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" I no longer have chronic pain and fibromyalgia after completing Dr. Charles Kwang’s customized herbal program.My back pain caused me to not sleep well. I couldn't pick up things from the floor. Now that I live in the states, I can see Dr. Kwang. After the first treatment I could feel the diffgerence right away."*


*Disclaimer:: Results may vary. These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, heal/cure or prevent any disease. Information on this site is provided for informational purposes only, it is not meant to substitute medical advice provided by your physician or any other medical professional. You should not use the information contained on this site for diagnosing or treating a health problem, disease, or prescribing any medication. Best results are only achieved when combined with diet and exercise



   Fibromyalgia facts

   What is fibromyalgia?

   What causes fibromyalgia?

   Is fibromyalgia hereditary?

   What are risk factors for fibromyalgia?

   What are fibromyalgia symptoms and signs? What are fibromyalgia tender points?

   How do health care professionals test for and diagnose fibromyalgia?

   What specialties of doctors treat fibromyalgia?

   What is the treatment for fibromyalgia?

   Are there any home remedies for fibromyalgia?

   What is the prognosis of fibromyalgia?

   Is it possible to prevent fibromyalgia?

   Are there support groups for fibromyalgia?

   What is the latest research on fibromyalgia?


   Fibromyalgia Center

   Fibromyalgia Overview Slideshow

   Take the Fibromyalgia Quiz

   Fibromyalgia: 12 Tips for Coping Slideshow

   Fibromyalgia FAQs

   Patient Comments: Fibromyalgia - Symptoms

   Patient Comments: Fibromyalgia - Treatment

   Patient Comments: Fibromyalgia - Diet and Lifestyle Changes

   Find a local Rheumatologist in your town


   Fibromyalgia facts

   What is fibromyalgia?

   What causes fibromyalgia?

   Is fibromyalgia hereditary?

   What are risk factors for fibromyalgia?

   What are fibromyalgia symptoms and signs? What are fibromyalgia tender points?

   How do health care professionals test for and diagnose fibromyalgia?

   What specialties of doctors treat fibromyalgia?

   What is the treatment for fibromyalgia?

   Are there any home remedies for fibromyalgia?

   What is the prognosis of fibromyalgia?

   Is it possible to prevent fibromyalgia?

   Are there support groups for fibromyalgia?

   What is the latest research on fibromyalgia?


Fibromyalgia facts


   Fibromyalgia is a pain syndrome characterized by chronic pain, fatigue, and tenderness to touch.

   Fibromyalgia syndrome is the most common medical cause of chronic, widespread pain in the United States.

   Fibromyalgia affects 2%-4% of people, mostly women.

   Defining fibromyalgia symptoms and signs include

       chronic pain, which may be in the muscles, joints, and/or bones,


       unrefreshing sleep, and

       tenderness throughout the body to light touch.

   Those with fibromyalgia may also experience

       depression and/or anxiety,

       cognitive difficulties, such as forgetfulness and lack of concentration (fibro fog),

       abdominal pain,

       dry eyes,

       chest wall pain,

       dry mouth,

       bladder symptoms,

       pelvic pain,

       heart palpitations,

       numbness and tingling,

       chemical sensitivities and multiple allergies, and

       weight gain.

   Exercise and getting enough sleep are very important in the management of fibromyalgia. Taking medications can help relieve the pain.

   The fact is there is no test to detect fibromyalgia. When a health care professional suspects fibromyalgia, sometimes tests are necessary to exclude other medical conditions.


What is fibromyalgia?


Fibromyalgia syndrome is a chronic pain condition (not a type of arthritis) that affects 4% of people in the United States. The disorder commonly affects the muscles and ligaments and usually has been present for years when a health care professional diagnoses the condition. Fibromyalgia was formerly known as fibrositis.


What causes fibromyalgia?


Fibromyalgia syndrome has been shown to be genetic. The disorder frequently becomes evident after stressful events. The stressful events may be emotional (such as a traumatic life event), physical (such as a motor-vehicle accident), or medical (such as certain infections). The chronic pain of rheumatoid arthritis, systemic lupus erythematosus, and other health conditions and autoimmune diseases can trigger the development of fibromyalgia.


The manner in which the brain and spinal cord process pain sensations is abnormal in fibromyalgia. The threshold at which stimuli cause pain or discomfort has been proven to be lower in fibromyalgia. The pain felt is more intense because the pain is amplified by the abnormalities in the central nervous system and in pain processing. Because of this, things that are not normally painful may be painful for someone with fibromyalgia. In addition, fibromyalgia causes the pain from any given cause to be worse. For example, a patient with fibromyalgia may find a massage painful instead of pleasant. In addition, back pain that someone without fibromyalgia experiences as moderate may be experienced as severe by someone with fibromyalgia, because the pain is amplified by abnormalities in pain processing by the central nervous system.

Quick GuideFibromyalgia Symptoms, Diagnosis & Treatment

Fibromyalgia Symptoms, Diagnosis & Treatment

Fibromyalgia is characterized by tender points.

Fibromyalgia Symptoms


The main symptom of fibromyalgia is pain that is believed to derive from an increased sensitivity to pain stimuli. The pain can be brought on by different situations, including noises, weather changes, or stress, but it may also occur without any relation to external events. The characteristic pain usually affects the neck, buttocks, shoulders, arms, upper back, and chest. "Tender points" are localized areas of the body that are tender to light touch. The tender points of fibromyalgia are commonly located around the elbows, shoulders, knees, hips, back of the head, and the sides of the breastbone.


Other common symptoms associated with fibromyalgia include


   fatigue, malaise, or tiredness,

   sleep disturbances,


   numbness or tingling in the hands and feet or various body parts, and

   irritable bladder.


Read more about fibromyalgia symptoms »


Is fibromyalgia hereditary?


Increasing evidence supports a strong genetic component to fibromyalgia. Siblings, parents, and children of people with fibromyalgia are eight times more likely to have the disorder than those who have no relatives with the health condition. There are several genes that have been suspected to play a role in fibromyalgia syndrome. Studies in twins suggest that half the risk of fibromyalgia and related disorders is genetic and half is environmental.


What are risk factors for fibromyalgia?


Because it is in part hereditary, a family history of fibromyalgia syndrome is a risk factor for the development of fibromyalgia. Other risk factors include autoimmune diseases such as rheumatoid arthritis, lupus, and ankylosing spondylitis, as people with these diseases are more likely to have fibromyalgia than the general population. These patients are referred to as having "secondary fibromyalgia" because the autoimmune disease may trigger fibromyalgia.


Other emotional and physical stressors such as physical trauma (especially involving the spine and trunk), emotional stress, and certain infections (hepatitis C, Epstein-Barr virus, parvovirus, and Lyme disease but not the common cold) are associated with the development of fibromyalgia in some.

Fibromyalgia Symptoms, Diagnosis, and Treatment


Fibromyalgia Overview Slideshow


Take the Fibromyalgia Quiz

Fibromyalgia Treatments and Tips to Ease Pain and Other Symptoms


Fibromyalgia: 12 Tips for Coping Slideshow


What are fibromyalgia symptoms and signs? What are fibromyalgia tender points?


   Readers Comments 40

   Share Your Story


The defining feature of fibromyalgia syndrome is chronic widespread pain and tenderness. This means pain in multiple areas of the body, most commonly in muscles, tendons, and joints. Joint stiffness is common, as well. The pain is generally above and below the waist, on the left side of the body and on the right side of the body but can be localized, often in the neck and shoulders or low back, initially. The pain is chronic, which means it is present for more than three months. People commonly feel as if they "hurt all over" with flu-like symptoms, or are about to develop a cold or the flu. It is common for some days to be worse than others, and many patients report "flare-ups" where their pain and other symptoms are worse for several days in a row or longer.


Fatigue is the other universal symptom of fibromyalgia. It is most noticeable upon awakening, but it may also be marked in the mid-afternoon. It is very common to wake up in the morning not feeling refreshed, even after sleeping through the night. Patients commonly feel they sleep "lightly" and may have multiple nighttime awakenings with difficulty returning to sleep.


While widespread pain, fatigue, and sleep problems are the defining symptoms of the syndrome, fibromyalgia is associated with many other symptoms. Disordered thinking (cognitive disturbances) is often referred to as "fibro fog." Patients describe difficulty with attention and completing tasks, as well as a general sense of being in a fog.


Depression and anxiety co-occur in 30%-50% of patients at the time of diagnosis with fibromyalgia. Headaches are present in more than half of patients. Patients also may have a variety of poorly understood additional symptoms, including abdominal pain, diarrhea, constipation, nausea, dry eyes, dry mouth, chest wall pain, pelvic pain, and bladder symptoms, heart palpitations, numbness and tingling (pins and needles), multiple allergies and chemical sensitivities, weight gain, and others.

Fibromyalgia tender points


The physical examination is remarkable for tenderness, particularly in specific anatomic locations, such as the back of the neck where the neck muscles connect to the skull. There are 18 such locations, which are referred to as fibromyalgia tender points. In the past, studies required patients to have 11 out of a possible 18 fibromyalgia tender points in order to be included in a scientific study on fibromyalgia, but this definition of fibromyalgia has changed in the past few years.

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How do health care professionals test for and diagnose fibromyalgia?


Health care professionals diagnose fibromyalgia based on the patient's symptoms, primarily widespread pain. Chronic widespread pain in the muscles and joints, in combination with fatigue and poor sleep, lead to the consideration of fibromyalgia. A health care professional will perform a thorough history and physical exam to exclude other illnesses presenting with similar symptoms.


There is no widely accepted blood test or X-ray test for fibromyalgia at this time. Any testing is done to exclude other conditions. Tests for inflammation are generally normal in isolated fibromyalgia.


Usually multiple soft-tissue areas ("fibromyalgia tender points") are tender to palpation. However, not all patients are tender at the tender points. In general, females are more likely to be tender at the classic fibromyalgia tender points than males.


The American College of Rheumatology developed new guidelines and diagnostic criteria to help diagnose patients with fibromyalgia. The new guidelines no longer require a certain number of tender points to be present to be confident that a patient has fibromyalgia. The new guidelines use pain and other symptoms of fibromyalgia to aid diagnosis. Patient questionnaires to assist in the diagnosis of fibromyalgia can be found online.


What specialties of doctors treat fibromyalgia?


Rheumatologists, internists, family medicine doctors, pain-management doctors, physical-medicine and rehabilitation doctors, and primary care providers all treat fibromyalgia. Health care practitioners other than physicians are also frequently involved in the treatment of fibromyalgia, including clinical psychologists, physical therapists, nurse practitioners, and physician assistants.

Fibromyalgia Symptoms, Diagnosis, and Treatment


Fibromyalgia Overview Slideshow


Take the Fibromyalgia Quiz

Fibromyalgia Treatments and Tips to Ease Pain and Other Symptoms


Fibromyalgia: 12 Tips for Coping Slideshow


What is the treatment for fibromyalgia?


   Readers Comments 72

   Share Your Story


There are both medication and non-medication treatments for fibromyalgia. Medication treatments frequently help manage the pain and sleeplessness from which fibromyalgia patients suffer. However, the non-medication treatments are really the basis of treatment for fibromyalgia. The non-medication treatments for fibromyalgia include education, exercise, and stress reduction. Sleep disorders may require both medication and non-medication treatments.


Education about fibromyalgia is very important. Often patients have suffered with symptoms for years, and simply knowing why they have pain can be a relief, as many patients become anxious not knowing what is causing their symptoms. Patients should also be educated about treatment approaches, good sleep hygiene, and the importance of treating conditions that may contribute to their symptoms. For example, when a patient with rheumatoid arthritis has fibromyalgia as well, poor control of their rheumatoid arthritis may lead to worsening of fibromyalgia pain and sleeplessness.


An exercise program is crucial in the treatment of fibromyalgia and should include stretching, strengthening, and aerobic exercise. Many patients with fibromyalgia find it difficult to institute a regular exercise program because they feel they are too tired to exercise and they may perceive that their pain and fatigue worsen when they begin to exercise. However, numerous scientific studies have shown that exercise for fibromyalgia, especially aerobic exercise, can improve pain, physical function, and a sense of well-being. Starting slow and sticking with the exercise program is very important. Low-impact aerobic activities such as swimming, water aerobics, walking, and biking are activities that patients with fibromyalgia find helpful. Many patients find it helpful to exercise in the morning. Some patients find yoga helpful for strengthening and stretching. This should also be accompanied by an aerobic exercise program.


Stress reduction is important for the self-management of fibromyalgia symptoms. Many patients feel that their symptoms are triggered by stress. Stress reduction can be challenging. There are many stressors in life; some can be changed and others cannot. Stress reduction involves a combination of changing stressors that can be changed and learning to lessen the body's stress reaction to the stressors that cannot be changed.


Cognitive behavioral therapy is a form of psychological therapy whereby a therapist and patient work together, to establish healthy patterns of behavior by replacing negative thoughts with more productive thoughts and actions. This has been proven to work in fibromyalgia. This form of therapy can be done one on one in an office setting, or even over the Internet.


The non-medication therapies are the cornerstone of treatment for fibromyalgia. With them, many people improve and may not require medications. Moreover, without focusing on sleep hygiene, stress reduction and exercise, it is difficult to improve, even with medication.


When used with non-medication therapies, medication treatments can help improve sleep, pain, and function in fibromyalgia. Administration of medications is most effective for pain relief when combined with ongoing non-medication treatments as discussed above. Medications often used in the treatment of fibromyalgia include medications in the antidepressant class (medications originally developed to treat anxiety and depression) and anticonvulsants (medications originally developed to treat seizures).


   Medications called "tricyclic antidepressants" have been used to treat fibromyalgia for many years. These medications include amitriptyline (Elavil), doxepin (Sinequan, Silenor), and desipramine (Norpramin). These medications are generally started in low doses and increased until adequate response is achieved. The advantage of these medications is that they are effective for sleep and pain, widely available, and less costly for most patients than some of the newer agents. Cyclobenzaprine (Flexeril) is a medication that is both a muscle relaxant and tricyclic antidepressant that can be used to help with sleep and pain in patients with fibromyalgia.

   Medications in the antidepressant class that affect the serotonin and the norepinephrine neurotransmitters (SNRI antidepressants) are frequently used in the treatment of fibromyalgia. These medications include duloxetine (Cymbalta), milnacipran (Savella), and venlafaxine (Effexor). Norepinephrine is a neurotransmitter in the brain, and increasing the levels of norepinephrine with these medications decreases pain levels. Fluoxetine (Prozac) is an antidepressant that affects mainly serotonin at low doses but increases norepinephrine as well at higher doses. Higher doses of fluoxetine can be used to treat fibromyalgia pain.

   Pregabalin (Lyrica) and gabapentin (Neurontin) are anticonvulsants (medications initially developed to treat seizures). There are many scientific studies showing that pregabalin and gabapentin can be effective for fibromyalgia pain.

   Tramadol (Ultram) is an opioid pain reliever which is helpful in some patients with fibromyalgia but should be used with caution as sometimes the use of opioids can worsen the pain cycle in fibromyalgia.

   Memantine (Namenda) is a medication commonly used for dementia. Preliminary studies show that memantine may be helpful with pain and other symptoms of fibromyalgia, but further studies are needed to confirm this.

   There have been small scientific studies of low-dose naltrexone (Revia, Vivitrol) in fibromyalgia. Naltrexone's main scientifically proven use is in treating narcotic addiction. In one small study, a very low dose of naltrexone was shown to benefit some patients with fibromyalgia. Further studies of low-dose naltrexone in fibromyalgia are needed to know if it really works.


A few notes on other treatments for fibromyalgia: Acupuncture can be helpful for some patients with fibromyalgia but is not usually recommended as one of the first-line treatments for fibromyalgia because the scientific studies on acupuncture for fibromyalgia patients have not shown definite benefit. Likewise, trigger point injections can be helpful for some patients. Alternative medicines have not been proven to be helpful in fibromyalgia; in particular, scientific studies on guaifenesin (Mucinex) show that it does not work. Of note, patients with vitamin D deficiency can have widespread arthralgia and myalgia, like fibromyalgia, which improves with vitamin D supplementation. While having a sufficient level of vitamin D is important to maintain bone health, a healthy immune system, and perhaps prevent certain types of cancer, vitamin D supplementation does not improve fibromyalgia symptoms in patients who have sufficient levels of vitamin D. Narcotic pain medications should be avoided in fibromyalgia because they may worsen the underlying problem.


Are there any home remedies for fibromyalgia?


   Readers Comments 8

   Share Your Story


The non-medication treatments for fibromyalgia are the cornerstone of treatment of the syndrome. These are education, stress reduction, improving sleep, and exercise.

Quick GuideFibromyalgia Symptoms, Diagnosis & Treatment

Fibromyalgia Symptoms, Diagnosis & Treatment


What is the prognosis of fibromyalgia?


The overall mortality is not increased in patients with fibromyalgia, and it is not an organ-threatening disease. However, many patients with fibromyalgia continue to suffer from long-term widespread pain. Once the diagnosis is confirmed, many fibromyalgia patients find their overall sense of well-being and their pain improves to more moderate levels with the treatments discussed above. There are some patients who experience a dramatic reduction in pain with changes in their life to reduce stress. However, these patients are always at risk for worsening of their symptoms in the future and should maintain efforts for a healthy lifestyle, including sleep hygiene, ongoing exercise, and stress management. Fibromyalgia patients have a higher rate of disability than the general population, but seeking permanent disability status is generally discouraged because it frequently leads to worsening of symptoms.

Fibromyalgia Symptoms, Diagnosis, and Treatment


Fibromyalgia Overview Slideshow


Take the Fibromyalgia Quiz

Fibromyalgia Treatments and Tips to Ease Pain and Other Symptoms


Fibromyalgia: 12 Tips for Coping Slideshow


Is it possible to prevent fibromyalgia?


Fibromyalgia is a syndrome with a genetic predisposition. It can be triggered by certain events, but the exact events leading to the onset of fibromyalgia is unknown. Because of this, there is no known way to prevent fibromyalgia. However, leading a healthy lifestyle, including getting enough sleep, eating healthy foods, and exercising, is the best way to stay healthy.


Are there support groups for fibromyalgia?


Yes, there are support groups for fibromyalgia. Local support groups and further information can be found through the Arthritis Foundation (, National Fibromyalgia Association (, or the National Fibromyalgia Partnership, Inc. (


What is the latest research on fibromyalgia?


There is ongoing medical research on fibromyalgia on many fronts. There is active research on the genes responsible for fibromyalgia, new medications, and new non-medication therapies to help pain. One recent study found that non-restorative sleep -- when one wakes up feeling tired after a full night of sleep -- is strongly tied to developing widespread pain. Medical researchers have linked anxiety to developing widespread pain.

Quick GuideFibromyalgia Symptoms, Diagnosis & Treatment

Fibromyalgia Symptoms, Diagnosis & Treatment

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What Is Fibromyalgia?




   Myths and Facts




   Rheumatoid Arthritis

   Psoriatic Arthritis



By Lynn Marks


Medically Reviewed by Samuel Mackenzie, MD, PhD


Fibromyalgia is a chronic (long-term) disorder defined by pain and tenderness throughout your body, as well as fatigue.


People with fibromyalgia tend to have a heightened sense of pain. This feeling is sometimes described as a constant muscle ache.


Formerly known as fibrositis, fibromyalgia is often considered a rheumatic, or “arthritis-like,” disorder. But unlike arthritis and certain related conditions, it doesn't cause damage to joints, muscles, or other tissues.


Fibromyalgia isn't a progressive disease, which means that it won't steadily worsen over time.


There's no cure for fibromyalgia, but treatments are available that may help relieve symptoms and improve your quality of life.

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How Common Is Fibromyalgia?


Fibromyalgia is one of the most common chronic pain disorders.


It affects about 10 million adults in the United States, as well as 3 to 6 percent of the world’s population, according to the National Fibromyalgia Association (NFA).


Although fibromyalgia can occur in anyone, it's more common in women. Between 75 and 90 percent of people diagnosed with the disorder are women, the NFA estimates.

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But at least some of this gender disparity may be due to bias in how doctors approach the diagnostic process, according to Don L. Goldenberg, MD, a rheumatologist and professor emeritus of medicine and nursing at Oregon Health and Science University in Portland.


The disorder affects people of all races and ethnicities. It’s slightly more common if you smoke, are obese, have a lower level of education, or experienced trauma during your childhood, according to Dr. Goldenberg.


Most people with fibromyalgia are diagnosed between ages 20 and 50, with symptoms typically showing up months or even years beforehand. Even children can have fibromyalgia.


But the incidence of the condition rises with age, so that by age 80, 8 percent of people meet the criteria for fibromyalgia, says the NFA.

What Causes Fibromyalgia?


Researchers don't know exactly what causes fibromyalgia, but it seems to occur when the body's central nervous system doesn't process pain properly.


While pain in fibromyalgia may feel like it’s coming from a specific area of your body, “It’s actually coming from the brain, from the central nervous system,” says Goldenberg. “The pain is not where you think it is.”


Even though it’s often grouped with rheumatic diseases like arthritis and lupus, fibromyalgia isn’t considered to be a disease of inflammation, or a joint or muscle disorder.

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It’s also not an autoimmune disorder — a condition in which the body’s immune system mistakenly attacks healthy tissues.


Goldenberg says that it’s a mistake to view fibromyalgia in simple cause-and-effect terms.


“The central nervous system is hypersensitive or hyperirritable,” he says. “It’s like the thermostat is set too high on sensitivity to your nervous system.”


But symptoms of fibromyalgia often begin after physical or emotional trauma, such as an illness, surgery, infection, stressful life event, or injury.


Some experts believe these events may trigger the onset of the disorder, but it’s unclear exactly how this connection could be explained.


According to the Mayo Clinic, repeated stimulation may cause the brains of people with fibromyalgia to change — leading to an increase in chemicals, known as neurotransmitters, that signal pain.


The actual pain receptors in the brain may also undergo changes, developing a kind of “memory” that leads them to overreact to pain signals.


To complicate matters, fibromyalgia can also occur seemingly spontaneously, in the absence of trauma.


Genetics may also play a role. Fibromyalgia is often seen in families, and having a relative with the disorder puts you at increased risk for it.


But genes alone aren’t responsible for fibromyalgia, according to the American College of Rheumatology.

Who Treats Fibromyalgia?


There’s no one medical specialty that treats fibromyalgia. Some family practice doctors or internists (internal medicine specialists) can recognize and manage the condition.


Other types of doctors who commonly treat fibromyalgia include:


   Rheumatologists, internists who specialize in treating arthritis and diseases of the joints, muscles, and soft tissues

   Neurologist, who treat diseases of the brain and nervous system

   Pain management doctors, who treat all forms of pain, including that caused by fibromyalgia


Pain Specialists

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Before making an appointment with any of these specialists, ask whether they treat fibromyalgia. Not all rheumatologists, neurologists, or pain management specialists are knowledgeable about fibromyalgia.

Symptoms and Diagnosis


Fibromyalgia is known for causing widespread pain and tenderness throughout the body, as well as fatigue. It can also cause difficulty sleeping, problems with memory or concentration (“fibro fog”), dizziness, numbness and tingling in the hands and feet, sensitivity to bright lights or loud noises, headaches, digestive issues, and dry eyes or mouth.


Because the symptoms of fibromyalgia overlap with those of many other conditions, diagnosing fibromyalgia can be difficult. In fact, it’s not uncommon to see several doctors and have many medical tests to rule out other conditions before getting a diagnosis of fibromyalgia.


Learn More About Fibromyalgia Symptoms and Diagnosis

Myths and Facts About Fibromyalgia


There’s a lot that medical professionals still don’t know about fibromyalgia, and the same holds true of the general public and the millions of people living with the condition. It is perhaps no surprise, then, that certain myths and outdated beliefs about fibromyalgia persist in some quarters.


At the same time, much has been learned about fibromyalgia over the years, so many of the common misconceptions and misunderstandings about the condition can now be firmly put to bed.


For individuals who have fibromyalgia, being informed is the best way to get good treatment and understand what lifestyle measures will help with symptoms.


Learn More About Fibromyalgia Myths and Facts

Common Overlapping Conditions


Having certain other medical conditions may be another risk factor for fibromyalgia.


In many cases, it isn’t clear whether these conditions might trigger the onset of fibromyalgia, or whether they are instead an effect of fibromyalgia — or whether both conditions are due to some other underlying cause.


People with fibromyalgia often also have:




   Neck or back pain, including disk disease

   Chronic fatigue syndrome

   Endocrine disorders, such as thyroid problems

   Esophageal motility disorders (problems with swallowing)

   Painful menstrual periods

   Breathing issues, such as hyperventilation

   Sjögren’s syndrome, an autoimmune disorder that causes dry eyes and mouth

   Lyme disease

   Heart valve problems

   Enthesopathies (detachment of a tendon or ligament)

   Irritable bowel syndrome (IBS)

   Tension headaches or migraines

   Temporomandibular joint (TMJ) syndrome, a condition that causes jaw pain

   A mood disorder, such as anxiety or depression

   Restless legs syndrome, a limb movement disorder characterized by unpleasant sensations in the legs

   Endometriosis, a condition in which tissue grows outside a woman's uterus

   A rheumatic disease, such as osteoarthritis, rheumatoid arthritis, lupus, or ankylosing spondylitis

   Vestibular disorders, such as vestibular neuritis or Ménière’s disease

   Sleep disorders, such as obstructive sleep apnea or chronic insomnia


Treatment for Fibromyalgia


Fibromyalgia is often best treated with a combination of approaches. For some people, certain types of prescription medication can help to reduce symptoms. For others, drugs have little effect, and for everyone, drugs have side effects that must be balanced with potential benefits.


According to the American College of Rheumatology, physical exercise is the most effective treatment for fibromyalgia. Gentle stretching and aerobic exercise can relieve pain and also prevent deconditioning, or getting weaker from lack of exercise. Exercise can also improve sleep. Working with a physical or occupational therapist can be helpful in getting started with an exercise regimen.


Some other lifestyle approaches that may improve fibromyalgia symptoms include stress reduction, not smoking, following a healthy diet, losing weight if you’re overweight, and establishing good sleep habits.


Learn More About Fibromyalgia Treatment

continue reading below

Drugs Approved for Fibromyalgia

Cymbalta (duloxetine)

Lyrica (pregabalin)

Savella (milnacipran)

Exercise for More Energy and Symptom Relief


Engaging in exercise may be the last thing on your mind when you hurt all over, but in fact, not exercising can make your pain worse. The best approach to being physically active when you have fibromyalgia is to start low and go slow. In other words, start with a few minutes of activity, and gradually increase the amount of time you’re active over several weeks or months to build your strength and endurance.


It’s better to do a little less than you’re capable of than to push too hard and trigger a fibromyalgia flare.


If you’re having a flare, reduce the time and intensity of your exercise sessions, but don’t be completely inactive.


Learn More About Good Exercises for People With Fibromyalgia

Fibromyalgia and Diet


For some people, making dietary changes can ease their fibromyalgia symptoms. Simply following a balanced, nutritious diet is a good start toward better health overall. Such a diet is high in whole foods, contains good sources of vitamin D such as cold-water fish or fortified milk or orange juice, includes foods high in magnesium such as dried beans and leafy greens, and is rich in antioxidants from deeply colored fruits and vegetables.


Beyond that, some research suggests that avoiding dietary excitotoxins — chemicals that excite the neurons in the brain — can provide additional symptom improvement. The most common excitotoxins in the Western diet are food additives used to enhance or sweeten the flavor of foods. Monosodium glutamate is an example of such an additive.


Learn More About What to Eat and What to Avoid

The Link Between Rheumatoid Arthritis and Fibromyalgia


Rheumatoid arthritis (RA) and fibromyalgia are two distinct disorders, but, according to the Arthritis Foundation, up to 30 percent of people with RA also develop fibromyalgia. When the two conditions occur together, pain from one can trigger or exacerbate pain from the other.


Among the key differences between RA and fibromyalgia are that RA is an autoimmune disease while fibromyalgia is not, and RA causes inflammation in and around the joints while fibromyalgia does not attack the joints. The pain of fibromyalgia tends to be widespread, seemingly coming from many points of the body at once.


Each condition is treated differently, but staying physical active can be helpful in both.


Learn More About the Link Between Rheumatoid Arthritis and Fibromyalgia

Is It Psoriatic Arthritis or Fibromyalgia?


Just as people with RA have a higher-than-average risk of developing fibromyalgia, so do people with psoriatic arthritis, a systemic autoimmune disease and an inflammatory form of arthritis. While there are different types of psoriatic arthritis, ultimately, they all cause joint pain, stiffness, and loss of function.


Doctors suspect co-occurring fibromyalgia when a person with psoriatic arthritis experiences persistent pain and fatigue, possibly accompanied by other symptoms of fibromyalgia, such as fibro fog, sleep problems, and irritable or overactive bladder.


One hazard of not recognizing fibromyalgia in a person with psoriatic arthritis is that a doctor might increase a drug dosage or change drug treatments for the psoriatic arthritis unnecessarily, possibly compromising that person’s treatment. Another hazard is that the fibromyalgia goes untreated.


Learn More About How Doctors Distinguish Between Psoriatic Arthritis and Fibromyalgia

Fibromyalgia Complications


The constant pain, fatigue, and lack of sleep associated with fibromyalgia can interfere with your daily life.


Many people are unable to function at work or at home, and become frustrated because this condition is often misunderstood.


Specific complications of fibromyalgia may include:


Mental Fog Some people with fibromyalgia experience lasting memory and cognitive problems that interfere with their ability to concentrate. This is often known as "fibro fog."


Hospitalization People with fibromyalgia are about twice as likely as others to be hospitalized for any reason, according to the Centers for Disease Control and Prevention (CDC).


Depression The CDC notes that people with fibromyalgia are more than three times as likely as others to have major depression, which makes mental health screening extremely important.


Death From Suicide or Injury The risk of death from these causes is higher than in the general population, though the overall risk of death isn’t any higher in people with fibromyalgia, according to the CDC.

Resources for Information and Connection


Living with fibromyalgia can be a frustrating and often lonely existence, particularly if you don’t know anyone else who has it. But with the growth of social media, it’s possible to at least connect online with others who have fibromyalgia, and many towns and cities have in-person support groups as well.


Getting good information about the disorder is important, too, and a number of organizations, including the National Fibromyalgia Association and the American College of Rheumatology, offer authoritative facts and guidance on managing fibromyalgia.


Learn More About Fibromyalgia Resources


Additional reporting by Quinn Phillips.

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National Fibromyalgia Association

National Fibromyalgia and Chronic Pain Association

American Chronic Pain Association

Medline Plus

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Last Updated: 4/5/2018

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Everything you need to know about fibromyalgia

Last updated Fri 5 January 2018

By Christian Nordqvist

Reviewed by Nancy Carteron, MD, FACR


   Symptoms Treatment Causes Diagnosis Diet Tender points


Fibromyalgia is a common and chronic syndrome that causes bodily pain and mental distress.


Symptoms of fibromyalgia can be confused with those of arthritis, or joint inflammation. However, unlike arthritis, it has not been found to cause joint or muscle inflammation and damage. It is seen as a rheumatic condition, in other words, one that causes soft tissue pain or myofascial pain.


According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), around 5 million adults aged 18 years or over in the United States experience fibromyalgia, and 80 to 90 percent of fibromyalgia patients are women.

Fast facts on fibromyalgia:


Here are some key points about fibromyalgia. More detail is in the main article.


   Fibromyalgia causes widespread pain, fatigue, and other types of discomfort.

   Symptoms resemble those of arthritis, but fibromyalgia affects the soft tissue, not the joints.

   The cause is unknown, but risk factors include traumatic injury, rheumatoid arthritis and other autoimmune disorders, such as lupus, and genetic factors.

   There is no cure, but medications, exercise, acupuncture, and behavioral therapy can help relieve symptoms and improve sleep quality.



Fibromyalgia can lead to widespread pain, sleep problems, and other symptoms.

Fibromyalgia can lead to widespread pain, sleep problems, and other symptoms.


Common symptoms include:


   widespread pain

   jaw pain and stiffness

   pain and tiredness in the face muscles and adjacent fibrous tissues

   stiff joints and muscles in the morning


   irregular sleep patterns

   irritable bowel syndrome (IBS)

   painful menstrual periods

   tingling and numbness in the hands and feet

   restless leg syndrome (RLS)

   sensitivity to cold or heat

   difficulties with memory and concentration, known as "fibro-fog"



The following are also possible:


Psoriatic Arthritis Relief - Take Control of Your Symptoms.

Psoriatic Arthritis May Be Causing Your Skin And Joint Symptoms.


   problems with vision


   pelvic and urinary problems

   weight gain


   cold or flu-like symptoms

   skin problems

   chest symptoms

   depression and anxiety

   breathing problems


Symptoms can appear at any time during a person's life, but they are most commonly reported around the age of 45 years.



Medical attention is needed because fibromyalgia can be difficult to manage. As it is a syndrome, each patient will experience a different set of symptoms, and an individual treatment plan will be necessary.


Treatment may include some or all of the following:

Around 20 percent of people with fibromyalgia try acupuncture within the first 2 years. It may work, but more research is needed.

Around 20 percent of people with fibromyalgia try acupuncture within the first 2 years. It may work, but more research is needed.


   an active exercise program



   behavior modification therapy

   chiropractic care


   physical therapy

   low-dose anti-depressants, although these are not a first-line treatment


People with fibromyalgia need to work with their doctor to come up with a treatment plan that provides the best results.




Drugs may be recommended to treat certain symptoms.


These may include over-the-counter (OTC) pain relievers. However, the European League Against Rheumatism (EULAR) issued a recommendation against using non-steroidal anti-inflammatory drugs (NSAIDs) to treat fibromyalgia in their updated 2016 guidelines.


Antidepressants, such as duloxetine, or Cymbalta, and milnacipran, or Savella, may help reduce pain. Anti-seizure drugs, such as gabapentin also known as Neurontin, and pregabalin, or Lyrica, may be prescribed.


However, a review has suggested that patients often stop using these drugs because they are not effective in relieving pain or because of their adverse effects.


Patients should tell the doctor about any other medications they are taking to avoid side-effects and interactions with other drugs.




A combination of aerobic exercise and resistance training, or strength training, has been linked to a reduction in pain, tenderness, stiffness, and sleep disturbance, in some patients.


If exercise is helping with symptoms, it is important to maintain consistency in order to see progress. Working out with a partner or personal trainer may help to keep the exercise program active.




Some patients have experienced improvements in their quality of life after starting acupuncture therapy for fibromyalgia. The number of sessions required will depend on the symptoms and their severity.


One study found that 1 in 5 people with fibromyalgia use acupuncture within 2 years of diagnosis. The researchers concluded that it may improve pain and stiffness. However, they call for more studies.


Behavior modification therapy


Behavior modification therapy is a form of cognitive behavioral therapy (CBT) that aims to reduce negative, stress- or pain-increasing behaviors and improve positive, mindful behaviors. It includes learning new coping skills and relaxation exercises.

Relieving chronic pain with behavioral strategies

Relieving chronic pain with behavioral strategies

Learn more about how behavioral therapy can help relieve chronic pain

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The exact cause of fibromyalgia is unclear. However, current thinking in the field of Rheumatology suggests that fibromyalgia is a problem with central pain processing in the brain, where there may be an increased sensitivity or perception of pain to a given trigger.


There is a range of likely risk factors, including:


   a stressful, traumatic physical or emotional event, such as a car accident

   repetitive injuries

   rheumatoid arthritis or other autoimmune diseases, such as lupus

   central nervous system (CNS) problems

   the way our genes regulate how we process painful stimuli


Fibromyalgia may also be hereditary. Females who have a close relative with fibromyalgia have a higher risk of experiencing it themselves.


People with rheumatoid arthritis, lupus, or spinal arthritis, known ankylosing spondylitis, have a higher risk of developing fibromyalgia, as do patients with some other rheumatic diseases.



It can take some time to confirm a diagnosis of fibromyalgia because the symptoms resemble those of other conditions, such as hypothyroidism. These conditions must first be ruled out before diagnosing fibromyalgia.


There are no laboratory tests for the condition, and this, too, can lead to delayed or missed diagnosis.


The American College of Rheumatology has established three criteria for diagnosing fibromyalgia.


   pain and symptoms over the previous week, out of 19 identified body parts, plus levels of fatigue, unsatisfactory sleep, or cognitive problems

   symptoms that have been ongoing for at least 3 months

   no presence of another health problem that would explain the symptoms


Previously, 'tender points' were used to diagnose the condition. However, these are no longer recommended to aid the diagnosis of fibromyalgia.



Dietary measures have been suggested for improving the symptoms of fibromyalgia.


These include:


   High-energy foods that are low in sugar: Foods such as almonds, beans, oatmeal, avocado, and tofu contain plenty of fiber but no added sugar. These can help boost energy throughout the day, helping to improve tiredness symptoms that occur as a result of the condition.

   Avoiding foods that have gluten: A 2014 study has suggested that gluten sensitivity can contribute to fibromyalgia. The study showed that removing foods that contain gluten from the diet may be able to reduce the pain, even in patients who do not have celiac disease. This is also linked to a diet plan for reducing inflammation.

   Cutting out fermentable oligo-di-mono-saccharides and polyols (FODMAP): A recent study showed that a diet low in FODMAP could have promising effects on pain levels in people with fibromyalgia.

   Not eating additives and excitotoxins: One report showed that cutting out additives from the diet, such as aspartame and monosodium glutamate (MSG), can reduce pain symptoms significantly. The pain of the people involved in the study was also shown to increase once these additives were put back in the diet.

   Eating more seeds and nuts: There is little evidence to support a direct relationship between seeds, nuts, and an improvement in fibromyalgia symptoms. However, they are known to contain powerful micronutrients and minerals that are important for cell function, and this may support people with the condition.


Maintaining a balanced diet and healthy weight is vital to ongoing health and can improve a person's quality of life. Studies have shown that people with both fibromyalgia and obesity showed an improvement in quality of life and pain symptoms once they lost weight.


More research is needed on the effects of diet on fibromyalgia, but making sure the diet is low in sugar and gluten is a good starting point. There is certainly no harm is trying these options to support treatment.

Tender points


When reading up on fibromyalgia, you may have come across the term 'tender points.'


These are certain areas of the body in which fibromyalgia is said to cause the most pain. These include the back of the head, inner knees, and outer elbows. Pain can also be increased in the neck and shoulders, the outer hips, and the upper chest.


Doctors used to diagnose fibromyalgia based on how they react to pressure at these points. However, this is no longer seen as an accurate way to diagnose the condition, and tender points are no longer used as a reliable indicator of fibromyalgia.


Injections are not advised at these points. However, the pain is now thought to be more widespread and present differently in different people. Instead of specific areas or points of pain, fibromyalgia is identified by the severity and chronic nature of the pain.


Seek medical attention to rule out other causes of pain in these areas.



There is no definitive cure for fibromyalgia, but more treatment options and clearer diagnostic criteria are now available.


Symptoms can improve significantly, as long as the patient follows their treatment plan.


Related coverage

Fibromyalgia sufferers might benefit from tailored acupuncture Previous research into the benefits of acupuncture for fibromyalgia sufferers has been inconclusive. A new study using a more tailored approach yields promising results. Read now

What is polyarthritis? Learn all about polyarthritis, a condition where pain and inflammation occur in multiple joints at once. We look at the symptoms, causes, and treatments. Read now

Reactive arthritis: Symptoms, risk factors, and treatment Reactive arthritis is a painful type of inflammation that can occur in the legs and back. Find out about the symptoms and how to treat this condition. Read now

How do you manage arthritis in hands? A look at arthritis in hands, a condition that can make moving fingers and grasping objects difficult. We look at the causes and diagnosis. Read now

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mother and daughter at grocery store

Fast Facts


   Fibromyalgia affects two - four percent of people, women more often than men.

   Fibromyalgia is not an autoimmune or inflammation based illness, but research suggests the nervous system is involved.

   Doctors diagnose fibromyalgia based on all the patient’s relevant symptoms (what you feel), no longer just on the number of tender places during an examination.

   There is no test to detect this disease, but you may need lab tests or X-rays to rule out other health problems.

   Though there is no cure, medications can reduce symptoms in some patients.

   Patients also may feel better with proper self-care, such as exercise and getting enough sleep.


Fibromyalgia is a common neurologic health problem that causes widespread pain and tenderness (sensitivity to touch). The pain and tenderness tend to come and go, and move about the body. Most often, people with this chronic (long-term) illness are fatigued (very tired) and have sleep problems. The diagnosis can be made with a careful examination.


Fibromyalgia is most common in women, though it can occur in men. It most often starts in middle adulthood, but can occur in the teen years and in old age. You are at higher risk for fibromyalgia if you have a rheumatic disease (health problem that affects the joints, muscles and bones). These include osteoarthritis, lupus, rheumatoid arthritis, or ankylosing spondylitis.

What is fibromyalgia?

What causes fibromyalgia?

How is fibromyalgia diagnosed?

How is fibromyalgia treated?

Living with fibromyalgia

The role of the rheumatologist

Additional Information


Updated March 2017 by Suleman Bhana, MD and reviewed by the American College of Rheumatology Committee on Communications and Marketing.


This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.

program and nutrition program. Results are not typical for any or all claims."


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