Let’s Talk About the Signs and Symptoms of Fibromyalgia
Pain—everywhere—is the calling card of this chronic disease. Here’s what else to keep an eye out for.
You’ve been feeling run down lately. Tired, achy, everything hurts. You can’t concentrate. You can’t sleep. You don’t feel like… you. It’s like you have the flu, but you don’t have a fever and you’re not getting better. Your doctor says nothing seems to be wrong, but the symptoms persist. What’s happening? It’s possible that it could be fibromyalgia, a chronic pain disorder. Here’s how to recognize the red flags of this condition, and where to get help.
Our Pro Panel
We went to some of the nation’s top experts in fibromyalgia to bring you the most up-to-date information possible.
Andrea L. Nicol, M.D.
Comprehensive pain management physician, Assistant Professor
University of Kansas Medical Center
Kansas City, KS
Shirin Peters, M.D.
Internal Medicine Specialist, Medical Director for Bethany Medical Clinic
Mount Sinai Beth Israel, NYU Langone Health Tisch Hospital
Manisha Mittal, M.D.
Rheumatologist, rheumatology director, Graduate Medical Education
St. Agnes Medical Center
Good question! While both conditions cause pain in the joints, ligaments, and soft tissues of the body, arthritis is an inflammatory and sometimes autoimmune disorder, while doctors believe that fibromyalgia is a unique pain syndrome. That said, a significant percent of people who have autoimmune conditions like lupus and rheumatoid arthritis also go on to develop fibromyalgia.
Not exactly. But pain signals in people with fibro get messed up. Allodynia, one fibro symptom, causes people to feel very slight sensations at 1000 decibels. For instance, a piece of paper resting on your arm can feel like bone-crushing pain. In hyperalgesia, another symptom, an event like having your foot stepped on goes from uncomfortable to unbearable in people with fibro.
There may be a biological explanation, but we know for sure is that for anyone struggling with chronic pain, the future can look bleak. We also know that people with depression are more prone to feelings of poor physical health, so in essence, it becomes a feedback loop: Fibro makes you feel hopeless, leading to depression, and depression make you feel fibro pain more acutely.
Fibromyalgia affects about 10 million Americans, or 2% to 4% of the population. Roughly four women are diagnosed with it for every one man, and it’s more common in middle-age people (although children, young adults, and the elderly can have it, too). While anyone can get fibro, people with a preexisting autoimmune disorder seems especially susceptible.
Refresh: What Is Fibromyalgia?
Fibromyalgia (sometimes shortened to just “fibro”) is a chronic neurologic pain condition, likely originating in the central nervous system, that is incurable. It has several dedicated medications to treat it, as well as non-medical treatments like physical therapy, cognitive behavioral therapy, and relaxation techniques. It isn’t a life-threatening disorder—it won’t cause a heart attack or a stroke, for instance—but it can raise your risk of major depression three-fold, so it’s important to get the help you need for this condition.
Fibromyalgia affects about 10 million Americans, or 2% to 4% of the population. More women are diagnosed with it than men, and it’s more common in middle-age people (though children, young adults, and the elderly can have it, too).
Now that you know more about what it is, let’s talk about how to recognize it.
What Are the Signs of Fibromyalgia?
Everyone with fibro is unique—you might have some of the common symptoms, but not others. You might have one or two more obscure symptoms, or the whole list of them. You also might have symptoms some of the time, during what’s known as a fibro flare, and then go without symptoms for months, or even years.
Or, unfortunately, you might live with extremely intense pain daily, without medical intervention. These are some of the most common signs and symptoms of fibromyalgia:
Fibro pain is can be chronic and unrelenting—but it can come and go, too, hurting in extreme degrees one day and not the next. The pain itself can change from a stabbing pain one day to a shooting pain the next. The pain can morph into a deep aching sensation or it may throb or cause you to twitch.
Fibromyalgia pain can happen anywhere in your body, but tender points are a hallmark of the disease—these “hot spots” are especially painful areas in one of 19 parts of your body associated with the disease. These include:
Your doctor will take into account your total number of tender points (and how long pain in these areas lasts for) when diagnosing the condition. How severe your tender point pain is depends on a whole host of things, including:
Time of day (fibro pain is usually worse in the morning)
Type of weather (pain worsens during cold/humid weather)
How much sleep you got
How much you’ve exercised
Whether you’re feeling stressed
This symptom is another giveaway that your pain is fibro-related. People with allodynia experience extreme pain from a sensation that doesn’t usually cause discomfort. For instance, something like a piece of paper lying on your arm could trigger sharp, shooting pains through your extremity, even though there is no evidence that the paper is causing harm.
Along with disturbances in pain signaling, many people with fibro experience difficulties with various cognitive processes. Issues can include memory loss, concentration problems, and problems thinking clearly, often referred to as fibro fog.
There’s tired, and then there’s fibro-tired. Fibromyalgia-related fatigue is a whole-body tiredness that’s so deep and draining you feel like you can’t recover from it. You can have profound exhaustion and poor stamina. You may find yourself spending entire days in bed because it’s too much of an effort to get up.
Just as normally pain-free experiences can cause pain in people with fibro, the degree of pain can also be magnified exponentially in people with the disease. For instance, a pinch on the arm that would usually feel like a 1 or 2 on a pain scale of 0 to 10, instead feels like a 9 or 10.
You can experience depression or anxiety—or both. In fact, people with fibromyalgia have a three times greater risk of developing severe depression than those without the disease.
People with fibro may experience tingling or numbness in their hands and feet.
Fibromyalgia is associated with several sleep disorders—a cruel twist, since the fibro fatigue also makes you feel like all you want to do is sleep. Researchers have found that people with fibromyalgia have specific abnormalities in the Stage 4 phase of sleep, or the “deep sleep” when your body typically repairs and heals itself. The reason this happens isn’t entirely clear, but it appears the brain of people with fibro is constantly “on,” and can’t rest, causing a documented increase in the number of tender points, post-sleep. Sleep apnea may also be related to fibro risk.
Everyone knows what morning stiffness is like, but it if you have fibro, it’s taken to an extreme. You’ll recognize it because it takes you several minutes to get from lying in bed to standing, and several more to make your way to the bathroom. Each move hurts—as if you have arthritis, but you don’t. This can happen in the morning or after you’ve been resting for a while.
Less-common signs and symptoms can include:
Dry eyes and mouth
Irritable bowel and bladder
Ringing in the ears
Sensitivity to light, sound, and odors
Skin sensitives and rashes
What to Do if You Have These Symptoms
Try to keep tabs on your signs and symptoms with a fibro log on your phone or in a paper diary, so you can bring this info to an appointment with your healthcare professional to discuss.
One useful tool: The American Chronic Pain Association website shares a log including a pain scale to rate how much you’re in pain, and a body map to show where the pain is, as well as a system for tracking your quality of life and level of everyday activities achieved.
Other things to write down:
What symptoms do you have?
How intense is the pain?
How often these symptoms occur?
Are these symptoms constant?
Do you have other health problems that could potentially be the cause of these issues?
Then, make an appointment to see your primary care doctor to review what you are experiencing. Once you’ve discussed your symptoms with your doctor, you may be referred to a specialist who has knowledge of fibromyalgia. Some of these specialists include:
Pain management specialist
Other doctors that might take part in this process include physiatrists/phycologists and physical therapists.
How Is Fibromyalgia Diagnosed?
Once you have reviewed your symptoms with your doctor or specialist, you will undergo a few tests and more questions to help create a more robust picture of what’s going on. These next steps may include:
A blood test: Your doctor will look for things that can mimic fibromyalgia to rule those out first, like hypothyroidism and polymyalgia rheumatica.
Medical history: Your doctor will take a full medical history, including asking questions about whether anyone else in your family has had fibro, and whether you have any other health issues that may be contributing to the disease.
X-rays: Your doctor may want to get imagery of a painful area to rule out fractures or other injuries.
Use diagnostic guidelines: Your doctor may ask you about having pain in 19 specific areas of the body that have been identified as common fibro tender points. Your physician may also ask about symptoms including fatigue and cognitive problems—a pattern of trouble over a three-month period or more, with no other health problem identified as contributing to these symptoms, can be a tip-off that it’s fibro.
At the end of the day, fibromyalgia is considered a “diagnosis of exclusion” or differential diagnosis because there are no clinical tests, like a blood test, that can tell for certain that it’s fibro you have. Your doctor will instead rule out other possible issues via blood tests and lab imaging, and then in the absence of these illnesses, diagnose fibro. In the future, more definitive tests and possibly brain imaging could further help doctors with this challenging diagnosis.
What is Fibro: Dialogues in Clinical Neuroscience. (2018). “Facts and myths pertaining to fibromyalgia.” ncbi.nlm.nih.gov/pmc/articles/PMC6016048/
Fibro Signs and Symptoms: The American Journal of Medicine. (2009). “Pathophysiology of Fibromyalgia.” ncbi.nlm.nih.gov/pmc/articles/PMC2821819/
Pain Symptom: National Fibromyalgia Association. (2020). “Fibromyalgia Symptoms.” fmaware.net/fibromyalgia-symptoms/
Sleep Symptom: Arthritis & Rheumatology. (2001). “Alpha Sleep Characteristics in Fibromyalgia.” pubmed.ncbi.nlm.nih.gov/11212164/
Fibro Fact Sheet, Symptoms: National Fibromyalgia & Chronic Pain Association. (2020). “FM Fact Sheet.” fibroandpain.org/fm-fact-sheet-2
Keeping a Fibromyalgia Log: American Chronic Pain Association. (2009). “Fibro Log.” theacpa.org/wp-content/uploads/2017/08/ACPA-FibroLog.pdf
Who Typically Treats Fibro: American College of Rheumatology. (2019). “Fibromyalgia.” rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Fibromyalgia
Testing for Fibro: Mayo Clinic. (2020). “Fibromyalgia: Understanding How It’s Diagnosed.” mayoclinic.org/diseases-conditions/fibromyalgia/in-depth/fibromyalgia-symptoms/art-20045401