Fibromyalgia: Causes, Symptoms & Management

Fibromyalgia is a chronic pain syndrome characterized by widespread musculoskeletal pain, fatigue, sleep disturbance, and cognitive dysfunction. The condition is believed to result from central sensitization—abnormal amplification of pain signals in the central nervous system. While fibromyalgia causes significant suffering, it is not progressive, does not cause joint damage, and is not life-threatening. Diagnosis is clinical, based on widespread pain and symptom severity.

The condition primarily affects middle-aged and older adults, with a strong female predominance.

Proposed mechanisms include:

• Central nervous system sensitization
• Abnormal neurotransmitter activity
• Altered neuroendocrine function
• Sleep disturbance
• Possible genetic predisposition
• Environmental stressors

Risk factors include:

• Female gender
• Middle age
• History of trauma or stress
• Sleep disorders
• Mood disorders
• Chronic infections
• Family history

Core symptoms:

• Widespread pain (axial and peripheral)
• Morning stiffness
• Fatigue (profound, disproportionate)
• Sleep disturbance (non-restorative)
• Cognitive dysfunction ("fibrofog")
• Mood disturbance (anxiety, depression)

Associated symptoms:

• Headaches
• Irritable bowel syndrome
• Temporomandibular joint dysfunction
• Restless leg syndrome

Diagnosis criteria include:

• Widespread pain index ≥7
• Symptom severity scale ≥5
• Symptoms persistent ≥3 months
• Absence of other explaining disorder

Pharmacological:

• Pregabalin (Lyrica)
• Duloxetine (Cymbalta)
• Milnacipran (Savella)
• NSAIDs (limited efficacy)
• Topical agents

Non-pharmacological (highly effective):

• Cardiovascular exercise
• Cognitive behavioral therapy (CBT)
• Mindfulness and relaxation techniques
• Sleep hygiene
• Patient education
• Multidisciplinary approach

Lifestyle modifications and patient engagement improve outcomes.

While fibromyalgia cannot be prevented, symptom management and flare prevention include:

• Consistent sleep schedule
• Regular gentle exercise
• Stress management
• Cognitive behavioral therapy
• Avoiding overexertion
• Managing comorbid mood disorders

See a doctor for widespread chronic pain and associated symptoms. Rheumatology referral helps confirm diagnosis and exclude other conditions. Multidisciplinary care with rheumatology, pain management, and mental health support optimizes outcomes.