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Chronic Pain And Fatigue (Fibromyalgia)

Updated: Nov 26, 2020

Fibromyalgia is a fairly common syndrome characterized by symptoms such as muscle pain, painful areas of the body called tender points, and fatigue.

The overall extent and nature of symptoms vary widely from person to person, and the symptoms may be chronic or they may come and go over time, sometimes making it challenging to get an accurate diagnosis.

Fibromyalgia does not harm organs and is almost never life-threatening, though it can significantly impact one's quality of life. The focus of treatment is to manage the pain and symptoms.

Rheumatic Condition

Fibromyalgia shares some symptoms with arthritis, including chronic pain and fatigue. Like arthritis, it is considered a rheumatic condition because it has an impact on the muscles, joints, and bones. The condition is different from chronic pain and arthritis in important ways, however, such as:

  • Fibromyalgia does not damage joints or muscles, and inflammation does not play a significant role, though many of the tender points are near the joints.

  • There are no outward signs of inflammation in adults. Children may experience some brief swelling.

  • Fibromyalgia is not a degenerative condition. Patients’ symptoms may improve following diagnosis and treatment.

Coexisting Conditions

Many individuals with fibromyalgia have at least one other medical condition. Other rheumatic conditions are especially common in those with fibromyalgia. An estimated 25% to 65% also have systemic lupus erythematosus, ankylosing spondylitis, or rheumatoid arthritis.

Symptoms of these coexisting conditions may overlap with those of fibromyalgia, leading to a delay in diagnosis. Further complicating a diagnosis is the fact that there is no single, widely accepted diagnostic test for fibromyalgia. Instead, diagnosis is based largely on the patient's symptoms and by using medical tests to rule out other conditions.

Cause Is Unknown

When an individual has fibromyalgia, the brain overreacts to pain signals, intensifying feelings of pain in different parts of the body. It is not known what sets off this reaction, though in some cases it appears to be tied to a stressful or traumatic event, illness, injury, or another disease. The condition runs in families, but a specific gene for fibromyalgia has not been found.

More Common in Women

It is estimated that about 2% to 4% of adults have fibromyalgia. About 80% to 90% of people with fibromyalgia are women, typically between the ages of 40 and 75, and the symptoms tend to be more severe in women.

In recent years, more men have been diagnosed than in the past, possibly as a result of shifts in the diagnostic criteria beginning in 2010. In children, the condition is most often diagnosed in adolescence and is known as juvenile-onset fibromyalgia.

Under-diagnosis is a major concern; it is believed that up to 75 percent of those with fibromyalgia have not been diagnosed.

Characteristic Symptoms of Fibromyalgia

Fibromyalgia symptoms typically intensify, or flare, periodically. These flares can be unpredictable; what was an invigorating walk one day could be excruciatingly painful the next.

Symptoms may also ease considerably or even disappear for days, months, or longer, only to re-appear again at a later date.

Fibromyalgia Range of Symptoms

The number and type of fibromyalgia symptoms vary with the individual, but chronic pain and stiffness, fatigue, sleep problems, and cognitive impairment are common.

Musculoskeletal pain

The body pain can range from a dull ache to a burning or shooting pain, and parts of the body may feel sore. Some individuals compare the body pain to that of the flu. The pain may be worsened by a variety of factors, such as physical activity, cold or damp weather, stress, or the time of day.

Tender points

A characteristic sign of fibromyalgia is the small, sensitive spots around the body known as tender points. Tender points are discreet areas of tenderness in the muscular and tendinous tissue in the body. Pain radiates out from these points, and some individuals have pain in many tender points.

These points are painful when minor pressure is applied, as when a doctor presses his or her finger on the area during a physical examination. The pain is felt in the body’s soft tissues, such as muscles and ligaments.


Many patients report stiffness, which is generally widespread and diffuse. As is typical of other rheumatic diseases, the stiffness is usually worse in the morning and may improve as the day progresses. It is usually exacerbated the day after physical exertion or exercise.


Patients sometimes report feeling exhausted or weighed down by fibromyalgia. It is common to experience short periods of energy (such as for 24 to 48 hours), only to rebound into feeling fatigued and tired again.

For some, fibromyalgia fatigue is more of a disability than the pain, as it can substantially impact quality of life. Fatigue can make it difficult to sustain or progress in a career, make social plans, and participate in life's milestones, such as family events. Lack of social interaction can in turn contribute to a feeling of isolation or depression.

Non-restorative sleep

Most individuals with fibromyalgia have sleep problems and feel tired upon waking no matter how long they sleep. Pain is often one cause, but individuals with fibromyalgia are also more likely than average to have sleep-related problems such as restless legs syndrome and sleep apnea, which causes breathing to stop briefly while sleeping.

These sleep disruptions may prevent an individual from getting the deep sleep that allows muscles to relax and tissues to rebuild. Some doctors think the lack of quality sleep may contribute to fibromyalgia’s mental sharpness and fatigue issues. Sleep deprivation has been shown to make pain worse even for those without chronic conditions.

Difficulty focusing

Difficulties with focusing, paying attention, and retaining new information are sometimes referred to as “brain fog” or “fibro fog.” Patients may also have trouble using the right words when they talk or have short-term memory loss. These cognitive issues tend to occur most when the individual is feeling tired, stressed, or anxious.

The lack of sharpness varies from person to person, and can last hours, weeks, or longer. For some people, the problem can be serious enough to affect job performance. Driving is unsafe if the impairment is severe.

Additional Symptoms and Coexisting Conditions

Individuals with fibromyalgia are more likely than others to have coexisting medical issues including, but not limited to:

  • Ankylosing spondylitis

  • Anxiety

  • Bladder problems, including painful or frequent urination

  • Coping with Fatigue syndrome

  • Depression

  • Dizziness/balance problems

  • Dry mouth

  • Extra sensitivity to bright light, foods, and noise

  • Gynecological problems, including endometriosis, painful periods, and vulvodynia

  • Hypothyroidism (underactive thyroid gland)

  • Irritable bowel syndrome

  • Low back pain

  • Multiple chemical sensitivities

  • Muscle twitches and cramps (also called muscle spasms)

  • Myofascial pain syndrome

  • Numbness/tingling in hands and feet

  • Post-traumatic stress disorder

  • Restless legs syndrome

  • Rheumatoid arthritis

  • Sleep apnea

  • Systemic lupus erythematosus (lupus)

  • Painful or frequent urination

  • Temporomandibular joint (TMJ) disorders, including tinnitus (ringing in the ears)

  • Tension and migraine headaches

  • Temperature sensitivity

Reponses to an online survey by the National Fibromyalgia Association with more than 10,000 responses also pointed to a large number of overlapping conditions. More than 60% reported low back pain, and more than 40% listed one or more these symptoms:

  • Arthritic joint pain

  • Balance problems

  • Irritable bowel syndrome

  • Muscle spasms

  • Numbness

  • Recurrent headaches

  • Tingling

Keeping a diary of activities, stressors, and environmental factors may help patients track what makes symptoms better or worse. Once these “triggers” are known, strategies to avoid or minimize them can be developed.

Modulating Factors

While the timing of some symptom flares is unpredictable, the following situations typically lead to an exacerbation of symptoms:

  • Cold, damp weather

  • Stress

  • Overexertion

The reverse is also true. Patients feel better with warm weather, hot baths, or even vacations from home or work. Non-steroidal anti-inflammatory medications (NSAIDs), such as ibuprofen and naproxen, usually do not alleviate symptoms.

How to Get a Fibromyalgia Diagnosis

Fibromyalgia is challenging to diagnose. Some people see a number of doctors—and seek answers for years—before getting an accurate diagnosis.

Clinical Tests

There is no widely accepted medical test to diagnose fibromyalgia. Instead, diagnostic tests are performed to see if another condition could be causing the symptoms.

Blood tests are usually ordered to rule out conditions with similar symptoms. Other tests will depend on the symptoms described, but may include X-rays or an electromyography (EMG), to evaluate muscles’ electrical activity.