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Fibromyalgia

Last updated: December 9, 2019

Summarytoggle arrow icon

Fibromyalgia (FM) is a neurosensory disorder characterized by chronic musculocutaneous pain. The etiology and pathogenesis of this condition are not fully understood, but, notably, there is no identifiable inflammation that causes the musculocutaneous symptoms. Patients typically present with functional symptoms (e.g., fatigue, unrefreshing sleep, morning stiffness) and often have a history of psychiatric disorders (e.g., depression, generalized anxiety disorder). Physical examination reveals characteristic tender points over multiple areas of the body with no signs of inflammation (i.e., no notable swelling, deformity, or erythema). Findings from laboratory tests are normal. Although this disorder is benign, it causes patients significant psychological strain and discomfort. Treatment focuses on lifestyle changes and multidisciplinary pain management.

Epidemiological data refers to the US, unless otherwise specified.

The pathophysiology of FM is not fully understood, but its etiology is likely multifactorial. The interaction of the following factors may play a role:

  • Genetic predisposition
  • Environmental triggers (e.g., physical or psychosocial stress)
  • Dysregulation of the neuroendocrine and autonomic nervous systems

References:[3]

Common symptoms

Common associations

The following disorders can manifest with symptoms that sometimes resemble those seen in FM, and these conditions may occur alongside FM.

References:[3][4][5][6][7][8][9][10]

  • FM is a clinical diagnosis.
    • The 2010 American College of Rheumatology (ACR) criteria take into account:
      • Symptom duration of at least 3 months
      • Patient self-reporting using the fibromyalgia score :
        • Widespread pain or tenderness in up to 19 different regions of the body (widespread pain index; WPI)
        • Presence and severity of symptoms such as fatigue, sleep disturbance, depression, headache, and cognitive impairment (symptom severity scale)
    • Traditionally, a tender-point examination was performed based on the 1990 ACR diagnostic criteria :
      • Symptom duration of at least 3 months
      • Tender points: ≥ 11 of 18 FM-associated localized areas of pain
      • Pain-affected areas: all four quadrants of the body
  • Laboratory values and imaging findings are normal (helpful for excluding other causes or comorbidities).

A combined assessment of the number, duration, and severity of cognitive and somatic symptoms provides the most accurate diagnosis.References:[4][10][11][12][13]

References:[9][10]

The differential diagnoses listed here are not exhaustive.

Initial approach

Nonresponders


References:[9][15][16][17]

  1. Chandola HC, Chakraborty A. Fibromyalgia and myofascial pain syndrome-a dilemma.. Indian journal of anaesthesia. 2009; 53 (5): p.575-81.
  2. Boomershine CS. Fibromyalgia Clinical Presentation. Fibromyalgia Clinical Presentation. New York, NY: WebMD. http://emedicine.medscape.com/article/329838-clinical#b2. Updated: July 31, 2016. Accessed: April 12, 2017.
  3. Goldenberg DL. Clinical manifestations and diagnosis of fibromyalgia in adults. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-fibromyalgia-in-adults?source=machineLearning&search=fibromyalgia&selectedTitle=1~142§ionRank=1&anchor=H8#H3.Last updated: September 14, 2016. Accessed: April 12, 2017.
  4. Jones GT, Atzeni F, Beasley M, Flüß E, Sarzi‐Puttini P, Macfarlane GJ. The Prevalence of Fibromyalgia in the General Population: A Comparison of the American College of Rheumatology 1990, 2010, and Modified 2010 Classification Criteria. Arthritis & Rheumatology. 2015; 67 (2): p.568-575. doi: 10.1002/art.38905 . | Open in Read by QxMD
  5. Arout CA et al.. Gender Differences in the Prevalence of Fibromyalgia and in Concomitant Medical and Psychiatric Disorders: A National Veterans Health Administration Study. Journal of Women's Health. 2018; 27 (8): p.1035-1044. doi: 10.1089/jwh.2017.6622 . | Open in Read by QxMD
  6. Bradley LA. Understanding Fibromyalgia and Its Related Disorders. Prim Care Companion J Clin Psychiatry. 2008; 10 (2): p.133-144.
  7. Le T, Bhushan V, Chen V, King M. First Aid for the USMLE Step 2 CK. McGraw-Hill Education ; 2015
  8. Kravitz HM, Katz RS. Fibrofog and fibromyalgia: a narrative review and implications for clinical practice. Rheumatol Int. 2015; 35 (7): p.1115-1125. doi: 10.1007/s00296-014-3208-7 . | Open in Read by QxMD
  9. Warren JW, Langenberg P, Clauw DJ. The number of existing functional somatic syndromes (FSSs) is an important risk factor for new, different FSSs. J Psychosom Res. 2012; 74 (1). doi: 10.1016/j.jpsychores.2012.09.002. . | Open in Read by QxMD
  10. Ondo WG. Clinical features and diagnosis of restless legs syndrome/Willis-Ekbom disease and periodic limb movement disorder in adults. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-restless-legs-syndrome-willis-ekbom-disease-and-periodic-limb-movement-disorder-in-adults?source=search_result&search=restless%20leg%20syndrome&selectedTitle=2~122.Last updated: January 25, 2017. Accessed: April 12, 2017.
  11. Judd BG, Sateia MJ. Classification of sleep disorders. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/classification-of-sleep-disorders?source=search_result&search=sleep%20disorder&selectedTitle=1~150.Last updated: May 6, 2015. Accessed: April 12, 2017.
  12. New and Modified Fibromyalgia Diagnostic Criteria. http://www.rheumatologynetwork.com/fibromyalgia/new-and-modified-fibromyalgia-diagnostic-criteria. Updated: February 8, 2012. Accessed: April 12, 2017.
  13. Fibromyalgia Diagnosis. http://www.fmcpaware.org/fibromyalgia/diagnosis.html. Updated: January 1, 2017. Accessed: April 12, 2017.
  14. CDC - Fibromyalgia Fact Sheet. https://www.cdc.gov/arthritis/basics/fibromyalgia.htm. Updated: March 13, 2017. Accessed: April 12, 2017.
  15. Painter JT, Crofford LJ. Chronic Opioid Use in Fibromyalgia Syndrome. Chronic Opioid Use in Fibromyalgia Syndrome. New York, NY: WebMD. http://www.medscape.com/viewarticle/780357. Updated: January 1, 2013. Accessed: April 12, 2017.
  16. Goldenberg DL. Initial treatment of fibromyalgia in adults. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/initial-treatment-of-fibromyalgia-in-adults?source=machineLearning&search=fibromyalgia%20treatment&selectedTitle=1~141§ionRank=1&anchor=H5#H7185818.Last updated: April 15, 2016. Accessed: April 12, 2017.
  17. Goldenberg DL, Burckhardt C, Crofford L. Stepwise fibromyalgia therapy. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/image?imageKey=RHEUM%2F60515&topicKey=RHEUM%2F5627&rank=1~141&source=see_link&search=fibromyalgia%20treatment&utdPopup=true.Last updated: January 1, 2017. Accessed: April 12, 2017.
  18. Herold G. Internal Medicine. Herold G ; 2014
  19. Wolfe F, Clauw DJ, Fitzcharles M-A, et al. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum. 2016; 46 (3): p.319-329. doi: 10.1016/j.semarthrit.2016.08.012 . | Open in Read by QxMD