Fibromyalgia — chronic widespread pain
Fibromyalgia is a chronic condition causing widespread pain, profound fatigue, poor sleep, and cognitive difficulties — often called “fibro fog”. It affects an estimated 2 to 4% of adults in the UK — women more than men.
It is real, disabling, and not “all in the mind” — but it is not inflammatory like rheumatoid arthritis — joints and organs are not damaged by the disease itself.
Core symptoms
Widespread pain:
- both sides of body
- above and below waist
- axial skeleton — neck, back, chest
- persists ≥3 months
- burning, aching, stabbing quality
- allodynia — tenderness to light touch
Fatigue:
- not relieved by rest
- post-exertional worsening common
Sleep:
- unrefreshing sleep — wake exhausted
- alpha-delta sleep anomaly described in research
Cognitive:
- poor concentration, word-finding difficulty, memory complaints
Associated (common):
- headache, migraine
- IBS symptoms
- anxiety and depression
- temporomandibular joint pain
- ** restless legs** sensations
Diagnosis — exclusion and pattern
No single test. GP assesses and orders:
- FBC — exclude anaemia
- TSH — exclude thyroid disease
- CRP/ESR — exclude inflammatory arthritis
- vitamin D if deficient risk
- consider coeliac if bowel symptoms
2016 ACR criteria (simplified clinically): widespread pain index + symptom severity — GP or rheumatology applies.
Do not label prematurely — investigate red flags (weight loss, focal neurology, inflammatory markers high).
What fibromyalgia is not
- Not joint inflammation — unlike RA
- Not progressive organ damage
- Not laziness or malingering
- Not cured by single blood test or scan
Treatment — multimodal approach
Exercise — cornerstone
Graded activity — start low, increase slowly:
- walking, swimming, cycling
- strength training — improves function in trials
- avoid boom-bust — crashing after overactivity
Physiotherapy referral helps pacing.
Psychological support
CBT, acceptance and commitment therapy (ACT) — improve coping and function — not “because it’s psychological” but because pain neuroscience involves brain processing.
Sleep hygiene
Regular schedule, limit caffeine/alcohol, CBT for insomnia — see insomnia.
Medicines (symptom relief — not cure)
| Medicine | Role |
|---|---|
| Amitriptyline (low dose) | Pain, sleep |
| Duloxetine | Pain, mood |
| Pregabalin/gabapentin | Pain — NICE chronic pain guidance limits use — discuss risks |
| Tramadol/opioids | Avoid long term — poor benefit-harm ratio |
No single drug works for everyone — trials often needed.
Self-management
- Fibromyalgia Action UK — support groups
- workplace adjustments — flexible hours
- pain management programmes — NHS multidisciplinary
Overlap with other conditions
Many patients also have:
Treat holistically — not siloed.
Prognosis
Chronic but fluctuating — not life-shortening. Many improve function with consistent pacing and exercise — rarely “disappears completely.”
Avoid:
- prolonged bed rest
- chasing unproven expensive tests
- doctor shopping for structural diagnosis missing
Fibromyalgia requires patience, multidisciplinary care, and activity pacing — validation and structured rehabilitation beat repeated scans showing nothing.
Common questions about fibromyalgia
- What are the symptoms of fibromyalgia?
- Widespread aching pain lasting 3+ months, severe fatigue, waking unrefreshed despite sleep, memory and concentration problems (fibro fog), headaches, irritable bowel symptoms, and sensitivity to touch — even light pressure hurts (allodynia). Symptoms fluctuate — good and bad days.
- What causes fibromyalgia?
- Unknown — central nervous system pain processing appears amplified — brain and spinal cord intensify pain signals. Triggers include physical trauma, surgery, infection, or emotional stress in some people. Not inflammatory arthritis — joints are not damaged.
- Is there a test for fibromyalgia?
- No definitive test — GP diagnoses after history, examination, and blood tests excluding other conditions (thyroid, inflammatory markers, vitamin D, anaemia). Tender points are less emphasised now — widespread pain and associated symptoms define diagnosis.
- What helps fibromyalgia pain?
- Paced graded exercise (walking, swimming, strength training started gently), CBT or ACT psychological therapy, sleep hygiene, and medicines — amitriptyline, duloxetine, pregabalin — for some people. Opioids generally not recommended long term.
- Is fibromyalgia the same as chronic fatigue syndrome?
- Overlapping conditions — both feature fatigue and pain. CFS/ME emphasises post-exertional malaise (crash after activity). Many people meet criteria for both — management overlaps with pacing and holistic support.
Sources
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