Fibromyalgia

What is fibromyalgia?

Fibromyalgia is a long-term condition that causes pain all over your body, along with extreme tiredness and disturbed sleep. It develops when your nervous system becomes more sensitive, turning up the volume on the pain signals sent to your brain.

Symptoms of fibromyalgia

Fibromyalgia affects everyone differently, and your symptoms may improve or get worse over time. Many people also have flare-ups, when symptoms suddenly become stronger for a few hours or days before settling again.

• widespread pain that can feel like aching, burning or throbbing
• extreme tiredness (fatigue), even after a full night's sleep
• problems sleeping, including trouble falling or staying asleep
• muscle stiffness and tenderness to touch
• “fibro fog”, such as trouble concentrating, thinking clearly or remembering things
• headaches or migraines
• digestive problems, such as bloating, constipation or diarrhoea
• increased sensitivity to light, noise, smells or temperature
• tingling or numbness in your hands and feet
• low mood, anxiety or depression.

Causes of fibromyalgia and who is at risk

No one knows exactly what causes fibromyalgia. Most experts think it happens because your central nervous system, made up of your brain and spinal cord, becomes overly sensitive and amplifies pain signals, so you feel pain more strongly than other people would.

Fibromyalgia can run in families, which suggests genes play a part, although scientists have not pinned down which ones. It's also often triggered by a stressful event, such as an injury, an infection, or a physically or emotionally difficult time in your life.

You may be more likely to develop fibromyalgia if you:

• are a woman, as fibromyalgia is more common in women than men
• are middle-aged, although it can affect people of any age, including children
• have a close family member with fibromyalgia
• have a mood disorder, such as anxiety or depression, or are under a lot of stress
• have another chronic pain condition or a rheumatic disease, such as rheumatoid arthritis or lupus
• have irritable bowel syndrome (IBS) or chronic back pain.

Estimates of how common fibromyalgia is vary between sources. The NHS suggests it could affect nearly 1 in 20 people to some degree. This range partly reflects how difficult fibromyalgia can be to diagnose.

How fibromyalgia is diagnosed

There's no single blood test, scan or x-ray that can confirm fibromyalgia. Instead, your doctor will ask about your symptoms and medical history, then examine you to check for tenderness across different areas of your body.

You may also have blood tests or x-rays, but these are used to rule out other conditions, such as thyroid problems or inflammatory arthritis, rather than to confirm fibromyalgia itself. Some private blood tests are advertised as fibromyalgia tests, but they are not considered accurate enough for most people.

Doctors often use set criteria to help with diagnosis. These typically look for widespread pain in at least 4 of 5 areas of your body, present for at least 3 months, with no other condition that fully explains the pain. You could still be diagnosed with fibromyalgia alongside another condition, such as depression, anxiety or IBS.

How fibromyalgia is treated

There's currently no cure for fibromyalgia, but a combination of treatments can ease your symptoms and make everyday life easier. No single treatment works for everyone, so you may need to try a few different approaches to find what suits you.

Fibromyalgia is not treated with surgery. Your care will usually combine lifestyle changes, talking therapies and medication.

Gentle, regular exercise is one of the most effective treatments. Low-impact activities such as walking, swimming, cycling or yoga can help reduce pain and improve your sleep and quality of life, even though it can feel hard to start when you're in pain. Good sleep habits and relaxation techniques, such as mindfulness, can also help you manage flare-ups.

Talking therapies can help too, including cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT). Both can help you manage pain, cope with stress and change unhelpful thinking patterns.

If your symptoms are moderate to severe, your doctor may also suggest medication. Options include antidepressants, which can help with both pain and mood, antiseizure medicines that ease nerve-related pain, and pain-blocking medicines that act on your brain and spinal cord. Commonly used medicines include duloxetine, milnacipran, pregabalin, amitriptyline and cyclobenzaprine, although opioid painkillers and sleep medicines are not usually recommended for fibromyalgia.

Some people also try complementary therapies, such as acupuncture, massage, heat therapy or hypnosis. There's not always strong scientific evidence that these help in the long term, but some people find they help them relax and cope better with their condition.

When to see a doctor

See a GP if you have widespread pain that has lasted for 3 months or more, especially alongside extreme tiredness or poor sleep. A diagnosis can help you access the right treatment and support, even though fibromyalgia can take time to identify.

You should also see your doctor if:

• your pain, tiredness or sleep problems are affecting your daily life
• you're finding it hard to cope physically or emotionally
• you notice ongoing low mood, anxiety or “fibro fog”.