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Diagnosis and Management of Fibromyalgia

Medically reviewed by Susan Kerrigan, MD, Marianne Madsen, Ananta Subedi, MD, and Rubaiya Mallay, DO on January 18, 2023

Fibromyalgia is a chronic condition that causes widespread musculoskeletal pain associated with severe fatigue, unrefreshing sleep, memory problems, depression, and anxiety. It is a disorder characterized by amplified pain signals in the brain and the spinal cord. The disorder could begin after physical and/or mental trauma such as infection, significant psychological stress, or a significant physical trauma. In other cases, there may not be any identifiable cause.


Women are affected more than men. In the US, around 4 million people suffer from this condition. It can affect various parts of your body with common one including the neck, shoulder, back, chest, hips, buttocks, arms, and legs. The cause of fibromyalgia is not known, but various factors can increase risk for it. It is associated with multiple other conditions including tension headache, temporomandibular joint (TMJ) pain, and irritable bowel disease (IBS).


How do I know if I have fibromyalgia?


Fibromyalgia causes symptoms that could mimic other conditions, so it may be difficult to diagnose this condition. The symptoms are quite variable among many patients.  Many of the symptoms are not specific for this condition. A good history taking and physical examination is key in making the diagnosis. Some common symptoms of the disease include:


  • Widespread pain
  • Fatigue
  • Non-refreshing sleep
  • Depression and/or anxiety
  • Problems with memory
  • Inability to concentrate or pay attention
  • Migraines and stress headaches
  • Irritable or overactive bladder 


Other symptoms, which are less common, may include:


  • A tingling sensation or numbness in the hands and feet
  • Symptoms of irritable bowel syndrome (diarrhea and constipation) 


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Fibromyalgia - Symptoms

Fibromyalgia - Symptoms

Causes and Risk Factors for Fibromyalgia


The cause of fibromyalgia has not been clearly identified. It is not an auto-immune condition like rheumatoid arthritis or lupus.  It is believed that repeated nerve stimulation could increase the chemicals that cause pain signals in the brain and the spinal cord. This leads to amplification of the pain signals.These are some of the suspected risk factors


  • Genetics: It tends to run in families, increasing the likelihood that there could be a genetic risk. This has not been well identified. 
  • Physical and/or emotional trauma
  • Infections: Certain illnesses could trigger the disease.
  • Female gender


Diagnosing fibromyalgia


There is no laboratory test to diagnose fibromyalgia. The most important aspect in its diagnosis is to exclude other causes for pain, including many auto-immune diseases and endocrine abnormalities. 


The main symptom for the disease is widespread pain throughout your body lasting for more than 3 months, but there are multiple other symptoms.  When your doctor examines you, he or she could find multiple soft tissue tenderness at various parts of your body. 


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Fibromyalgia - Testing and Diagnosis

Fibromyalgia - Testing and Diagnosis

Managing fibromyalgia


The treatment of fibromyalgia is challenging due to the lack of effective therapies. The treatment of fibromyalgia includes non-pharmacological therapies and pharmacological options. 


Non-pharmacological therapies play a vital role in managing the fibromyalgia symptoms. These include:


  • Regular low impact exercise: Start slow and increase your exercise time gradually)
  • Stretching exercise like Yoga and Tai Chi 
  • Adequate treatment of anxiety and/or depression
  • Stress management (deep breathing exercises, psychological support, counseling) 
  • Adequate sleep 
  • Find time in your everyday routine to rest and relax 


Pharmacological therapies are also available. FDA-approved medications for the management of some of the symptoms of fibromyalgia include:


  • Pregabalin (lyrica)
  • Duloxetine (Cymbalta) 
  • Milnacipran (Savella) 


These medications have some role in management of the symptoms but are beneficial only to a few patients. These medications must be used in combination with the non-pharmacological options discussed above to have the best outcomes. Other non-opioid medications  (acetaminophen, NSAIDs) could be of help to relieve some of the pain. Opioids are frequently used in fibromyalgia treatment, but the available evidence suggests that the opioids medications are not effective–they have negative effects with poor long-term outcomes. Use of opioids is not recommended to treat the pain symptoms of fibromyalgia. 


Written by Natan Rosenfeld

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