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# Fibromyalgia

A long-term condition with widespread body pain, tiredness, poor sleep and trouble concentrating, caused by the [nervous system](https://durgical.com/en/anatomy/system/nervous-system/) amplifying pain signals.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Trapezius](https://durgical.com/en/anatomy/trapezius-muscle/)
- [Suboccipital muscles](https://durgical.com/en/anatomy/rectus-posterior-major-capitis-muscle/)
- [Gluteus medius](https://durgical.com/en/anatomy/gluteus-medius-muscle/)
- [Levator scapulae](https://durgical.com/en/anatomy/levator-scapulae/)
- [Rhomboids](https://durgical.com/en/anatomy/rhomboid-major-muscle/)
- [Sternocleidomastoid](https://durgical.com/en/anatomy/sternocleidomastoid-muscle/)
- [Gluteus medius tendon](https://durgical.com/en/anatomy/tendon-of-gluteus-medius/)

## Why it happens

- [Pain and temperature: pathways and modulation](https://durgical.com/en/physiology/pain-and-temperature-pathways-and-modulation/)
- [Wakefulness, sleep, the EEG and seizures](https://durgical.com/en/physiology/wakefulness-sleep-the-eeg-and-seizures/)
- [The main neurotransmitters](https://durgical.com/en/physiology/the-main-neurotransmitters/)

## What it is

A chronic pain syndrome with widespread musculoskeletal pain lasting at least three months, together with fatigue, unrefreshing sleep and cognitive symptoms («fibro fog»). Joints and muscles look normal and inflammatory tests are normal; it is understood as a disorder of central pain processing (nociplastic pain).

## Who gets it

One of the most common reasons for consulting rheumatology and primary care, affecting a few percent of adults worldwide, with similar figures reported in Latin American surveys. It is diagnosed far more often in women, usually between 30 and 60 years, and often coexists with depression, anxiety and other chronic pain conditions.

## Causes

- Central sensitisation: the brain and [spinal cord](https://durgical.com/en/anatomy/spinal-cord/) amplify and prolong pain signals
- Genetic predisposition; it clusters in families
- Triggers such as physical trauma, infection, surgery or prolonged psychological stress
- Can appear on top of an inflammatory rheumatic disease (secondary or concomitant fibromyalgia)

## Risk factors

- Female sex and middle age
- Family history of fibromyalgia
- Rheumatoid arthritis, lupus or other chronic pain conditions
- Depression, anxiety, post-traumatic stress or a history of abuse
- Sleep disorders and physical inactivity
- Obesity

## Pathophysiology

Pain-processing pathways become hypersensitive: ascending signals are amplified, descending inhibitory pathways (serotonin and noradrenaline) are weak, and pain-related neurotransmitters such as substance P and glutamate are raised. Non-restorative sleep and stress feed the cycle. There is no inflammation or structural damage of muscles or joints.

## Symptoms and signs

- Widespread pain on both sides of the body, above and below the waist, often in the neck, shoulders, back and hips
- Tenderness to light pressure (allodynia) in soft-tissue areas
- Fatigue and unrefreshing sleep
- Poor concentration and memory («fibro fog»)
- Morning stiffness that is usually short, headaches, and irritable bowel symptoms
- Low mood or anxiety

## Red flags

- Fever, weight loss or night sweats, which suggest another disease
- Joint swelling, rash or raised inflammatory markers (consider an inflammatory rheumatic disease)
- Objective muscle weakness or neurological deficits
- New pain after age 50 with headache or jaw pain (polymyalgia or giant cell arteritis)
- Suicidal thoughts in a person with chronic pain and depression

## Diagnosis

**Clinical**
A clinical diagnosis based on widespread pain for at least three months plus fatigue, sleep and cognitive symptoms, using criteria such as the ACR 2010/2016 widespread pain index and symptom severity scale; counting tender points is no longer required. Examination shows no synovitis or weakness.

**Tests**
Basic tests to exclude look-alikes: complete blood count, ESR and CRP, TSH, creatine kinase, [liver](https://durgical.com/en/anatomy/liver/) and [kidney](https://durgical.com/en/anatomy/kidney/) function, and vitamin D where relevant. Autoantibodies (ANA, rheumatoid factor) only if the clinical picture suggests autoimmune disease.

**Imaging**
Not needed for diagnosis; imaging is guided by specific findings, not ordered routinely.

## Differential diagnosis

- Hypothyroidism
- Polymyalgia rheumatica and inflammatory myopathies
- Rheumatoid arthritis, lupus and other connective tissue diseases
- Statin-related myopathy or vitamin D deficiency
- Depression with somatic symptoms and obstructive sleep apnoea
- Chronic fatigue syndrome (myalgic encephalomyelitis)

## Goal of treatment

Reduce pain and fatigue, improve sleep and function, and help the person stay active and self-manage, rather than aim for a cure.

## Treatment

**Lifestyle**
Patient education plus regular graded aerobic exercise and strength training are the most effective first-line measures; sleep hygiene and weight control.

**Conservative**
Cognitive behavioural therapy, mindfulness and other psychological therapies; physical therapy, hydrotherapy, tai chi or yoga.

**Medical**
Medicines are adjuncts: low-dose tricyclic antidepressants (amitriptyline), SNRIs (duloxetine, milnacipran) or gabapentinoids (pregabalin). Opioids and corticosteroids are not recommended; NSAIDs help little.

**Follow-up**
Regular review of function, mood and sleep; screening for depression and suicide risk; avoid repeated unnecessary tests.

## Complications

- Disability, missed work and reduced quality of life
- Depression and anxiety
- Sedentary lifestyle, deconditioning and weight gain
- Harm from inappropriate opioid use or repeated investigations

## Prognosis

Usually a long-lasting condition with flares and calmer periods. Most people improve their function with exercise, education and psychological support, even if some pain persists; it does not damage joints or shorten life.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the main mechanism thought to cause fibromyalgia?

Central sensitisation: abnormal amplification of pain processing in the central nervous system (nociplastic pain), without tissue inflammation.

## What do the ESR, CRP and examination of the joints usually show in fibromyalgia?

They are normal: there is no synovitis and no rise in inflammatory markers.

## Which treatment has the strongest evidence in fibromyalgia?

Regular graded aerobic exercise together with patient education.

## Which drug classes are used as adjuncts, and which should be avoided?

Tricyclics, SNRIs and gabapentinoids may help; opioids and corticosteroids should be avoided.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/conditions/fibromyalgia/)

## Related conditions

- [Major depressive disorder](https://durgical.com/en/conditions/major-depressive-disorder/)
- [Generalized anxiety disorder](https://durgical.com/en/conditions/generalized-anxiety-disorder/)
- [Hypothyroidism](https://durgical.com/en/conditions/hypothyroidism/)
- [Irritable bowel syndrome](https://durgical.com/en/conditions/irritable-bowel-syndrome/)
- [Tension-type headache](https://durgical.com/en/conditions/tension-type-headache/)
- [Migraine](https://durgical.com/en/conditions/migraine/)
- [Obstructive sleep apnoea](https://durgical.com/en/conditions/obstructive-sleep-apnoea/)
- [Restless legs syndrome](https://durgical.com/en/conditions/restless-legs-syndrome/)
- [Rheumatoid arthritis](https://durgical.com/en/conditions/rheumatoid-arthritis/)
- [Systemic lupus erythematosus](https://durgical.com/en/conditions/systemic-lupus-erythematosus/)
- [Polymyalgia rheumatica](https://durgical.com/en/conditions/polymyalgia-rheumatica/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Fibromyalgia](https://medlineplus.gov/ency/article/000427.htm) (MedlinePlus (U.S. National Library of Medicine), 2025).

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Source: https://durgical.com/en/conditions/fibromyalgia/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/fibromyalgia/