Fibromyalgia Causes, Symptoms, Diagnosis and Treatment

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The Universal Guide to Fibromyalgia: Everything you ever wanted to know, straight from the experts.

In This Article: What Is Fibromyalgia?   |    Causes   |    Symptoms   |    Diagnosis   |    Treatment   |    Living with Fibromyalgia   |    Sources

Every illness has its own unique set of challenges, but there’s something about an “invisible illness” that has even more hurdles. Even though your particular condition isn’t necessarily visible to the outside world, you still get up each day knowing that you’ll face struggles that seem “easy” for everyone else.

woman in bed hidiing under her pillow and beddingBesides widespread body pain, some people with fibromyalgia experience sleep difficulties. Photo Source:

And so it goes for fibromyalgia . As a disorder that’s characterized by intense, widespread pain, you might wake up and wonder if you can handle going to the grocery store or if you should just stay in bed. Do you feel good enough to work out? Socialize? Or even take a shower? When you have fibromyalgia, these things might consume your mind.

It gets even more complicated, because fibromyalgia presents differently from most forms of back pain. That means—lucky you—many traditional forms of back pain treatment won’t work.

Read on to learn more about this often-misunderstood disorder that causes not only back pain but pain throughout the rest of the body as well.

What Is Fibromyalgia?

Fibromyalgia is a chronic pain disorder that affects millions of Americans each year—primarily women—and can be both physically and emotionally distressing. Fibromyalgia comes from the Latin term for fibrous tissue (fibro) and the Greek words for muscle (myo) and pain (algia). Indeed, fibromyalgia sufferers experience widespread chronic muscle pain.

Imagine your body as a web browser and fibromyalgia as a series of open tabs. One tab is deep muscle soreness. Another is back pain. There’s a tab for insomnia and another for depression. And then there are five more tabs of general fatigue that aren’t loading. With all of these tabs open, your whole system might start to slow or shut down.

Fibromyalgia, a chronic and often misunderstood condition, is complicated like that. And to add insult to injury—not only do doctors often misdiagnose it, until recently, some have questioned its legitimacy as an actual disorder.

But fibromyalgia is very much real. And it’s thought that about 4 million people in the U.S. (that’s 2 to 4% of the adult population), are impacted by it, says Ai Mukai, M.D., a board certified Physical Medicine and Rehabilitation doctor at Austin’s Texas Orthopedics.

She adds that it tends to be more common in middle-aged adults, and women in particular. “Women are anywhere between 3 to 9 times more likely to have fibromyalgia,” Dr. Mukai elaborates.

If you’ve lived with widespread muscle pain for more than 3 months with other symptoms such as sleep disturbance, mood, memory issues, and fatigue, then—congrats, you might be diagnosed with the F word.

fibromyalgia symptomsFibromyalgia is a widespread chronic pain disorder that affects many different areas and functions of the body. Photo Source: Are the Possible Causes of Fibromyalgia?

Like so many misunderstood conditions, fibromyalgia can be brought on by a host of causes.

“Fibromyalgia is a complex condition driven by a concept called central sensitization (CS),” says Mike Bierle, MD, an associate professor of medicine with the Division of General Internal Medicine at Mayo Clinic and a core faculty member of the Fibromyalgia and Chronic Fatigue clinic. 

“I think about CS as a change in the strategy the nervous system uses to analyze, interpret, and respond to sensations,” Dr. Bierle continues. “This certainly affects the pain signals but can also affect other senses, leading to sensitivities to touch, smell, light, sound, foods, and medications.”

Dr. Bierle adds that these sensitivities are often associated with what he calls “traumatic insults” that activate the survival part of the brain, or the limbic system. These insults can be:

  • Physical, emotional, or sexual abuse
  • Traumatic events such as a motor vehicle accident or loss of a loved one
  • Medical events such as surgery, pregnancy/childbirth, or infections

Although at times Dr. Bierle says he and his colleagues aren’t able to identify an insult, he notes that several changes in the nervous system can contribute to these issues.

  • Hyperalgesia: The nervous system amplifies pain, “turning up the ‘volume’ from a 2 to an 11,” says Dr. Bierle
  • Allodynia: The nervous system converts a non-pain signal into a pain signal
  • Centralization of pain: The brain and spinal cord create pain signals without waiting for stimulus from the nerves

Some medical conditions can increase the risk of developing fibromyalgia, including:

“There are theories that it may be linked to female reproductive hormones, since there seems to be higher incidence of fibromyalgia in women of reproductive age,” Dr. Mukai says, stating that autoimmune conditions and genetics can additionally come into play.

“There’s a lot of overlap in symptoms with autoimmune conditions, which is pain in multiple areas of body, and fibromyalgia,” she continues. “The patient population most affected—namely, women —is similar. Also, there seems to be some genetic component. People with family members with fibromyalgia seem to have a higher risk of developing it, but an exact genetic link has not been established.”

Dr. Mukai also says that post-traumatic stress disorder (PTSD) can be a contributing factor.

Fibromyalgia Flare Triggers

Fibromyalgia Flare TriggersThe most common triggers of a fibromyalgia flare up.

While we’re talking about causes, it’s also important to recognize that fibromyalgia is prone to flare-ups, when your symptoms intensify. These flare-ups can be triggered by:

  • Stress
  • Sleep deprivation
  • Infection
  • Surgery
  • A medication change
  • Repetitive movements
  • Poor posture
  • Trauma

Fibromyalgia flare trigger stressStress can trigger a fibromyalgia flareup

What Are Common Fibromyalgia Symptoms and How Does It Cause Back Pain?

Dr. Bierle shares these hallmark symptoms of fibromyalgia, which are similar between women and men:

  • Whole body pain
  • Fatigue
  • Memory and concentration difficulties
  • Unrefreshing sleep
  • Headaches
  • Abdominal pain
  • Diarrhea
  • Constipation
  • Mood problems

“Back and neck pain are very common in patients with fibromyalgia,” Dr. Bierle says. “A common story I hear from patients is that their pain started in the neck and/or back and then spread to other areas of the body over weeks, months, or years.”

Fibromyalgia can also lead to deconditioning (a loss of muscle strength), resulting in a worsening of other causes of neck and back pain, such as degenerative disc disease, radiculopathy, or spinal stenosis.

“Patients with other causes of back pain, like a herniated disc, can experience more severe symptoms that last longer and may not respond to treatments as would be expected,” Dr. Bierle notes.  

Fibromyalgia doesn’t limit itself to paraspinal back pain, either. According to Dr. Mukai, “it can cause pain anywhere in the body where there are soft tissues and muscles. Fibromyalgia pain is different than more specific spine-related pain like sciatica or disc pain. It tends to be more diffuse and not in a specific location.”

There are other conditions that can co-exist with fibromyalgia. These comorbidities can include:

  • Anxiety
  • Autoimmune conditions
  • Chronic fatigue syndrome
  • Depression
  • Interstitial cystitis
  • Irritable bowel syndrome
  • Irritable bladder
  • Migraine headaches
  • Pelvic floor disfunction
  • Post-traumatic stress disorder (PTSD)
  • Postural orthostatic tachycardia syndrome
  • Raynaud’s Syndrome
  • Restless legs syndrome
  • Sleep disturbance
  • TMJ or temporomandibular joint disorder
  • Vulvodynia (chronic pain in the vaginal area)

Fibromyalgia is not a life-threatening disorder, but it does need to be addressed.

“Fibromyalgia typically waxes and wanes, and can get worse if not treated effectively, like any chronic medical condition,” Dr. Bierle says. He adds that fibromyalgia won’t turn into another condition, like rheumatoid arthritis or lupus.

But it can greatly impact your quality of life.

“Depression, anxiety, deconditioning, social isolation, and difficulties working are common,” Dr. Bierle observes. It’s expensive, too, costing the U.S. healthcare system somewhere in the neighborhood of $12 to $14 billion every year.

How Can You Get a Fibromyalgia Diagnosis?

Wish we could say that there’s an X-ray or lab test you can take, but, “Typically, a rheumatologist will see patients for widespread pain and will do tests to rule out autoimmune and rheumatological conditions,” Dr. Mukai says. “Sometimes, one can have fibromyalgia on top of autoimmune conditions. It is typically a ‘diagnosis of exclusion,’ meaning other conditions causing pain need to be ruled out. There are no classic X-ray findings or lab findings with fibromyalgia.”

Fibromyalgia diagnosis of exclusionThere's no one test for fibromyalgia; your treatment team will have to rule out other conditions one by one, which is called a diagnosis of exclusion.

Patients can expect blood tests looking at things such as:

  • Blood counts
  • Kidney function
  • Thyroid function
  • Electrolytes
  • Muscle enzymes
  • Liver enzymes
  • Blood sugar

Conditions that can mimic fibromyalgia symptoms include:

  • Inflammatory conditions
  • Anemia
  • Thyroid dysfunction
  • Rheumatoid arthritis
  • Muscle disorders
  • Nerve damage
  • Depression and other mood disorders
  • Gastrointestinal conditions
  • Some cancers

What Are Some Fibromyalgia Treatment Options?

Fibromyalgia treatment is heavily weighted toward medication. Over-the-counter options include:

  • Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen
  • Acetaminophen (e.g. Tylenol)
  • Topical ointments such as those containing menthol or capsaicin

If your pain is severe, your doctor will bring out the big guns: prescriptions. These may include:

  • Fibromyalgia nerve pain medications like Lyrica or Neurontin
  • Muscle relaxers
  • Antidepressants

…or some combination of the above. “In general, opioid prescriptions and spinal injections are not going to be helpful for fibromyalgia pain,” says Dr. Mukai.

“Side effects are more common in patients with fibromyalgia due to the changes within their nervous system, so starting at low doses and gradually increasing is recommended,” Dr. Bierle adds.

Surgery is often a common solution to a myriad of health issues, but fibromyalgia isn’t one of them. Dr. Mukai explains that at this time, surgery isn’t an option for fibromyalgia patients because its structural causes have yet to be identified.

Although the baseline of diagnostic criteria for fibromyalgia was set by The American College of Rheumatology back in 1990, there have been many new findings on the disorder since then. For example, experts have been studying new types of remedies for fibromyalgia, such as diet changes and ozone therapy—both were found to be effective.

A Mayo Clinic study suggests that fibromyalgia patients commonly use complimentary and integrative treatments; another determined that an animal-assisted activity session may improve physical and mental health parameters in the short term (up to two weeks) in patients with fibromyalgia. 

What Are Some Strategies for Living with Fibromyalgia?

Outside of medication, there are many coping mechanisms and lifestyle tweaks that can aid fibromyalgia.

“Mostly the treatment is managing symptoms,” Dr. Mukai says.

These treatments (which can take 6 to 12 months to be effective) encompass the physical and mental aspects of fibromyalgia.

“Fibromyalgia patients are best treated in a comprehensive pain management program or practice, with psychologists and psychiatrists, pain management doctors, physical therapists, and nutritionists,” Dr. Mukai shares.

Fibromyalgia teamFibromyalgia is best managed by a multidisciplinary treatment team.

Dr. Bierle stresses the importance of adding treatments gradually over time rather than all at once. You have a serious condition and you don’t want to overload your body and take on additional mental stress, both of which can make your fibromyalgia worse.

As you tackle the physical characteristics of fibromyalgia, you have several options available to you.

  • Acupuncture, gentle chiropractic sessions, and massage—Dr. Mukai warns that deep pressure massage “can be painful.”
  • An anti-inflammatory diet with lots of fruits, veggies and lean meats like fish—think Mediterranean diet and you’ll be 90% there
  • Supplements such as omega 3, vitamin D, and magnesium
  • Gentle yoga
  • Aquatic therapy
  • Reiki, an alternative form of energy healing delivered through the palms of a practitioner
  • Quitting smoking (“Smoking cigarettes is associated with worse pain in both fibromyalgia and chronic back pain,” Dr. Bierle says)

The mental hurdles that people with fibromyalgia have to jump over every day can seem insurmountable. “Many patients with fibromyalgia ‘look healthy’ from the outside and struggle with having people understand the magnitude of the impact of their symptoms on their lives,” Dr. Mukai points out.

“Non-medication treatments are preferred as they can help ‘re-train the brain’,” Dr. Bierle says. 

Here are some ways to help yourself mentally if you’ve been diagnosed with fibromyalgia.

  • Biofeedback, a mind-body technique that uses visual and auditory feedback to help you gain awareness and control involuntary bodily functions, like pain from fibromyalgia
  • Cognitive behavioral therapy (CBT), which can achieve a similar outcome to biofeedback. “Both biofeedback and cognitive behavioral therapy help with three of the main components of fibromyalgia—mood, sleep, and pain,” Dr. Mukai says. “Biofeedback and CBT can give some control back to the patient on how their body responds to stress.”
  • Meditation, yoga, and tai chi. Dr. Bierle adds, “We believe these mindfulness interventions help turn down the activity of the survival part of the brain by activating the frontal lobe, which is the part of the brain that is usually in control.”
  • Quality sleep, since a lack of sleep can lead to difficulty healing and muscles relaxing, in turn causing more pain and an even lower mood. “It’s a vicious cycle,” Dr. Mukai reflects.

“Energy conservation and moderation techniques are critical to preventing ‘push and crash’ cycles,” Dr. Bierle says.

To get through your daily life, Dr. Mukai says that it’s all about coping, stress management, self-care, and optimizing nutrition, sleep, and exercise.

She says, “Being able to understand your triggers and learning your tolerance level for stress and activities help. Sleep hygiene—meaning avoiding T.V. and other bright screens before bedtime, having a cool, dark, soothing environment for sleep, and setting a regular sleep-wake cycle—all help.”

Although this condition involves head-to-toe pain, the associated fibromyalgia back pain and fibromyalgia neck pain can be quite bothersome—luckily, this is where these treatments can be a big help. As Dr. Bierle says, “Most people with back pain don’t have fibromyalgia, but many people with fibromyalgia report back pain.”

Back pain is just one of the many discomforts that people with fibromyalgia grapple with daily. If you or someone you care about suspects fibromyalgia or wants to have better control over symptoms, look no further than a doctor who specializes in pain management. Those painful mornings faced with a choice between staying in bed and going out into the world might seem a lot brighter with the right care team in place.


Interesting Fibromyalgia Stats: Arthritis & Rhematology. (February 1990) “The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee”

Interesting Fibromyalgia Stats: Annals of Medicine. (May 2019) “Dietary interventions in fibromyalgia: a systematic review”

Interesting Fibromyalgia Stats: European Review for Medical and Pharmacological Sciences. (2019) “Ozone therapy in 65 patients with fibromyalgia: an effective therapy”

Interesting Fibromyalgia Stats: Mayo Clinic. (October 2019) “Use of Complementary and Integrative Therapies by Fibromyalgia Patients: A 14-Year Follow-up Study”

Fibromyalgia Studies and Back Pain: Mayo Clinic. (August 2020) “The Impact of a 20-Minute Animal-Assisted Activity Session on the Physiological and Emotional States in Patients With Fibromyalgia”

Fibromyalgia Studies and Back Pain: Arthritis & Rheumatology. (December 2013) “Prevalence of the fibromyalgia phenotype in patients with spine pain presenting to a tertiary care pain clinic and the potential treatment implications”

Fibromyalgia Studies and Back Pain: The Journal of Pain. (September 2016) “Overlapping Chronic Pain Conditions: Implications for Diagnosis and Classification”

Possible Causes of Fibromyalgia: Clinical Rheumatology. (November 2006) “Central sensitization: a biopsychosocial explanation for chronic widespread pain in patients with fibromyalgia and chronic fatigue syndrome”

Possible Causes of Fibromyalgia: The Journal of Pain. (November 2006) “Sex Hormones and Pain in Regularly Menstruating Women With Fibromyalgia Syndrome”

Possible Causes of Fibromyalgia: Seminars in Arthritis and Rheumatism. (August 2002) “Prevalence of post-traumatic stress disorder in fibromyalgia patients: Overlapping syndromes or post-traumatic fibromyalgia syndrome?”

What Are Common Fibromyalgia Symptoms and How Does It Cause Back Pain?: Clinical Biomechanics. (July 2012) “Functional capacity, muscle strength and falls in women with fibromyalgia”

What Are Common Fibromyalgia Symptoms and How Does It Cause Back Pain?: Pain Research and Treatment. (2012) “Fibromyalgia and Depression”

Living with Fibromyalgia: Mayo Clinic Proceedings. (June 2006) “Improvement in Fibromyalgia Symptoms With Acupuncture: Results of a Randomized Controlled Trial”

Living with Fibromyalgia: Scandinavian Journal of Rheumatology. (2000) “Vegan diet alleviates fibromyalgia symptoms”

Living with Fibromyalgia: Apunts Sports Medicine. (January-March 2018) “Therapeutic physical exercise and supplements to treat fibromyalgia”

Living with Fibromyalgia: PAIN. (November 2010) “A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia”

Living with Fibromyalgia: Rheumatology International. (February 2008) “Effectiveness of aquatic therapy in the treatment of fibromyalgia syndrome: a randomized controlled open study”

Living with Fibromyalgia: National Fibromyalgia Association. (June 2007) “Reiki Therapy and Fibromyalgia”

Living with Fibromyalgia: Scandinavian Journal of Rheumatology. (2002) “Relationship between fibromyalgia features and smoking”

Continue Reading: Causes of Fibromyalgia

Updated on: 03/30/21
Steven Richeimer, MD
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