What is fibromyalgia?

Fibromyalgia is defined by widespread chronic pain, as well as a broad spectrum of related symptoms including fatigue, cognitive dysfunction, and reduced physical function.

It is a condition affecting the soft tissues. It tends to be seen predominantly in women but can occur in men, and in all age groups.

It was believed in the middle 19th century as a type of rheumatism. Subsequently it has been described at various times in many terms: fibrositis, tension myalgia, myositis, myofascia syndrome, to name but a few. In the past, many patients were often labeled as “neurotic” because of their unexplained symptoms. Up until recently (and there may still be) doctors who still believed it was entirely psychological in basis.

It was not until 1990 that it was described as a disease rather than a syndrome by the American College of Rheumatology (ACR) and criteria were devised to diagnose it, in order that researchers could be sure while studying fibromyalgia patients that they were all studying the same thing. In 1993 the World Health Organisation finally distinguished fibromyalgia from other rheumatic disorders and accepted the definition adopted by the ACR.

Today it is recognised and treated by a variety of physicians. Doctors may run a multitude of tests to determine the cause of the symtoms and find inconclusive results. However, it is diagnosed on criteria requiring the patient to have widespread pain for a minimum of three months and at least 11 of 18 specified tender spots in all four body quadrants.

The root cause of fibromyalgia is still the subject of ongoing research. As more is learned, there is a growing concensus that this is a disorder of the nervous system rather than of the musculoskeletal system as was previously thought. Thus, the neurological symptoms such as memory loss, lack of concentration, trouble making decisions, etc., fit logically with the illness.

While there is as yet no medical cure for the condition, there is a lot people with fibromyalgia can do to improve the quality of their lives.

What are possible factors in causing fibromyalgia?

• Your sex 
Fibromyalgia occurs more often in women than in men.

• Age
Fibromyalgia tends to develop during early and middle adulthood. However, it can also occur in children and older adults.

• Disturbed sleep patterns
It’s unclear whether sleeping difficulties are a cause or a result of fibromyalgia — but people with sleep disorders, such as night-time muscle spasms in the legs, restless legs syndrome or sleep apnoea, can also develop fibromyalgia.

• Family history
The genetic factor should also be considered. You may be more likely to develop fibromyalgia if a relative also has had the condition.

• Rheumatic disease 
If you have a rheumatic disease, such as rheumatoid arthritis, lupus or ankylosing spondylitis, you may be more likely to have fibromyalgia.


Doctors don’t know what causes fibromyalgia. Current thinking centres around a theory called “central sensitization.” This theory states that people with fibromyalgia have a lower threshold for pain because of increased sensitivity in the brain to pain signals. Researchers believe repeated nerve stimulation causes the brains of people with fibromyalgia to change. This change involves an abnormal increase in levels of certain chemicals in the brain (neurotransmitters) that signal pain.

In addition, the brain’s pain receptors (neurons), which receive signals from the neurotransmitters, seem to develop a sort of memory of the pain and become more sensitive, meaning they can overreact to pain signals. In this way, pressure on a spot on the body that wouldn’t hurt someone without fibromyalgia can be very painful to someone who has the condition. But what initiates this process of central sensitization isn’t known.

It’s likely that a number of factors contribute to the development of fibromyalgia. Other theories as to the cause include:

  • Sleep disturbances. Some researchers theorize that disturbed sleep patterns may be a cause rather than just a symptom of fibromyalgia.
  • Injury. An injury or trauma, particularly in the upper spinal region, may trigger the development of fibromyalgia in some people. An injury may affect your central nervous system, which may trigger fibromyalgia.
  • Infection. Some researchers believe that a viral or bacterial infection may trigger fibromyalgia.
  • Abnormalities of the autonomic (sympathetic) nervous system. Part of your autonomic nervous system — the sympathetic, or involuntary, system — controls bodily functions that you don’t consciously control, such as heart rate, blood vessel contraction, sweating, salivary flow and intestinal movements. It’s thought that sympathetic nervous system dysfunction occurs in people with fibromyalgia, particularly at night, which leads to fatigue, stiffness, dizziness and other signs and symptoms associated with the condition.
  • Changes in muscle metabolism. For example, deconditioning and decreased blood flow to muscles may contribute to decreased strength and fatigue. Differences in metabolism and abnormalities in the hormonal substance that influences the activity of nerves may play a role.

Psychological stress and hormonal changes also have been considered as possible causes of fibromyalgia.

What are the symptoms of fibromyalgia?

Pain knows no boundaries. Although fibromyalgia may leave you feeling achy over your whole body, you’re most likely to feel sharper pain where muscles attach to joints or in muscle areas called trigger points; places that may be especially painful include the elbow, forearm, hip, knee, shoulder, neck, jaw, and back. Fatigue and difficulty sleeping are other common symptoms.

Patients report trouble falling asleep and, more importantly, staying asleep.  Repeated arousals prevent them from reaching deep, restorative sleep.  As a result, the night is spent in “quasi-sleep” and they often wake up in the morning feeling unrefreshed and exhausted.  Some studies have shown that fibromyalgia patients have abnormal alpha NonREM sleep stages, the periods during which the most restful sleep is attained.

A host of other physical symptoms experienced by fibromyalgia people include:
• Headache
• Dizziness
• Dry eyes and mouth
• Light sensitivity
• Sensitivity to heat and cold
• Morning stiffness
• Chest pain
• Sore throat
• Swollen glands
• Blurred vision
• Intolerance to alcohol
• Muscle weakness
• Vulvodynia
• Painful menstruation
• Decreased interest in sex
• Thyroid disease
• Immune system dysfunction
• Weight gain
• Irritable bowel syndrome
• bladder problems
• nausea
• digestive problems

and others…

These can be accompanied by a number of neurological symptoms, including:
• Poor concentration
• Difficulty in understanding speech
• Difficulty in speaking
• Reading dysfunction
• Memory problems
• Bumping into things
• Dropping things
• Diminished comprehension
• Anxiety
• Depression
• Panic attacks

How can fibromyalgia be treated?

There is no overnight cure for fibromyalgia but with the help of your doctor and family it is possible to find ways of managing your symptoms so that you can continue with your normal activities as much as possible. Your doctor may be able to help you by making the diagnosis of fibromyalgia and helping you put a plan in place to manage the condition. Your family can also help with understanding and encouragement.

Your doctor can prescribe a variety of medications which may help with the pain. These include painkillers such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) (of which there are many). A steroid injection in the affected area may give temporary relief if one or two places are particularly painful.

Your doctor can also try to help with the sleep disturbance. Sleeping in a soft collar can help some people sleep better, particularly if the neck is uncomfortable. There is no harm in you trying this for a week or so, providing you do not get into the habit of wearing it during the day. Ordinary sleeping tablets are best avoided because they are often habit-forming and eventually lose their effect.

Many people with fibromyalgia can also be helped by an anti-depressant drug. Some of the older ones, such as tricyclic anti-depressants, have been found to be effective for long-term pain. They may also have a sedative effect and help to restore a sleep pattern. This can be helpful even if you do not have the depression which is often associated with fibromyalgia. The benefit may not be immediate, and you may notice side-effects – drowsiness, dry mouth, constipation, weight gain — before the benefits, so it is worth trying for at least a couple of months before deciding if they are helpful.  Newer forms of antidepressants – selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) have fewer side effects than tricyclic antidepressants and are also sometime used to treat chronic pain.

Your doctor may also refer you to a physiotherapist, an occupational therapist or a counsellor for further information and advice about fibromyalgia.