Fibromyalgia Explained: Symptoms, Causes, Diagnosis & Treatment Guide

Fibromyalgia: Rheumatologists Explain This Complex Pain Syndrome

By Dr. Jane B. Ayala, FACR and Dr. Thomas A. Rennie, FACR Board Certified in Internal Medicine and Rheumatology

What Is Fibromyalgia?

Fibromyalgia is a complex and often misunderstood condition characterized by widespread musculoskeletal pain that affects muscles, ligaments, tendons, and sometimes nerves. Unlike autoimmune or inflammatory diseases, fibromyalgia does not cause tissue damage or systemic inflammation, but the symptoms can be just as debilitating.

People living with fibromyalgia often describe their pain as a persistent, deep ache that never truly goes away. They may also experience:

• Severe fatigue, even after a full night’s sleep
• Cognitive dysfunction (commonly called “fibro fog”)
• Non-restorative sleep
• Chronic headaches
• Irritable bowel syndrome (IBS)
• Interstitial cystitis
• Depression and anxiety

While the precise cause of fibromyalgia remains unclear, we do know that it stems from a disruption in how the central nervous system processes pain.

This condition is associated with abnormal levels of certain neurotransmitters like serotonin, norepinephrine, glutamate, and substance P – leading to amplified pain perception.

Who Gets Fibromyalgia?

Fibromyalgia is far more common in women than in men, and it typically begins between the ages of 30 and 60. That said, it can affect anyone, including adolescents and the elderly.

Many people with fibromyalgia also have coexisting conditions such as rheumatoid arthritis, lupus, or other autoimmune diseases – leading to confusion about whether fibromyalgia is an autoimmune disorder itself (it is not).

Common Symptoms of Fibromyalgia

While widespread pain is the hallmark, fibromyalgia is a multi-symptom syndrome. Fibromyalgia symptoms can include:

Widespread Pain

Pain must be present on both sides of the body and above and below the waist. It is often described as a constant dull ache.

Fatigue

This isn’t just tiredness – it’s an overwhelming exhaustion that doesn’t improve with rest.

Cognitive Dysfunction (“Fibro Fog”)

Patients often report problems with memory, focus, word recall, and mental clarity.

Sleep Disturbance

Even when patients sleep 8 – 9 hours, they may wake up feeling unrested. Sleep studies often show disruptions in deep (restorative) sleep phases.

Additional Symptoms

• Migraines or chronic headaches
• IBS (bloating, gas, constipation, diarrhea)
• Bladder pain or frequency
• Depression or anxiety

How Is Fibromyalgia Diagnosed?

There is no single test for fibromyalgia. Diagnosis is based on a comprehensive clinical evaluation, including history, physical examination, and ruling out other causes of widespread pain.

         1990 ACR Criteria

• Pain in all four quadrants of the body
• Tenderness in at least 11 of 18 specified points

          2010 ACR Criteria
         (Updated)

• Use of a Widespread Pain Index (WPI) and a Symptom Severity Score (SSS)
• Includes fatigue, cognitive symptoms, and unrefreshing sleep
• Does not require tender point examination

What Causes Fibromyalgia?

The exact cause is not fully understood, but current research points to a phenomenon known as central sensitization. This means the central nervous system becomes hypersensitive to stimuli that wouldn’t normally be painful.

There is also evidence of:

• Altered neurotransmitter levels (serotonin, norepinephrine, glutamate)
• Genetic predisposition
• History of trauma (physical or emotional)
• Sleep disorders
• Coexisting chronic pain conditions

Treatment Options for Fibromyalgia

There is no single cure for fibromyalgia. Management must be personalized and multi-faceted. The goal is to reduce symptoms, improve function, and enhance quality of life.

Lifestyle Strategies Include:

Sleep Hygiene

Establishing a consistent sleep routine is essential. Avoid stimulants like caffeine before bed, and limit screen exposure. For many, sleep quality is the single most important factor in improving fatigue and pain.

Exercise

Gentle aerobic exercise is one of the most effective treatments. Start with low-impact options like:

• Water aerobics
• Walking
• Tai chi
• Pilates or restorative yoga

Exercise should begin slowly and progress gradually. Pacing is critical to avoid post-exertional flares.

Psychological Therapies Include:

Cognitive Behavioral Therapy (CBT)

CBT helps reframe negative thought patterns that often amplify pain and fatigue. It’s particularly helpful for patients dealing with anxiety, catastrophizing, or depression.

Mind-Body Therapies

These may include mindfulness meditation, biofeedback, and even guided imagery. These approaches help modulate the stress-pain connection.

Medications May Include:

Several medications are FDA-approved or commonly used off-label to treat fibromyalgia symptoms.

^{*Brand names are trademarks of their respective owners. SNRI= Serotonin-Norepinephrine Reuptake Inhibitor}

Note: NSAIDs, opioids, and steroids are generally not very effective and are not recommended as long-term treatments.

Complementary and Alternative Therapies Include:

• Massage therapy
• Acupuncture
• Chiropractic care
• CBD-inclusive topicals for muscle and nerve pain (be sure to check clinical sources and product quality to ensure non-detectible levels of THC)

These can be helpful when used as part of a broader plan – but rarely work in isolation.

Living With Fibromyalgia

Fibromyalgia is a chronic condition, but it is not progressive and does not damage joints or muscles. With the right management plan, many patients can experience significant relief and maintain a high quality of life.

It’s important for patients to feel heard, believed, and supported – both by their medical providers and within their personal lives. A collaborative, patient-centered approach is key to effective long-term care.

When to See a Rheumatologist

If you’re experiencing widespread pain, extreme fatigue, and mental fog with no clear explanation – and especially if you’ve already been evaluated by other specialists – a rheumatologist may be the right next step. We specialize in distinguishing fibromyalgia from autoimmune or inflammatory diseases and can build a comprehensive care strategy tailored to you.

Some Final Thoughts

Fibromyalgia is real. It is diagnosable. And it is manageable.

While it can be frustrating to live with an “invisible” illness that is often misunderstood, the science around fibromyalgia has evolved rapidly. What matters most is understanding your symptoms, identifying your triggers, and working with a care team that understands the full picture – not just the pain.

Exploring Everyday Relief Options

While fibromyalgia requires a multifaceted management plan directed by healthcare professionals, many individuals also seek additional ways to support muscle comfort and relaxation, joint mobility, and everyday recovery.

That’s where products like Rheum Relief may play a role – helping to soothe minor aches and discomfort that can accompany an active lifestyle.

Learn more about Rheum Relief here

Note: This content is for educational purposes only and does not constitute, nor should it be taken as personal medical advice. Rheum Relief is not intended to diagnose, treat, cure, or prevent any disease. Always consult a qualified healthcare provider for medical guidance.