term fibromyalgia does not accurately describe the condition. That is, there is little evidence that the disease is due to a problem with peripheral tissues such as muscles, tendons and ligaments (although the pain is often felt in these tissues).
About 1 in 50 people develop fibromyalgia at some stage. It is seven times more common in women than in men. In most cases it first develops between the ages of 25 and 55. It is less common in younger adults, and is uncommon in children.
The main symptoms are pains felt in many areas of the body, and tiredness. Some people also develop other symptoms. The severity of symptoms varies from person to person.
Pain can occur in any area of the body. Typically, many areas of the body are affected, and some people feel the pain all over. The neck and back are the sites that are often the most painful. The severity of the pain can vary from day to day. The pains may be made worse by stress, cold or activity. After a night's sleep, you may also feel quite stiff for a few hours. Many areas of the body may also be quite tender.
Tiredness (fatigue) is common, and is sometimes severe. In some cases it is more distressing than the pain. It is also common to have a poor sleep pattern. You may wake feeling exhausted. Many people feel worst first thing in the morning, but improve by the afternoon. Even a small amount of activity may make you tired. The tiredness may cause you to have poor concentration.
Various other symptoms have been reported by people with fibromyalgia. Also, there are a number of other conditions that often occur at the same time as fibromyalgia. As a consequence, quite a number of other symptoms may occur in people with fibromyalgia.
Fibromyalgia is usually diagnosed by the typical symptoms and a doctor's examination.
To make a firm diagnosis, symptoms should include widespread pain involving both sides of the body, above and below the waist, as well as the neck, back and pelvis, and have been present for at least three months.
A doctor's examination will find tenderness in various parts of the body. During the examination a doctor may press firmly with a thumb on various parts of your body. The amount of pressure used does not cause pain in people without fibromyalgia. However, the pressure typically causes people with fibromyalgia to wince with pain. The increased sensitivity to pressure (being tender to mild pressure) can be in many places in the body, and may be all over. However, a doctor may press on certain specific sites (as shown in the diagram). These sites are generally fairly sensitive areas and the easiest to check for tenderness which is typical in people with fibromyalgia.
Apart from finding areas of tenderness, the examination by a doctor will usually find no other abnormality. There is no laboratory test that confirms the condition. However, tests are advised in some cases to rule out other diseases that can cause similar symptoms. For example, your doctor may do some blood tests to rule out an underactive thyroid, early arthritis, etc.
The guidelines point out that optimal treatment requires a combination of treatments: treatment without medication and treatment with medication. Also, that treatment should be tailored to the individual according to pain intensity, function, and whether such features as depression, tiredness and sleep problems are also present.
Exercise does not always help, but studies have shown that it improves symptoms in a good number of cases. If you are able, consider gradually building up to more and more exercise. Aerobic exercises which cause little pounding, such as walking, cycling and swimming, are thought to be the best form of exercise to improve symptoms. Stretching exercises such as yoga may also help. A doctor or physiotherapist can advise on a suitable programme for your particular circumstances. The aim is to exercise safely and without increased pain. Note: pain and stiffness can get worse for a short while when you first start on an exercise programme.