Fibromyalgia#Symptoms

The term "fibromyalgia" was derived from Neo-Latin fibro-, meaning "fibrous tissues";{{Cite web |title=Fibro- |url=http://dictionary.reference.com/browse/fibro- |url-status=live |archive-url=https://web.archive.org/web/20091213070938/http://dictionary.reference.com/browse/fibro- |archive-date=13 December 2009 |access-date=21 May 2008 |publisher=Dictionary.com}} Greek μυο- myo-, "muscle";{{Cite web |date=12 April 2009 |title=Meaning of myo |url=http://www.bartleby.com/61/94/M0509400.html |archive-url=https://web.archive.org/web/20090412005428/http://www.bartleby.com/61/94/M0509400.html |archive-date=12 April 2009 |access-date=26 August 2012}} and Greek άλγος algos, "pain";{{Cite web |date=12 April 2009 |title=Meaning of algos |url=http://www.bartleby.com/61/59/A0195900.html |archive-url=https://web.archive.org/web/20090412005958/http://www.bartleby.com/61/59/A0195900.html |archive-date=12 April 2009 |access-date=26 August 2012}} thus, the term literally means "muscle and fibrous connective tissue pain".{{Cite book |url=https://books.google.com/books?id=JxEiRjNm8nMC&pg=PA165 |title=Neurobiological foundations for EMDR practice |vauthors=Bergmann U |date=2012 |publisher=Springer Pub. Co. |isbn=978-0-8261-0938-5 |location=New York |page=165}} Thus, this term is inaccurate and misleading, as it only reflects a part of the syndrome symptom set.{{Cite journal|title= Not the Last Word: Fibromyalgia is Real|date=2015 |pmc=4709307 |journal=Clinical Orthopaedics and Related Research |volume=474 |issue=2 |pages=304–309 |doi=10.1007/s11999-015-4670-6 |pmid=26676117 | vauthors = Bernstein J }}

The term FM is increasingly used.{{Cite web|url=https://www.hopkinsarthritis.org/arthritis-news/fibromyalgia-news/evidence-suggests-the-pain-in-fibromyalgia-is-real/|title=Finding Fibro: Emerging Evidence Suggests that the Pain in Fibromyalgia is Real|first=Arthritis|last=Center|date=16 January 2008}}{{Cite journal|title=Facts and myths pertaining to fibromyalgia|first1=Winfried|last1=Häuser|first2=Mary-Ann|last2=Fitzcharles|date=25 March 2018|journal=Dialogues in Clinical Neuroscience|volume=20|issue=1|pages=53–62 |doi=10.31887/DCNS.2018.20.1/whau|doi-broken-date=25 February 2025 |pmid=29946212 |pmc=6016048 }}{{Cite journal|title=Review of Fibromyalgia (FM) Syndrome Treatments|first1=Liraz|last1=Cohen-Biton|first2=Dan|last2=Buskila|first3=Rachel|last3=Nissanholtz-Gannot|date=24 September 2022|journal=International Journal of Environmental Research and Public Health|volume=19|issue=19|page=12106|doi=10.3390/ijerph191912106|doi-access=free |pmid=36231406 |pmc=9566124 }}

In the International Classification of Diseases (ICD-11) fibromyalgia syndrome is an inclusion in the category of "Chronic widespread pain" (CWP) code MG30.01. This is diffuse pain in at least 4 of 5 body regions, and is associated with emotional distress or functional disability (i.e. interference in daily life activities and reduced participation in social roles).https://icd.who.int/browse/2025-01/mms/en#849253504

FM is within the functional somatic syndrome group of diagnoses, i.e. chronic diagnoses with no identifiable organic cause.

People with fibromyalgia differ in several dimensions: severity, adjustment, symptom profile, psychological profile, and response to treatment. There may be clear clusters of symptom characteristics within fibromyalgia.{{cite journal | vauthors = Gianlorenço AC, Costa V, Fabris-Moraes W, Menacho M, Alves LG, Martinez-Magallanes D, Fregni F | title = Cluster analysis in fibromyalgia: a systematic review | journal = Rheumatology International | volume = 44 | issue = 11 | pages = 2389–2402 | date = November 2024 | pmid = 38748219 | doi = 10.1007/s00296-024-05616-2 }}{{cite journal | vauthors = Hoskin TL, Whipple MO, Nanda S, Vincent A | title = Longitudinal stability of fibromyalgia symptom clusters | journal = Arthritis Research & Therapy | volume = 20 | issue = 1 | page = 37 | date = February 2018 | pmid = 29486783 | doi = 10.1186/s13075-018-1532-0 | doi-access = free | pmc = 5830338 }}{{Cite journal|title=CNS imaging characteristics in fibromyalgia patients with and without peripheral nerve involvement|first1=Hans-Christoph|last1=Aster|first2=Dimitar|last2=Evdokimov|first3=Alexandra|last3=Braun|first4=Nurcan|last4=Üçeyler|first5=Thomas|last5=Kampf|first6=Mirko|last6=Pham|first7=György A|last7=Homola|first8=Claudia|last8=Sommer|date=25 April 2022|journal=Scientific Reports|volume=12|issue=1 |page=6707 |doi=10.1038/s41598-022-10489-1 |pmid=35469050 |pmc=9038916 |bibcode=2022NatSR..12.6707A }} A 2018 study (n=256) classified FM people into three subgroups by variability in symptoms; low, high and mixed.high variability in anxiety, moderate variability in pain, fatigue, and depressed mood, and low variability in pain unpleasantness{{Cite journal|title=Pain and Fatigue Variability Patterns Distinguish Subgroups of Fibromyalgia Patients|first1=Emily J.|last1=Bartley|first2=Michael E.|last2=Robinson|first3=Roland|last3=Staud|date=20 April 2018|journal=The Journal of Pain|volume=19|issue=4|pages=372–381|doi=10.1016/j.jpain.2017.11.014|pmid=29253551|pmc=5869098}}

The defining symptoms of fibromyalgia are chronic widespread pain, fatigue, and sleep disturbance. Other symptoms may include heightened pain in response to tactile pressure (allodynia), cognitive problems, musculoskeletal stiffness, environmental sensitivity, hypervigilance, sexual dysfunction,{{Cite journal |vauthors=Besiroglu MD, Dursun MD |date=July 2019 |title=The association between fibromyalgia and female sexual dysfunction: a systematic review and meta-analysis of observational studies |journal=International Journal of Impotence Research |volume=31 |issue=4 |pages=288–297 |doi=10.1038/s41443-018-0098-3 |pmid=30467351 }} and visual symptoms.{{Cite journal |vauthors=Zdebik N, Zdebik A, Bogusławska J, Przeździecka-Dołyk J, Turno-Kręcicka A |date=January 2021 |title=Fibromyalgia syndrome and the eye – A review |journal=Survey of Ophthalmology |volume=66 |issue=1 |pages=132–137 |doi=10.1016/j.survophthal.2020.05.006 |pmid=32512032 }}

The key symptoms of fibromyalgia often present concurrently, in varying severity, and are intertwined with and influence each other.{{Cite journal|title=Beyond pain in fibromyalgia: insights into the symptom of fatigue|first1=Ann|last1=Vincent|first2=Roberto P.|last2=Benzo|first3=Mary O.|last3=Whipple|first4=Samantha J.|last4=McAllister|first5=Patricia J.|last5=Erwin|first6=Leorey N.|last6=Saligan|date=20 May 2013|journal=Arthritis Research & Therapy|volume=15|issue=6|pages=221|doi=10.1186/ar4395|doi-access=free |pmid=24289848|pmc=3978642}}

Fibromyalgia is predominantly a chronic pain disorder. According to the NHS, widespread pain is one major symptom, which could feel like an ache, a burning sensation, or a sharp, stabbing pain. Patients are also highly sensitive to pain, and the slightest touch can cause pain. Pain also tends to linger for longer when a patient experiences pain.{{Cite web|url=https://www.nhs.uk/conditions/fibromyalgia/symptoms/|title=Fibromyalgia - Symptoms|date=20 October 2017|website=nhs.uk|access-date=21 October 2020|archive-date=23 March 2018|archive-url=https://web.archive.org/web/20180323080320/https://www.nhs.uk/conditions/fibromyalgia/symptoms/|url-status=live}} The pain associated with fibromyalgia is often a constant dull ache that has lasted for at least three months, occurring on both sides of the body and above and below the waist.{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780|title=Fibromyalgia: Combination of treatments often required-Fibromyalgia - Symptoms & causes|website=Mayo Clinic}}

Pain in fibromyalgia may include contributions from central pain, peripheral musculoskeletal pain generators, neuropathic pain and other pathways.

The way pain is experienced in FM may be effected by cognitive ability, depression, somatization, psychological trauma, anxiety, social deprivation/isolation, gender, maladaptive thoughts, and ineffective coping strategies.{{Cite journal|url=https://esmed.org/MRA/mra/article/view/4835|title=Chasing the Perplexing Purple Butterfly through Biopsychosocial Model-based Precision Medicine: the Enigma of Fibromyalgia Unraveled|first1=Poorvi|last1=Kulshreshtha|first2=Osama|last2=Neyaz|first3=Arun|last3=Goel|first4=Pradeep Bhanudas|last4=Barde|first5=Didhiti|last5=Mukherjee|first6=Kishore Kumar|last6=Deepak|first7=Rajesh|last7=Kathrotia|date=20 January 2024|journal=Medical Research Archives|volume=11|issue=12|via=esmed.org|doi=10.18103/mra.v11i12.4835}} Insomnia and nonrestorative sleep may have a particularly strong effect.{{Cite journal|url=https://www.nature.com/articles/s41598-024-64059-8|title=Associations between pain intensity, psychosocial factors, and pain-related disability in 4285 patients with chronic pain|first1=Live|last1=Landmark|first2=Hans Fredrik|last2=Sunde|first3=Egil A.|last3=Fors|first4=Leif Edward Ottesen|last4=Kennair|first5=Annahita|last5=Sayadian|first6=Caroline|last6=Backelin|first7=Silje Endresen|last7=Reme|date=12 June 2024|journal=Scientific Reports|volume=14|issue=1|pages=13477|via=www.nature.com|doi=10.1038/s41598-024-64059-8|pmid=38866885 |bibcode=2024NatSR..1413477L |hdl=11250/3151112|hdl-access=free}}

Fatigue is one of the defining symptoms of fibromyalgia. Patients may experience physical or mental fatigue. Physical fatigue can present as a feeling of exhaustion after exercise or limitation in daily activities. Fibromyalgia fatigue can range from feeling mildly tired to flu-like exhaustion. Severe fatigue may come on suddenly and make it difficult to be active at all. The impact of fatigue can be severe and pose more of a problem than the pain.{{Cite web|url=https://www.arthritis.org/diseases/fibromyalgia|title=Fibromyalgia | Arthritis Foundation|website=www.arthritis.org|access-date=25 February 2025|archive-date=26 February 2025|archive-url=https://web.archive.org/web/20250226111151/https://www.arthritis.org/diseases/fibromyalgia|url-status=live}} Fatigue is a complicated, multifactorial, and vexing symptom that is highly prevalent (76%) and stubbornly persistent, as evidenced by longitudinal studies over 5 years.{{Cite journal|title=Beyond pain in fibromyalgia: insights into the symptom of fatigue|first1=Ann|last1=Vincent|first2=Roberto P|last2=Benzo|first3=Mary O|last3=Whipple|first4=Samantha J|last4=McAllister|first5=Patricia J|last5=Erwin|first6=Leorey N|last6=Saligan|date=25 February 2013|journal=Arthritis Research & Therapy|volume=15|issue=6|page=221|doi=10.1186/ar4395|doi-access=free |pmid=24289848 |pmc=3978642 }} Fatigue does not improve with sleep or rest.{{Cite web|url=https://www.versusarthritis.org/about-arthritis/conditions/fibromyalgia|title=Fibromyalgia|website=Versus Arthritis}} Meds seem to have little impact on FM fatigue.{{cite journal |last1=Beckers |first1=Esther |last2=Hermans |first2=Kasper |last3=Van Tubergen |first3=Astrid |last4=Boonen |first4=Annelies |title=Fatigue in patients with rheumatic and musculoskeletal diseases: a scoping review on definitions, measurement instruments, determinants, consequences and interventions |journal=RMD Open |date=August 2023 |volume=9 |issue=3 |pages=e003056 |doi=10.1136/rmdopen-2023-003056 |pmid=37541741 |pmc=10407379 }}

Sleep problems are a core symptom of fibromyalgia. These include difficulty falling or staying asleep, awakening while sleeping, and waking up feeling unrefreshed.{{Cite journal|url=https://onlinelibrary.wiley.com/doi/full/10.1111/jan.14977|title=Sleeping is a nightmare: A qualitative study on the experience and management of poor sleep quality in women with fibromyalgia|first1=Carolina|last1=Climent-Sanz|first2=Montserrat|last2=Gea-Sánchez|first3=Helena|last3=Fernández-Lago|first4=José Tomás|last4=Mateos-García|first5=Francesc|last5=Rubí-Carnacea|first6=Erica|last6=Briones-Vozmediano|date=16 May 2021|journal=Journal of Advanced Nursing|volume=77|issue=11|pages=4549–4562|via=Wiley Online Library|doi=10.1111/jan.14977|pmid=34268797 }} A meta-analysis compared quantitative and qualitative sleep metrics in people with fibromyalgia and healthy people. Individuals with fibromyalgia indicated lower sleep quality and efficiency, longer wake time after sleep start, shorter sleep duration, lighter sleep, and greater trouble initiating sleep when quantitatively assessed; and more difficulty initiating sleep when qualitatively assessed.{{Cite journal |vauthors=Wu YL, Chang LY, Lee HC, Fang SC, Tsai PS |date=May 2017 |title=Sleep disturbances in fibromyalgia: A meta-analysis of case-control studies |journal=Journal of Psychosomatic Research |volume=96 |pages=89–97 |doi=10.1016/j.jpsychores.2017.03.011 |pmid=28545798}}

Sleep problems may contribute to pain by decreased release of IGF-1 and human growth hormone, leading to decreased tissue repair.{{Cite journal |vauthors=Kimura S, Toyoura M, Toyota Y, Takaoka Y |date=December 2020 |title=Serum concentrations of insulin-like growth factor-1 as a biomarker of improved circadian rhythm sleep-wake disorder in school-aged children |journal=Journal of Clinical Sleep Medicine |volume=16 |issue=12 |pages=2073–2078 |doi=10.5664/jcsm.8778 |pmc=7848940 |pmid=32876042}} Improving sleep quality can help people with fibromyalgia manage pain.{{Cite journal |vauthors=Spaeth M, Rizzi M, Sarzi-Puttini P |date=April 2011 |title=Fibromyalgia and sleep |journal=Best Practice & Research. Clinical Rheumatology |volume=25 |issue=2 |pages=227–239 |doi=10.1016/j.berh.2011.03.004 |pmid=22094198}}{{Cite journal |vauthors=Bradley LA |date=December 2009 |title=Pathophysiology of fibromyalgia |journal=The American Journal of Medicine |volume=122 |issue=12 Suppl |pages=S22–S30 |doi=10.1016/j.amjmed.2009.09.008 |pmc=2821819 |pmid=19962493}}

Many people with fibromyalgia experience cognitive problems (known as fibrofog or brain fog).{{Cite web |last=CDC |date=2025-02-07 |title=Fibromyalgia |url=https://www.cdc.gov/arthritis/fibromyalgia/ |access-date=2025-04-03 |website=Arthritis |language=en-us}}{{Cite web |date=2017-10-20 |title=Fibromyalgia - Symptoms |url=https://www.nhs.uk/conditions/fibromyalgia/symptoms/ |access-date=2025-04-03 |website=nhs.uk |language=en}} One study found that approximately 50% of fibromyalgia patients experienced subjective cognitive dysfunction and that it was associated with higher levels of pain and other fibromyalgia symptoms.{{Cite journal |vauthors=Wolfe F, Rasker JJ, Ten Klooster P, Häuser W |date=December 2021 |title=Subjective Cognitive Dysfunction in Patients With and Without Fibromyalgia: Prevalence, Predictors, Correlates, and Consequences |journal=Cureus |volume=13 |issue=12 |pages=e20351 |doi=10.7759/cureus.20351 |pmc=8752385 |pmid=35036191 |doi-access=free}} The American Pain Society recognizes these problems as a major feature of fibromyalgia. About 75% of people with fibromyalgia report significant problems with concentration, memory, and multitasking.{{Cite journal |vauthors=Bell T, Trost Z, Buelow MT, Clay O, Younger J, Moore D, Crowe M |date=September 2018 |title=Meta-analysis of cognitive performance in fibromyalgia |journal=Journal of Clinical and Experimental Neuropsychology |volume=40 |issue=7 |pages=698–714 |doi=10.1080/13803395.2017.1422699 |pmc=6151134 |pmid=29388512}} A 2018 meta-analysis found that the largest differences between people with fibromyalgia and healthy subjects were in inhibitory control, memory, and processing speed.

One study found that cognitive problems may largely be a secondary effect of other FM symptoms.{{Cite journal|title=Cognitive Impairments in Fibromyalgia Syndrome: Associations With Positive and Negative Affect, Alexithymia, Pain Catastrophizing and Self-Esteem|first1=Carmen M.|last1=Galvez-Sánchez|first2=Gustavo A.|last2=Reyes Del Paso|first3=Stefan|last3=Duschek|date=16 May 2018|journal=Frontiers in Psychology|volume=9|pages=377|doi=10.3389/fpsyg.2018.00377|doi-access=free |pmid=29623059|pmc=5874325}} One hypothesis is that chronic pain in fibromyalgia compromises attention systems, resulting in cognitive problems.

People with fibromyalgia may experience hyperalgesia (abnormally increased sensitivity to pain){{Cite web|url=https://www.cdc.gov/arthritis/fibromyalgia/|title=Fibromyalgia|date=7 February 2025|website=Arthritis}} and allodynia (pain from a stimulus that does not normally elicit pain).{{Cite web|url=https://my.clevelandclinic.org/health/symptoms/21570-allodynia#possible-causes|title=Allodynia: Why Does Everything Hurt?|website=Cleveland Clinic}} FM people may be intolerant to bright lights, loud noises,{{Cite journal |vauthors=Staud R, Godfrey MM, Robinson ME |date=August 2021 |title=Fibromyalgia Patients Are Not Only Hypersensitive to Painful Stimuli But Also to Acoustic Stimuli |journal=The Journal of Pain |volume=22 |issue=8 |pages=914–925 |doi=10.1016/j.jpain.2021.02.009 |pmid=33636370 |doi-access=free}} perfumes, and cold.{{Cite journal |vauthors=Berwick RJ, Siew S, Andersson DA, Marshall A, Goebel A |date=May 2021 |title=A Systematic Review Into the Influence of Temperature on Fibromyalgia Pain: Meteorological Studies and Quantitative Sensory Testing |journal=The Journal of Pain |volume=22 |issue=5 |pages=473–486 |doi=10.1016/j.jpain.2020.12.005 |pmid=33421589 |doi-access=free}}{{Cite journal|title=Fibromyalgia and increased subjective sensory sensitivity across multiple senses|first1=Chloe|last1=Rafferty|first2=Jamie|last2=Ward|date=27 April 2024|journal=Perception|volume=53|issue=4|pages=276–286|doi=10.1177/03010066241234037|pmid=38410035|pmc=10960319 }}{{Cite web|url=https://www.niams.nih.gov/health-topics/fibromyalgia|title=Fibromyalgia|first=NIAMS Science Communications and Outreach|last=Branch|date=5 April 2017|website=National Institute of Arthritis and Musculoskeletal and Skin Diseases}} Not all FM guides include extreme sensitivity as a symptom. A small 2025 study found no correlation between measured sensitivity and FM disease burden.{{Cite journal|title=Pain sensitization in fibromyalgia. Cross-sectional associations between quantitative sensory testing of pain sensitization and fibromyalgia disease burden|first1=Pernille Steen|last1=Pettersen|first2=Trond|last2=Haugmark|first3=Inger Jorid|last3=Berg|first4=Hilde Berner|last4=Hammer|first5=Tuhina|last5=Neogi|first6=Heidi|last6=Zangi|first7=Ida K.|last7=Haugen|first8=Sella Aarrestad|last8=Provan|date=16 January 2025|journal=European Journal of Pain (London, England)|volume=29|issue=1|pages=e4771|doi=10.1002/ejp.4771|pmid=39670546|pmc=11639049}}

A 2021 review found that fibromyalgia caused ocular discomfort (foreign body sensation and irritation) and visual disturbances (blurred vision).{{cite journal |last1=Zdebik |first1=Natalia |last2=Zdebik |first2=Alexander |last3=Bogusławska |first3=Joanna |last4=Przeździecka-Dołyk |first4=Joanna |last5=Turno-Kręcicka |first5=Anna |title=Fibromyalgia syndrome and the eye—A review |journal=Survey of Ophthalmology |date=January 2021 |volume=66 |issue=1 |pages=132–137 |doi=10.1016/j.survophthal.2020.05.006 |pmid=32512032 }}

Fibromyalgia as a stand-alone diagnosis is uncommon, as most fibromyalgia patients often have other chronic overlapping pain problems or mental disorders.

Comorbidities can give higher levels of pain and other symptoms.{{Cite journal|title=Impact of migraine and fibromyalgia on temporomandibular disorder: A retrospective study on pain, psychological factors and quality of life|first1=Pankaew|last1=Yakkaphan|first2=Giorgio|last2=Lambru|first3=Tara|last3=Renton|date=16 May 2024|journal=Journal of Oral Rehabilitation|volume=51|issue=10|pages=2029–2042|doi=10.1111/joor.13789|pmid=38965737 |doi-access=free}}

Fibromyalgia is associated with mental health issues including;

• Anxiety{{cite journal | vauthors = Kleykamp BA, Ferguson MC, McNicol E, Bixho I, Arnold LM, Edwards RR, Fillingim R, Grol-Prokopczyk H, Turk DC, Dworkin RH | title = The Prevalence of Psychiatric and Chronic Pain Comorbidities in Fibromyalgia: an ACTTION systematic review | journal = Seminars in Arthritis and Rheumatism | volume = 51 | issue = 1 | pages = 166–174 | date = February 2021 | pmid = 33383293 | doi = 10.1016/j.semarthrit.2020.10.006 }}
• Posttraumatic stress disorder – Approximately one third of patients presenting with an FM diagnosis also meet criteria for posttraumatic stress disorder (PTSD)
• Bipolar disorder
• Alexithymia{{cite journal | vauthors = Habibi Asgarabad M, Salehi Yegaei P, Jafari F, Azami-Aghdash S, Lumley MA | title = The relationship of alexithymia to pain and other symptoms in fibromyalgia: A systematic review and meta-analysis | journal = European Journal of Pain | volume = 27 | issue = 3 | pages = 321–337 | date = March 2023 | pmid = 36471652 | doi = 10.1002/ejp.2064 }}
• Depression{{cite journal | vauthors = Fitzcharles MA, Perrot S, Häuser W | title = Comorbid fibromyalgia: A qualitative review of prevalence and importance | journal = European Journal of Pain | volume = 22 | issue = 9 | pages = 1565–1576 | date = October 2018 | pmid = 29802812 | doi = 10.1002/ejp.1252 | doi-access = free }}{{cite journal | vauthors = Yepez D, Grandes XA, Talanki Manjunatha R, Habib S, Sangaraju SL | title = Fibromyalgia and Depression: A Literature Review of Their Shared Aspects | journal = Cureus | volume = 14 | issue = 5 | pages = e24909 | date = May 2022 | pmid = 35698706 | pmc = 9187156 | doi = 10.7759/cureus.24909 | doi-access = free }} – Patients with fibromyalgia are five times more likely to have major depression than the general population.{{cite journal | vauthors = Løge-Hagen JS, Sæle A, Juhl C, Bech P, Stenager E, Mellentin AI | title = Prevalence of depressive disorder among patients with fibromyalgia: Systematic review and meta-analysis | journal = Journal of Affective Disorders | volume = 245 | pages = 1098–1105 | date = February 2019 | pmid = 30699852 | doi = 10.1016/j.jad.2018.12.001 }}

Experiencing pain and limited energy from having fibromyalgia leads to less activity, leading to social isolation and increased stress levels, which tends to cause anxiety and depression.{{Cite web | vauthors = Bruce DF | date = 28 August 2024 | veditors = Zelman D | work = WebMD |title=Fibromyalgia and Depression |url=https://www.webmd.com/fibromyalgia/fibromyalgia-and-depression |access-date=2024-04-01 |language=en}} Separation fo symptoms due to depression or FM can be difficult.{{Cite journal|title=Recognizing and Treating Major Depression in Fibromyalgia: A Narrative Primer for the Non-Psychiatrist|first1=Bala|last1=Munipalli|first2=Mohit|last2=Chauhan|first3=Anjali M.|last3=Morris|first4=Ridwan|last4=Ahmad|first5=Maliha|last5=Fatima|first6=Madeleine E.|last6=Allman|first7=Shehzad K.|last7=Niazi|first8=Barbara K.|last8=Bruce|date=16 May 2024|journal=Journal of Primary Care & Community Health|volume=15|pages=21501319241281221|doi=10.1177/21501319241281221|pmid=39279389|pmc=11409298}}

Numerous chronic pain conditions are often comorbid with fibromyalgia. These include:

• Chronic tension headaches
• Myofascial pain syndrome
• Temporomandibular disorders

Neurological disorders that have been linked to pain or fibromyalgia include:

• Multiple sclerosis
• Post-polio syndrome
• Neuropathic pain
• Parkinson's disease

Fibromyalgia largely overlaps with several syndromes that may share the same pathogenetic mechanisms.{{cite journal | vauthors = Goldenberg DL | title = How to understand the overlap of long COVID, chronic fatigue syndrome/myalgic encephalomyelitis, fibromyalgia and irritable bowel syndromes | journal = Seminars in Arthritis and Rheumatism | volume = 67 | page = 152455 | date = August 2024 | pmid = 38761526 | doi = 10.1016/j.semarthrit.2024.152455 }} These include myalgic encephalomyelitis/chronic fatigue syndrome{{cite journal | vauthors = Anderson G, Maes M | title = Mitochondria and immunity in chronic fatigue syndrome | journal = Progress in Neuro-Psychopharmacology & Biological Psychiatry | volume = 103 | issue = | page = 109976 | date = December 2020 | pmid = 32470498 | doi = 10.1016/j.pnpbp.2020.109976 }}{{cite journal | vauthors = Ramírez-Morales R, Bermúdez-Benítez E, Martínez-Martínez LA, Martínez-Lavín M | title = Clinical overlap between fibromyalgia and myalgic encephalomyelitis. A systematic review and meta-analysis | journal = Autoimmunity Reviews | volume = 21 | issue = 8 | page = 103129 | date = August 2022 | pmid = 35690247 | doi = 10.1016/j.autrev.2022.103129 | doi-access = free }} and irritable bowel syndrome.

Comorbid fibromyalgia has been reported to occur in 20–30% of individuals with rheumatic diseases,{{cite journal | vauthors = Macfarlane GJ, Pathan E, Siebert S, Packham J, Gaffney K, Choy E, Sengupta R, Atzeni F, Martin KR, Jones GT, Dean LE | title = AxSpA patients who also meet criteria for fibromyalgia: identifying distinct patient clusters using data from a UK national register (BSRBR-AS) | journal = BMC Rheumatology | volume = 3 | issue = 1 | page = 19 | date = 20 May 2019 | pmid = 31143851 | pmc = 6532149 | doi = 10.1186/s41927-019-0066-7 | doi-access = free }} including rheumatoid arthritis (RA).{{Cite journal|title=Predicting Disease Activity in Rheumatoid Arthritis With the Fibromyalgia Survey Questionnaire: Does the Severity of Fibromyalgia Symptoms Matter?|first1=Alexander M.|last1=Gorzewski|first2=Andrew C.|last2=Heisler|first3=Tuhina|last3=Neogi|first4=Lutfiyya N.|last4=Muhammad|first5=Jing|last5=Song|first6=Dorothy|last6=Dunlop|first7=Clifton O.|last7=Bingham|first8=Marcy B.|last8=Bolster|first9=Daniel J.|last9=Clauw|first10=Wendy|last10=Marder|first11=Yvonne C.|last11=Lee|date=16 May 2023|journal=The Journal of Rheumatology|volume=50|issue=5|pages=684–689|doi=10.3899/jrheum.220507|pmid=36521924|pmc=10159881}} It has been reported in people with noninflammatory musculoskeletal diseases.

The prevalence of fibromyalgia in gastrointestinal disease has been described mostly for celiac disease and irritable bowel syndrome (IBS). IBS and fibromyalgia share similar pathogenic mechanisms, involving immune system mast cells, inflammatory biomarkers, hormones, and neurotransmitters such as serotonin. Changes in the gut biome alter serotonin levels, leading to autonomic nervous system hyperstimulation.{{cite journal | vauthors = Valencia C, Fatima H, Nwankwo I, Anam M, Maharjan S, Amjad Z, Abaza A, Vasavada AM, Sadhu A, Khan S | title = A Correlation Between the Pathogenic Processes of Fibromyalgia and Irritable Bowel Syndrome in the Middle-Aged Population: A Systematic Review | journal = Cureus | volume = 14 | issue = 10 | pages = e29923 | date = October 2022 | pmid = 36381861 | pmc = 9635936 | doi = 10.7759/cureus.29923 | doi-access = free }}

Other conditions that are associated with fibromyalgia include obesity,{{cite journal |vauthors=D'Onghia M, Ciaffi J, Lisi L, Mancarella L, Ricci S, Stefanelli N, Meliconi R, Ursini F |date=April 2021 |title=Fibromyalgia and obesity: A comprehensive systematic review and meta-analysis |journal=Seminars in Arthritis and Rheumatism |volume=51 |issue=2 |pages=409–424 |doi=10.1016/j.semarthrit.2021.02.007 |pmid=33676126}} connective tissue disorders,{{cite journal | vauthors = Alsiri N, Alhadhoud M, Alkatefi T, Palmer S | title = The concomitant diagnosis of fibromyalgia and connective tissue disorders: A systematic review | journal = Seminars in Arthritis and Rheumatism | volume = 58 | page = 152127 | date = February 2023 | pmid = 36462303 | doi = 10.1016/j.semarthrit.2022.152127 | url = https://pureportal.coventry.ac.uk/en/publications/the-concomitant-diagnosis-of-fibromyalgia-and-connective-tissue-disorders(c96e4f4b-408a-4961-aa4e-4bdf8704e370).html }} cardiovascular autonomic abnormalities,{{cite journal | vauthors = Kocyigit BF, Akyol A | title = Coexistence of fibromyalgia syndrome and inflammatory rheumatic diseases, and autonomic cardiovascular system involvement in fibromyalgia syndrome | journal = Clinical Rheumatology | volume = 42 | issue = 3 | pages = 645–652 | date = March 2023 | pmid = 36151442 | doi = 10.1007/s10067-022-06385-8 }} obstructive sleep apnea-hypopnea syndrome,{{cite journal | vauthors = He J, Chen M, Huang N, Wang B | title = Fibromyalgia in obstructive sleep apnea-hypopnea syndrome: a systematic review and meta-analysis | journal = Frontiers in Physiology | volume = 15 | page = 1394865 | date = 2024 | pmid = 38831795 | pmc = 11144865 | doi = 10.3389/fphys.2024.1394865 | doi-access = free }} restless leg syndrome{{cite journal | vauthors = Padhan P, Maikap D, Pathak M | title = Restless leg syndrome in rheumatic conditions: Its prevalence and risk factors, a meta-analysis | journal = International Journal of Rheumatic Diseases | volume = 26 | issue = 6 | pages = 1111–1119 | date = June 2023 | pmid = 37137528 | doi = 10.1111/1756-185X.14710 }} and an overactive bladder.{{cite journal | vauthors = Goldberg N, Tamam S, Weintraub AY | title = The association between overactive bladder and fibromyalgia: A systematic review and meta-analysis | journal = International Journal of Gynaecology and Obstetrics | volume = 159 | issue = 3 | pages = 630–641 | date = December 2022 | pmid = 35641437 | doi = 10.1002/ijgo.14290 }}

The cause of fibromyalgia is unknown.{{cite journal | vauthors = Sarzi-Puttini P, Atzeni F, Mease PJ | title = Chronic widespread pain: from peripheral to central evolution | journal = Best Practice & Research. Clinical Rheumatology | volume = 25 | issue = 2 | pages = 133–139 | date = April 2011 | pmid = 22094190 | doi = 10.1016/j.berh.2011.04.001 }}{{cite journal | vauthors = Schmidt-Wilcke T, Clauw DJ | title = Fibromyalgia: from pathophysiology to therapy | journal = Nature Reviews. Rheumatology | volume = 7 | issue = 9 | pages = 518–527 | date = July 2011 | pmid = 21769128 | doi = 10.1038/nrrheum.2011.98 }} However, several risk factors, genetic and environmental, have been identified.

Genetics plays a major role in fibromyalgia and may explain up to 50% of the disease's susceptibility.{{cite journal | vauthors = D'Agnelli S, Arendt-Nielsen L, Gerra MC, Zatorri K, Boggiani L, Baciarello M, Bignami E | title = Fibromyalgia: Genetics and epigenetics insights may provide the basis for the development of diagnostic biomarkers | journal = Molecular Pain | volume = 15 | page = 1744806918819944 | date = January 2019 | pmid = 30486733 | pmc = 6322092 | doi = 10.1177/1744806918819944 }} Fibromyalgia is potentially associated with polymorphisms of genes in the serotoninergic,{{cite journal | vauthors = Ablin JN, Buskila D | title = Update on the genetics of the fibromyalgia syndrome | journal = Best Practice & Research. Clinical Rheumatology | volume = 29 | issue = 1 | pages = 20–28 | date = February 2015 | pmid = 26266996 | doi = 10.1016/j.berh.2015.04.018 }} dopaminergic and catecholaminergic systems. Several genes have been suggested as candidates for susceptibility to fibromyalgia. These include SLC6A4, TRPV2, MYT1L, NRXN3, and the 5-HT2A receptor 102T/C polymorphism.{{cite journal | vauthors = Lee YH, Choi SJ, Ji JD, Song GG | title = Candidate gene studies of fibromyalgia: a systematic review and meta-analysis | journal = Rheumatology International | volume = 32 | issue = 2 | pages = 417–426 | date = February 2012 | pmid = 21120487 | doi = 10.1007/s00296-010-1678-9 }} The heritability of fibromyalgia is estimated to be higher in patients younger than 50.{{cite journal | vauthors = Dutta D, Brummett CM, Moser SE, Fritsche LG, Tsodikov A, Lee S, Clauw DJ, Scott LJ | title = Heritability of the Fibromyalgia Phenotype Varies by Age | journal = Arthritis & Rheumatology | volume = 72 | issue = 5 | pages = 815–823 | date = May 2020 | pmid = 31736264 | pmc = 8372844 | doi = 10.1002/art.41171 }}

Nearly all the genes suggested as potential risk factors for fibromyalgia are associated with neurotransmitters and their receptors. Neuropathic pain and major depressive disorder often co-occur with fibromyalgia — the reason for this comorbidity appears to be due to shared genetic abnormalities, which leads to impairments in monoaminergic, glutamatergic, neurotrophic, opioid and proinflammatory cytokine signaling. In these vulnerable individuals, psychological stress or illness can cause abnormalities in inflammatory and stress pathways that regulate mood and pain. Eventually, a sensitization and kindling effect occurs in certain neurons leading to the establishment of fibromyalgia and sometimes a mood disorder.{{cite journal | vauthors = Maletic V, Raison CL | title = Neurobiology of depression, fibromyalgia and neuropathic pain | journal = Frontiers in Bioscience | volume = 14 | issue = 14 | pages = 5291–5338 | date = June 2009 | pmid = 19482616 | doi = 10.2741/3598 | doi-access = free }}

Stress may be an important precipitating factor in the development of fibromyalgia.{{cite journal | vauthors = Martins DF, Viseux FJ, Salm DC, Ribeiro AC, da Silva HK, Seim LA, Bittencourt EB, Bianco G, Moré AO, Reed WR, Mazzardo-Martins L | title = The role of the vagus nerve in fibromyalgia syndrome | journal = Neuroscience and Biobehavioral Reviews | volume = 131 | pages = 1136–1149 | date = December 2021 | pmid = 34710514 | doi = 10.1016/j.neubiorev.2021.10.021 }} A 2021 meta-analysis found psychological trauma to be strongly associated with fibromyalgia.{{cite journal | vauthors = Kaleycheva N, Cullen AE, Evans R, Harris T, Nicholson T, Chalder T | title = The role of lifetime stressors in adult fibromyalgia: systematic review and meta-analysis of case-control studies | journal = Psychological Medicine | volume = 51 | issue = 2 | pages = 177–193 | date = January 2021 | pmid = 33602373 | doi = 10.1017/S0033291720004547 | doi-access = free }}{{cite journal | vauthors = Jung YH, Kim H, Lee D, Lee JY, Moon JY, Choi SH, Kang DH | title = Dysfunctional energy metabolisms in fibromyalgia compared with healthy subjects | journal = Molecular Pain | volume = 17 | page = 17448069211012833 | date = January 2021 | pmid = 33940974 | pmc = 8113919 | doi = 10.1177/17448069211012833 }} People who suffered abuse in their lifetime were three times more likely to have fibromyalgia; people who suffered medical trauma or other stressors in their lifetime were about twice as likely.

Some authors have proposed that, because exposure to stressful conditions can alter the function of the hypothalamic-pituitary-adrenal (HPA) axis, the development of fibromyalgia may stem from stress-induced disruption of the HPA axis.{{cite journal |last1=Casale |first1=Roberto |last2=Sarzi-Puttini |first2=Piercarlo |last3=Botto |first3=Rossana |last4=Alciati |first4=Alessandra |last5=Batticciotto |first5=Alberto |last6=Marotto |first6=Daniela |last7=Torta |first7=Riccardo |title=Fibromyalgia and the concept of resilience |journal=Clinical and Experimental Rheumatology |date=2019 |volume=37 Suppl 116 |issue=1 |pages=105–113 |pmid=30747098 }}

A 2022 review found that between 6% and 27% of people with FM reported an infectious inciting event (e.g. Epstein-Barr virus, Lyme disease), with up to 40% describing worsening symptoms after infection.{{cite journal | pmc=10012866 | date=2022 | title=Chronic pain and infection: Mechanisms, causes, conditions, treatments, and controversies | journal=BMJ Medicine | volume=1 | issue=1 | pages=e000108 | doi=10.1136/bmjmed-2021-000108 | pmid=36936554 | vauthors = Cohen SP, Wang EJ, Doshi TL, Vase L, Cawcutt KA, Tontisirin N }}

Other risk markers for fibromyalgia include:{{cite journal |vauthors=Tan AC, Jaaniste T, Champion D |date=2019-05-05 |title=Chronic Widespread Pain and Fibromyalgia Syndrome: Life-Course Risk Markers in Young People |journal=Pain Research & Management |volume=2019 |page=6584753 |doi=10.1155/2019/6584753 |pmc=6525804 |pmid=31191788 |doi-access=free}}

• Premature birth
• Female sex
• Childhood cognitive and psychosocial problems
• Primary pain disorders
• Multiregional pain
• Infectious illness
• Hypermobility of joints
• Iron deficiency
• Small-fiber polyneuropathy

Metal-induced allergic inflammation has also been linked with fibromyalgia, especially in response to nickel but also inorganic mercury, cadmium, and lead.{{cite journal | vauthors = Roach K, Roberts J | title = A comprehensive summary of disease variants implicated in metal allergy | journal = Journal of Toxicology and Environmental Health Part B: Critical Reviews | volume = 25 | issue = 6 | pages = 279–341 | date = August 2022 | pmid = 35975293 | pmc = 9968405 | doi = 10.1080/10937404.2022.2104981 | bibcode = 2022JTEHB..25..279R }}

Following the COVID-19 pandemic, some have suggested that the SARS-CoV-2 virus may trigger fibromyalgia.{{cite journal | vauthors = Fialho MF, Brum ES, Oliveira SM | title = Could the fibromyalgia syndrome be triggered or enhanced by COVID-19? | journal = Inflammopharmacology | volume = 31 | issue = 2 | pages = 633–651 | date = April 2023 | pmid = 36849853 | pmc = 9970139 | doi = 10.1007/s10787-023-01160-w }}

Studies on personality and fibromyalgia have shown inconsistent results. Although some have suggested that fibromyalgia patients are more likely to have specific personality traits, it appears that in comparison to other diseases – when anxiety and depression are statistically controlled for{{Snd}}personality has far less relevance.{{cite journal |vauthors=Conversano C, Marchi L, Rebecca C, Carmassi C, Contena B, Bazzichi LM, Gemignani A |date=2018-09-28 |title=Personality Traits in Fibromyalgia (FM): Does FM Personality Exists? A Systematic Review |journal=Clinical Practice and Epidemiology in Mental Health |volume=14 |issue=1 |pages=223–232 |doi=10.2174/1745017901814010223 |pmc=6166394 |pmid=30294356 |quote=Personality traits are often studied in patients with rheumatic diseases and, most of all, in those with fibromyalgia. However, the literature on this topic presents inconsistent results...Although in many studies FM patients are compared with healthy controls and personality differences are found, when comparison is made with other disorders with controlled depression, personality traits appear to be less relevant than before.}}

As of 2023, the pathophysiology of fibromyalgia has not yet been elucidated{{Cite journal|url=https://www.mdpi.com/2227-9059/10/12/3070|title=Fibromyalgia Pathophysiology|first1=Gyorfi|last1=Michael|first2=Rupp|last2=Adam|first3=Abd-Elsayed|last3=Alaa|date=16 December 2022|journal=Biomedicines|volume=10|issue=12|doi=10.3390/biomedicine|doi-broken-date=16 May 2025 |doi-access=free }}{{cite journal | vauthors = de Tommaso M, Vecchio E, Nolano M | title = The puzzle of fibromyalgia between central sensitization syndrome and small fiber neuropathy: a narrative review on neurophysiological and morphological evidence | journal = Neurological Sciences | volume = 43 | issue = 3 | pages = 1667–1684 | date = March 2022 | pmid = 35028777 | doi = 10.1007/s10072-021-05806-x }} and several theories have been suggested. The prevailing view is that fibromyalgia is a condition resulting from an amplification of pain by the central nervous system.{{cite journal | vauthors = Pinto AM, Luís M, Geenen R, Palavra F, Lumley MA, Ablin JN, Amris K, Branco J, Buskila D, Castelhano J, Castelo-Branco M, Crofford LJ, Fitzcharles MA, Häuser W, Kosek E, Mease PJ, Marques TR, Jacobs JW, Castilho P, da Silva JA | title = Neurophysiological and psychosocial mechanisms of fibromyalgia: A comprehensive review and call for an integrative model | journal = Neuroscience and Biobehavioral Reviews | volume = 151 | page = 105235 | date = August 2023 | pmid = 37207842 | doi = 10.1016/j.neubiorev.2023.105235 | hdl-access = free | hdl = 1874/429361 }} Substantial biological findings have backed up this notion, leading to development and adoption of the concept of nociplastic pain.

Fibromyalgia is associated with the deregulation of proteins related to complement and coagulation cascades, as well as to iron metabolism.{{cite journal | vauthors = Gkouvi A, Tsiogkas SG, Bogdanos DP, Gika H, Goulis DG, Grammatikopoulou MG | title = Proteomics in Patients with Fibromyalgia Syndrome: A Systematic Review of Observational Studies | journal = Current Pain and Headache Reports | volume = 28 | issue = 7 | pages = 565–586 | date = July 2024 | pmid = 38652420 | pmc = 11271354 | doi = 10.1007/s11916-024-01244-4 | doi-access = free }} An excessive oxidative stress response may cause dysregulation of many proteins.

Chronic pain can be divided into three categories. Nociceptive pain is pain caused by inflammation or damage to tissues. Neuropathic pain is pain caused by nerve damage. Nociplastic pain (or central sensitization) is less understood and is the common explanation of the pain experienced in fibromyalgia.{{cite journal | vauthors = Mezhov V, Guymer E, Littlejohn G | title = Central sensitivity and fibromyalgia | journal = Internal Medicine Journal | volume = 51 | issue = 12 | pages = 1990–1998 | date = December 2021 | pmid = 34139045 | doi = 10.1111/imj.15430 | doi-access = free }}{{cite journal | vauthors = den Boer C, Dries L, Terluin B, van der Wouden JC, Blankenstein AH, van Wilgen CP, Lucassen P, van der Horst HE | title = Central sensitization in chronic pain and medically unexplained symptom research: A systematic review of definitions, operationalizations and measurement instruments | journal = Journal of Psychosomatic Research | volume = 117 | pages = 32–40 | date = February 2019 | pmid = 30665594 | doi = 10.1016/j.jpsychores.2018.12.010 }} Because the three forms of pain can overlap, fibromyalgia patients may experience nociceptive (e.g., rheumatic illnesses) and neuropathic (e.g., small fiber neuropathy) pain, in addition to nociplastic pain.

{{Main|Nociplastic pain}}

Fibromyalgia can be viewed as a condition of nociplastic pain.{{cite journal | vauthors = Bidari A, Ghavidel-Parsa B | title = Nociplastic pain concept, a mechanistic basis for pragmatic approach to fibromyalgia | journal = Clinical Rheumatology | volume = 41 | issue = 10 | pages = 2939–2947 | date = October 2022 | pmid = 35701625 | doi = 10.1007/s10067-022-06229-5 }} Nociplastic pain is caused by an altered function of pain-related sensory pathways in the periphery and the central nervous system, resulting in hypersensitivity.{{cite journal | vauthors = Nijs J, Lahousse A, Kapreli E, Bilika P, Saraçoğlu İ, Malfliet A, Coppieters I, De Baets L, Leysen L, Roose E, Clark J, Voogt L, Huysmans E | title = Nociplastic Pain Criteria or Recognition of Central Sensitization? Pain Phenotyping in the Past, Present and Future | journal = Journal of Clinical Medicine | volume = 10 | issue = 15 | page = 3203 | date = July 2021 | pmid = 34361986 | pmc = 8347369 | doi = 10.3390/jcm10153203 | doi-access = free }}

Nociplastic pain has been referred to as "Nociplastic pain syndrome" because it is coupled with other symptoms including fatigue, sleep disturbance, cognitive disturbance, hypersensitivity to environmental stimuli, anxiety, and depression. Nociplastic pain states can be triggered by a variety of stressors such as trauma, infections and chronic stressors.{{cite journal | pmc=11503076 | date=2024 | title=From fibrositis to fibromyalgia to nociplastic pain: How rheumatology helped get us here and where do we go from here? | journal=Annals of the Rheumatic Diseases | volume=83 | issue=11 | pages=1421–1427 | doi=10.1136/ard-2023-225327 | pmid=39107083 | vauthors = Clauw DJ }} A 2024 review said that symptoms such as fatigue, sleep, memory and mood problems, and sensitivity to non-painful sensory stimuli were also CNS-driven symptoms that were inherent to nociplastic pain.{{cite journal |last1=Kaplan |first1=Chelsea M. |last2=Kelleher |first2=Eoin |last3=Irani |first3=Anushka |last4=Schrepf |first4=Andrew |last5=Clauw |first5=Daniel J. |last6=Harte |first6=Steven E. |title=Deciphering nociplastic pain: clinical features, risk factors and potential mechanisms |journal=Nature Reviews Neurology |date=June 2024 |volume=20 |issue=6 |pages=347–363 |doi=10.1038/s41582-024-00966-8 |pmid=38755449 }}

Nociplastic pain may caused by either (1) increased processing of pain stimuli or (2) decreased suppression of pain stimuli at several levels in the nervous system, or both.

An alternative hypothesis to nociplastic pain views fibromyalgia as a stress-related dysautonomia with neuropathic pain features.{{cite journal | vauthors = Martínez-Lavín M | title = Fibromyalgia and small fiber neuropathy: the plot thickens! | journal = Clinical Rheumatology | volume = 37 | issue = 12 | pages = 3167–3171 | date = December 2018 | pmid = 30238382 | doi = 10.1007/s10067-018-4300-2 }} This view highlights the role of autonomic and peripheral nociceptive nervous systems in the generation of widespread pain, fatigue, and insomnia.{{cite journal | vauthors = Martínez-Lavín M | title = Dorsal root ganglia: fibromyalgia pain factory? | journal = Clinical Rheumatology | volume = 40 | issue = 2 | pages = 783–787 | date = February 2021 | pmid = 33409721 | pmc = 7787228 | doi = 10.1007/s10067-020-05528-z }} The description of small fiber neuropathy in a subgroup of fibromyalgia patients supports the disease neuropathic-autonomic underpinning. However, others claim that small fiber neuropathy occurs only in small groups of those with fibromyalgia.{{cite journal | vauthors = Häuser W, Fitzcharles MA | title = Facts and myths pertaining to fibromyalgia | journal = Dialogues in Clinical Neuroscience | volume = 20 | issue = 1 | pages = 53–62 | date = March 2018 | pmid = 29946212 | pmc = 6016048 | doi = 10.31887/dcns.2018.20.1/whauser }}

Some suggest that fibromyalgia is caused or maintained by a decreased vagal tone, which is indicated by low levels of heart rate variability, signaling a heightened sympathetic response.{{cite journal | vauthors = Martinez-Lavin M, Holman AJ | title = Heart rate variability analysis in rheumatology: past, present… and future? | journal = Clinical and Experimental Rheumatology | volume = 39 | issue = 5 | pages = 927–930 | date = 2021 | pmid = 34464245 | doi = 10.55563/clinexprheumatol/nmvth1 | doi-access = free }} Accordingly, several studies show that clinical improvement is associated with an increase in heart rate variability.{{cite journal | vauthors = Figueroa A, Kingsley JD, McMillan V, Panton LB | title = Resistance exercise training improves heart rate variability in women with fibromyalgia | journal = Clinical Physiology and Functional Imaging | volume = 28 | issue = 1 | pages = 49–54 | date = January 2008 | pmid = 18005081 | doi = 10.1111/j.1475-097X.2007.00776.x | doi-access = free }}{{cite journal | vauthors = Park HY, Jung WS, Kim J, Hwang H, Lim K | title = Twelve Weeks of Aerobic Exercise at the Lactate Threshold Improves Autonomic Nervous System Function, Body Composition, and Aerobic Performance in Women with Obesity | journal = Journal of Obesity & Metabolic Syndrome | volume = 29 | issue = 1 | pages = 67–75 | date = March 2020 | pmid = 32045515 | pmc = 7118007 | doi = 10.7570/jomes19063 }} Some examples of interventions that increase the heart rate variability and vagal tone are meditation, yoga, mindfulness, and exercise.

In 2023 the Fibromyalgia: Imbalance of Threat and Soothing Systems (FITSS) model was suggested as a working hypothesis.{{cite journal | vauthors = Pinto AM, Geenen R, Wager TD, Lumley MA, Häuser W, Kosek E, Ablin JN, Amris K, Branco J, Buskila D, Castelhano J, Castelo-Branco M, Crofford LJ, Fitzcharles MA, López-Solà M, Luís M, Marques TR, Mease PJ, Palavra F, Rhudy JL, Uddin LQ, Castilho P, Jacobs JW, da Silva JA | title = Emotion regulation and the salience network: a hypothetical integrative model of fibromyalgia | journal = Nature Reviews. Rheumatology | volume = 19 | issue = 1 | pages = 44–60 | date = January 2023 | pmid = 36471023 | doi = 10.1038/s41584-022-00873-6 | hdl = 1874/426650 | hdl-access = free }} According to the FITSS model, the salience network (also known as the midcingulo-insular network) may remain continuously hyperactive due to an imbalance in emotion regulation, which is reflected by an overactive "threat" system and an underactive "soothing" system. This hyperactivation, along with other mechanisms, may contribute to fibromyalgia.

Some neurochemical abnormalities that occur in fibromyalgia also regulate mood, sleep, and energy, thus explaining why mood, sleep, and fatigue problems are commonly co-morbid with fibromyalgia.{{Cite journal |vauthors=Clauw DJ, Arnold LM, McCarberg BH |date=September 2011 |title=The science of fibromyalgia |journal=Mayo Clinic Proceedings |volume=86 |issue=9 |pages=907–911 |doi=10.4065/mcp.2011.0206 |pmc=3258006 |pmid=21878603}} Serotonin is the most widely studied neurotransmitter in fibromyalgia. It is hypothesized that an imbalance in the serotoninergic system may lead to the development of fibromyalgia.{{cite journal | vauthors = Singh L, Kaur A, Bhatti MS, Bhatti R | title = Possible Molecular Mediators Involved and Mechanistic Insight into Fibromyalgia and Associated Co-morbidities | journal = Neurochemical Research | volume = 44 | issue = 7 | pages = 1517–1532 | date = July 2019 | pmid = 31004261 | doi = 10.1007/s11064-019-02805-5 }} There is also some data that suggests altered dopaminergic and noradrenergic signaling in fibromyalgia.{{cite journal |last1=Bellato |first1=Enrico |last2=Marini |first2=Eleonora |last3=Castoldi |first3=Filippo |last4=Barbasetti |first4=Nicola |last5=Mattei |first5=Lorenzo |last6=Bonasia |first6=Davide Edoardo |last7=Blonna |first7=Davide |title=Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment |journal=Pain Research and Treatment |date=4 November 2012 |volume=2012 |pages=1–17 |doi=10.1155/2012/426130 |doi-access=free |pmid=23213512 |pmc=3503476 }} Supporting the monoamine related theories is the efficacy of monoaminergic antidepressants in fibromyalgia.{{cite journal |vauthors=Mascarenhas RO, Souza MB, Oliveira MX, Lacerda AC, Mendonça VA, Henschke N, Oliveira VC |date=January 2021 |title=Association of Therapies With Reduced Pain and Improved Quality of Life in Patients With Fibromyalgia: A Systematic Review and Meta-analysis |journal=JAMA Internal Medicine |volume=181 |issue=1 |pages=104–112 |doi=10.1001/jamainternmed.2020.5651 |pmc=7589080 |pmid=33104162}} Glutamate/creatine ratios within the bilateral ventrolateral prefrontal cortex were found to be significantly higher in fibromyalgia patients than in controls and may disrupt glutamate neurotransmission.{{cite journal | vauthors = Feraco P, Bacci A, Pedrabissi F, Passamonti L, Zampogna G, Pedrabissi F, Malavolta N, Leonardi M | title = Metabolic abnormalities in pain-processing regions of patients with fibromyalgia: a 3T MR spectroscopy study | journal = AJNR. American Journal of Neuroradiology | volume = 32 | issue = 9 | pages = 1585–1590 | date = October 2011 | pmid = 21799042 | pmc = 7965402 | doi = 10.3174/ajnr.A2550 }}

Neuroimaging studies have observed that fibromyalgia patients have increased grey matter in the right postcentral gyrus and left angular gyrus, and decreased grey matter in the right cingulate gyrus, right paracingulate gyrus, left cerebellum, and left gyrus rectus.{{cite journal | vauthors = Xin M, Qu Y, Peng X, Zhu D, Cheng S | title = A systematic review and meta-analysis of voxel-based morphometric studies of fibromyalgia | journal = Frontiers in Neuroscience | volume = 17 | page = 1164145 | date = 2023-05-09 | pmid = 37229427 | pmc = 10203234 | doi = 10.3389/fnins.2023.1164145 | doi-access = free }} These regions are associated with affective and cognitive functions and with motor adaptations to pain processing. Other studies have documented decreased grey matter of the default mode network in people with fibromyalgia.{{cite journal | vauthors = Lin C, Lee SH, Weng HH | title = Gray Matter Atrophy within the Default Mode Network of Fibromyalgia: A Meta-Analysis of Voxel-Based Morphometry Studies | journal = BioMed Research International | volume = 2016 | page = 7296125 | date = 1 January 2016 | pmid = 28105430 | pmc = 5220433 | doi = 10.1155/2016/7296125 | doi-access = free }} These deficits are associated with pain processing.

Studies on the neuroendocrine system and HPA axis in fibromyalgia have been inconsistent. The depressed function of the HPA axis results in adrenal insufficiency and potentially chronic fatigue.{{cite journal | vauthors= Assavarittirong C, Samborski W, Grygiel-Górniak B | title=Oxidative Stress in Fibromyalgia: From Pathology to Treatment| journal=Oxidative Medicine and Cellular Longevity | volume=2022 | page=1582432 | year=2022 | doi = 10.1155/2022/1582432 | pmc=9556195 | pmid=36246401| doi-access=free}}

One study found fibromyalgia patients exhibited higher plasma cortisol, more extreme peaks and troughs, and higher rates of dexamethasone non-suppression. However, other studies have only found correlations between a higher cortisol awakening response and pain, and not any other abnormalities in cortisol. Increased baseline ACTH and increase in response to stress have been observed, and hypothesized to be a result of decreased negative feedback.

Pro-oxidative processes correlate with pain in fibromyalgia patients. Decreased mitochondrial membrane potential, increased superoxide activity, and increased lipid peroxidation production are observed. The high proportion of lipids in the central nervous system (CNS) makes the CNS especially vulnerable to free radical damage. Levels of lipid peroxidation products correlate with fibromyalgia symptoms.

Inflammation has been suggested to have a role in the pathogenesis of fibromyalgia.{{cite journal | vauthors = Coskun Benlidayi I | title = Role of inflammation in the pathogenesis and treatment of fibromyalgia | journal = Rheumatology International | volume = 39 | issue = 5 | pages = 781–791 | date = May 2019 | pmid = 30756137 | doi = 10.1007/s00296-019-04251-6 }} People with fibromyalgia tend to have higher levels of inflammatory cytokines IL-6, and IL-8.{{cite journal | vauthors = Uçeyler N, Häuser W, Sommer C | title = Systematic review with meta-analysis: cytokines in fibromyalgia syndrome | journal = BMC Musculoskeletal Disorders | volume = 12 | page = 245 | date = October 2011 | pmid = 22034969 | pmc = 3234198 | doi = 10.1186/1471-2474-12-245 | doi-access = free }}{{cite journal | vauthors = Rodriguez-Pintó I, Agmon-Levin N, Howard A, Shoenfeld Y | title = Fibromyalgia and cytokines | journal = Immunology Letters | volume = 161 | issue = 2 | pages = 200–203 | date = October 2014 | pmid = 24462815 | doi = 10.1016/j.imlet.2014.01.009 }} There are also increased levels of the pro-inflammatory cytokines IL-1 receptor antagonist. Increased levels of pro-inflammatory cytokines may increase sensitivity to pain, and contribute to mood problems.{{cite journal | vauthors = Dell'Osso L, Bazzichi L, Baroni S, Falaschi V, Conversano C, Carmassi C, Marazziti D | title = The inflammatory hypothesis of mood spectrum broadened to fibromyalgia and chronic fatigue syndrome | journal = Clinical and Experimental Rheumatology | volume = 33 | issue = 1 Suppl 88 | pages = S109–S116 | date = 1 January 2015 | pmid = 25786052 }} Anti-inflammatory interleukins such as IL-10 have also been associated with fibromyalgia.

Neurogenic inflammation has been proposed as a contributing factor to fibromyalgia.{{cite journal | vauthors = Littlejohn G | title = Neurogenic neuroinflammation in fibromyalgia and complex regional pain syndrome | journal = Nature Reviews. Rheumatology | volume = 11 | issue = 11 | pages = 639–648 | date = November 2015 | pmid = 26241184 | doi = 10.1038/nrrheum.2015.100 }}

A repeated observation shows that autoimmunity triggers, such as traumas and infections, are among the most frequent events preceding the onset of fibromyalgia.{{cite journal | vauthors = Bazzichi L, Giacomelli C, Consensi A, Giorgi V, Batticciotto A, Di Franco M, Sarzi-Puttini P | title = One year in review 2020: fibromyalgia | journal = Clinical and Experimental Rheumatology | volume = 38 | issue = 1 | pages = 3–8 | date = 2020 | pmid = 32116216 }} A 2024 discussion concluded that the complexity of FM may mean both autoimmune and non-autoimmune mechanisms occur in FM, possibly in different subgroups of FM.{{cite journal |last1=Clauw |first1=Daniel |last2=Sarzi-Puttini |first2=Piercarlo |last3=Pellegrino |first3=Greta |last4=Shoenfeld |first4=Yehuda |title=Is fibromyalgia an autoimmune disorder? |journal=Autoimmunity Reviews |date=January 2024 |volume=23 |issue=1 |page=103424 |doi=10.1016/j.autrev.2023.103424 |pmid=37634681 |hdl=2434/1032448 |hdl-access=free }}

Though there is a lack of evidence in this area, it is hypothesized that gut bacteria may play a role in fibromyalgia.{{cite journal | vauthors = Erdrich S, Hawrelak JA, Myers SP, Harnett JE | title = Determining the association between fibromyalgia, the gut microbiome and its biomarkers: A systematic review | journal = BMC Musculoskeletal Disorders | volume = 21 | issue = 1 | page = 181 | date = March 2020 | pmid = 32192466 | pmc = 7083062 | doi = 10.1186/s12891-020-03201-9 | doi-access = free }} People with fibromyalgia are more likely to show dysbiosis, a decrease in microbiota diversity.{{cite journal | vauthors = Wang Y, Wei J, Zhang W, Doherty M, Zhang Y, Xie H, Li W, Wang N, Lei G, Zeng C | title = Gut dysbiosis in rheumatic diseases: A systematic review and meta-analysis of 92 observational studies | journal = eBioMedicine | volume = 80 | page = 104055 | date = June 2022 | pmid = 35594658 | pmc = 9120231 | doi = 10.1016/j.ebiom.2022.104055 }} There is a bidirectional interplay between the gut and the nervous system. Therefore, the gut can affect the nervous system, but the nervous system can also affect the gut. Neurological effects mediated via the autonomic nervous system as well as the hypothalamic pituitary adrenal axis are directed to intestinal functional effector cells, which in turn are under the influence of the gut microbiota.{{cite journal | vauthors = Minerbi A, Fitzcharles MA | title = Gut microbiome: pertinence in fibromyalgia | journal = Clinical and Experimental Rheumatology | volume = 38 | issue = 1 | pages = 99–104 | date = January 2020 | pmid = 32116215 }}

The gut-brain axis, which connects the gut microbiome to the brain via the enteric nervous system, is another area of research. Fibromyalgia patients have less varied gut flora and altered serum metabolome levels of glutamate and serine,{{cite journal | vauthors = Clos-Garcia M, Andrés-Marin N, Fernández-Eulate G, Abecia L, Lavín JL, van Liempd S, Cabrera D, Royo F, Valero A, Errazquin N, Vega MC, Govillard L, Tackett MR, Tejada G, Gónzalez E, Anguita J, Bujanda L, Orcasitas AM, Aransay AM, Maíz O, López de Munain A, Falcón-Pérez JM | title = Gut microbiome and serum metabolome analyses identify molecular biomarkers and altered glutamate metabolism in fibromyalgia | journal = eBioMedicine | volume = 46 | pages = 499–511 | date = August 2019 | pmid = 31327695 | pmc = 6710987 | doi = 10.1016/j.ebiom.2019.07.031 }} implying abnormalities in neurotransmitter metabolism.

Some commentators see FM as arising from biopsychosocial factors.{{Cite journal|title=Psychosomatic Approach to Fibromyalgia Syndrome: Concept, Diagnosis and Treatment|first=Sang-Shin|last=Lee|date=31 December 2021|journal=Kosin Medical Journal|volume=36|issue=2|pages=79–99|doi=10.7180/kmj.2021.36.2.79|doi-access=free}}

Diagnosis of fibromyalgia is hampered by the lack of any single pathological feature, laboratory finding, or biomarker.{{cite journal |vauthors=Galvez-Sánchez CM, Reyes Del Paso GA |date=April 2020 |title=Diagnostic Criteria for Fibromyalgia: Critical Review and Future Perspectives |journal=Journal of Clinical Medicine |volume=9 |issue=4 |page=1219 |doi=10.3390/jcm9041219 |pmc=7230253 |pmid=32340369 |quote=Furthermore, in many cases the FMS diagnosis is fundamentally based on the exclusion of other similar diseases; in spite of that practice not being recommended because of its lack of precision and the high possibility of misdiagnosis. |doi-access=free}} In most cases, people with fibromyalgia symptoms may have laboratory test results that appear normal and many of their symptoms may mimic those of other rheumatic conditions such as arthritis or osteoporosis.{{cite journal | vauthors = Häuser W, Fitzcharles MA | title = Facts and myths pertaining to fibromyalgia | journal = Dialogues in Clinical Neuroscience | volume = 20 | issue = 1 | pages = 53–62 | date = March 2018 | pmid = 29946212 | pmc = 6016048 | doi = 10.31887/DCNS.2018.20.1/whauser }}

Specific diagnostic criteria for fibromyalgia have evolved. However a 2025 review found that challenges and limitations continue, due to patients over- or under-estimating their symptoms, or describing them differently.https://www.mdpi.com/20770383/14/3/955 Some people can move into and out of an FM diagnostic level over time as their symptoms vary. Different diagnostic criteria can give varying results.{{Cite web|url=https://www.the-rheumatologist.org/article/using-different-fibromyalgia-criteria-affects-prevalence-estimates/?singlepage=1|title=Using Different Fibromyalgia Criteria Affects Prevalence Estimates}}

The 2016 diagnostic criteria of the American College of Rheumatology require all of the following:

1. "Generalized pain, defined as pain in at least 4 of 5 regions, is present."
2. "Symptoms have been present at a similar level for at least 3 months."
3. "Widespread pain index (WPI) ≥ 7 and symptom severity scale (SSS) score ≥ 5 OR WPI of 4–6 and SSS score ≥ 9."
4. "A diagnosis of fibromyalgia is valid irrespective of other diagnoses. A diagnosis of fibromyalgia does not exclude the presence of other clinically important illnesses."{{cite journal |last1=Wolfe |first1=Frederick |last2=Clauw |first2=Daniel J. |last3=Fitzcharles |first3=Mary-Ann |last4=Goldenberg |first4=Don L. |last5=Häuser |first5=Winfried |last6=Katz |first6=Robert L. |last7=Mease |first7=Philip J. |last8=Russell |first8=Anthony S. |last9=Russell |first9=Irwin Jon |last10=Walitt |first10=Brian |title=2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria |journal=Seminars in Arthritis and Rheumatism |date=December 2016 |volume=46 |issue=3 |pages=319–329 |doi=10.1016/j.semarthrit.2016.08.012 |pmid=27916278 }}

File:Widespread Pain Index Areas.svg

• The 5 body regions are right upper, left upper, right lower, left lower and axial.{{Cite journal|url=https://www.sciencedirect.com/science/article/abs/pii/S0049017216302086|title=2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria|first1=Frederick|last1=Wolfe|first2=Daniel J.|last2=Clauw|first3=Mary-Ann|last3=Fitzcharles|first4=Don L.|last4=Goldenberg|first5=Winfried|last5=Häuser|first6=Robert L.|last6=Katz|first7=Philip J.|last7=Mease|first8=Anthony S.|last8=Russell|first9=Irwin Jon|last9=Russell|first10=Brian|last10=Walitt|date=1 December 2016|journal=Seminars in Arthritis and Rheumatism|volume=46|issue=3|pages=319–329|via=ScienceDirect|doi=10.1016/j.semarthrit.2016.08.012|pmid=27916278 }}https://www.rcp.ac.uk/media/yuhdz53b/fibromyalgia-syndrome-diagnostic-worksheet_1_0_0.pdf
• The Widespread Pain Index (WPI) had been introduced by the American College of Rheumatology in 2010. It measures the number of body regions experiencing pain, out of a total of 19: left and right shoulder girdle, upper arm, lower arm, hip/buttock/trochanter, upper leg, lower leg, and jaw; plus the chest, abdomen, neck, upper back and lower back.
• The Symptom Severity Scale (SSS) assesses the severity of six symptoms; fatigue (score 0-3, for no problem, mild, moderate and severe), trouble thinking or remembering (0-3), waking up tired (unrefreshed) (0-3), pain or cramps in lower abdomen (0-1), depression (0-1) and headache (0-1).{{Cite web |title=Fibromyalgia diagnostic worksheet Symptom severity scale (SSS) |url=https://www.rcp.ac.uk/media/yuhdz53b/fibromyalgia-syndrome-diagnostic-worksheet_1_0_0.pdf |website=www.rcp.ac.uk}}

As of 2022, among diagnosis methods in the US, the ACR 2016 criteria have been judged as the best diagnosis criteria available.{{Cite journal|title=Disentangling Diagnosis and Management of Fibromyalgia|first1=Ji-Hyoun|last1=Kang|first2=Sung-Eun|last2=Choi|first3=Dong-Jin|last3=Park|first4=Shin-Seok|last4=Lee|date=1 January 2022|journal=Journal of Rheumatic Diseases|volume=29|issue=1|pages=4–13|doi=10.4078/jrd.2022.29.1.4|pmid=37476701|pmc=10324920}}They have also been found to most accurately match pre-existing FM diagnoses. {{Cite journal|title=Comparison of the AAPT Fibromyalgia Diagnostic Criteria and Modified FAS Criteria with Existing ACR Criteria for Fibromyalgia in Korean Patients|first1=Ji-Hyoun|last1=Kang|first2=Sung-Eun|last2=Choi|first3=Haimuzi|last3=Xu|first4=Dong-Jin|last4=Park|first5=Jung-Kil|last5=Lee|first6=Shin-Seok|last6=Lee|date=21 May 2021|journal=Rheumatology and Therapy|volume=8|issue=2|pages=1003–1014 |doi=10.1007/s40744-021-00318-8|pmid=34021490 |pmc=8217352 }} The UK RCP also recommends these criteria for FM diagnosis.{{Cite web|url=https://www.rcp.ac.uk/improving-care/resources/the-diagnosis-of-fibromyalgia-syndrome/|title=The diagnosis of fibromyalgia syndrome|website=www.rcp.ac.uk}} A similar diagnostic approach is taken in Germany.{{Cite web|url=https://gesund.bund.de/en/fibromyalgia|title=Fibromyalgia: causes and treatment|date=21 October 2022|website=gesund.bund.de}}

The polysymptomatic distress scale (PSD) was derived from the 2010 ACR diagnosis criteria, and aimed to measure FM severity.The PSD was calculated by adding the widespread pain index (WPI) and symptoms severity scale (SSS). One PSD severity banding was none (0-3), mild (4-7), moderate (8-11), severe (12-19), and very severe (20-31). {{Cite journal|title=The Use of Polysymptomatic Distress Categories in the Evaluation of Fibromyalgia (FM) and FM Severity|first1=Frederick|last1=Wolfe|first2=Brian T.|last2=Walitt|first3=Johannes J.|last3=Rasker|first4=Robert S.|last4=Katz|first5=Winfried|last5=Häuser|date=16 August 2015|journal=The Journal of Rheumatology|volume=42|issue=8|pages=1494–1501|doi=10.3899/jrheum.141519|pmid=26077414|pmc=4755344}}

File:Fibromyalgia pain sites APS 2019.svg

In 2019, the American Pain Society in collaboration with the U.S. Food and Drug Administration developed a new diagnostic system using two dimensions.{{cite journal | vauthors = Arnold LM, Bennett RM, Crofford LJ, Dean LE, Clauw DJ, Goldenberg DL, Fitzcharles MA, Paiva ES, Staud R, Sarzi-Puttini P, Buskila D, Macfarlane GJ | title = AAPT Diagnostic Criteria for Fibromyalgia | journal = The Journal of Pain | volume = 20 | issue = 6 | pages = 611–628 | date = June 2019 | pmid = 30453109 | doi = 10.1016/j.jpain.2018.10.008 | doi-access = free | hdl = 2434/632765 | hdl-access = free }} The first dimension included core diagnostic criteria and the second included common features. In accordance to the 2016 diagnosis guidelines, the presence of another medical condition or pain disorder does not rule out the diagnosis of fibromyalgia. Nonetheless, other conditions should be ruled out as the main explaining reason for the patient's symptoms.

The core diagnostic criteria are:

1. Multisite pain defined as six or more pain sites from a total of nine possible sites (head, arms, chest, abdomen, upper back, lower back, and legs), for at least three months
2. Moderate to severe sleep problems or fatigue, for at least three months

Common features found in fibromyalgia patients can assist the diagnosis process. These are tenderness (sensitivity to light pressure), dyscognition (difficulty to think), musculoskeletal stiffness, and environmental sensitivity or hypervigilance.

This diagnosis criteria set was influenced by the theory of central pain processing.

The Fibromyalgia Impact Questionnaire (FIQ){{Cite web|url=https://www.physio-pedia.com/Fibromyalgia_Impact_Questionnaire_(FIQ)|title=Fibromyalgia Impact Questionnaire (FIQ)|website=Physiopedia}} was introduced in 1991{{cite journal |last1=Burckhardt |first1=C. S. |last2=Clark |first2=S. R. |last3=Bennett |first3=R. M. |title=The fibromyalgia impact questionnaire: development and validation |journal=The Journal of Rheumatology |date=May 1991 |volume=18 |issue=5 |pages=728–733 |pmid=1865419 }} and the Revised Fibromyalgia Impact Questionnaire (FIQR){{Cite web|url=https://www.physio-pedia.com/Revised_Fibromyalgia_Impact_Questionnaire_(FIQR)|title=Revised Fibromyalgia Impact Questionnaire (FIQR)|website=Physiopedia}} in 2009.{{cite journal | vauthors = Bennett RM, Friend R, Jones KD, Ward R, Han BK, Ross RL | title = The Revised Fibromyalgia Impact Questionnaire (FIQR): validation and psychometric properties | journal = Arthritis Research & Therapy | volume = 11 | issue = 4 | pages = R120 | date = 2009-01-01 | pmid = 19664287 | pmc = 2745803 | doi = 10.1186/ar2783 | doi-access = free }} It is used as a way of measuring the impact of fibromyalgia on living, although there is some debate on ratings scales.{{Cite journal|url=https://ard.bmj.com/content/81/Suppl_1/1091.2|title=Pos1492-Hpr Psychometric Properties of the Fibromyalgia Impact Questionnaire – Revised in Fibromyalgia and Chronic Widespread Pain: A Rasch Analysis|first1=P. H.|last1=Duhn|first2=K.|last2=Amris|first3=H.|last3=Bliddal|first4=E. E.|last4=Wæhrens|date=1 June 2022|journal=Annals of the Rheumatic Diseases|volume=81|issue=Suppl 1|pages=1091|via=ard.bmj.com|doi=10.1136/annrheumdis-2022-eular.5187}}{{Cite journal|url=https://www.sciencedirect.com/science/article/abs/pii/S0924933816004995|title=Exploring the factorial structure of the revised Fibromyalgia Impact Questionnaire (FIQR) in a Portuguese sample of fibromyalgia patients|first1=A. M.|last1=Pinto|first2=C.|last2=Costa|first3=A. T.|last3=Pereira|first4=M.|last4=Marques|first5=J. A.|last5=Pereira da Silva|first6=A.|last6=Macedo|date=1 March 2016|journal=European Psychiatry|volume=33|pages=S206–S207|via=ScienceDirect|doi=10.1016/j.eurpsy.2016.01.495}}

Components of a differential diagnosis include

• the person's medical history; early chronic pain, a childhood history of pain, an emergence of broad pain following physical and/or psychosocial stress, a general hypersensitivity to touch, smell, noise, taste, hypervigilance, and various somatic symptoms (gastrointestinal, urology, gynecology, neurology) may signal FM.
• a physical examination and laboratory investigations may be used to eliminate alternative causes.{{cite journal | vauthors = Goldenberg DL | title = Diagnosis and differential diagnosis of fibromyalgia | journal = The American Journal of Medicine | volume = 122 | issue = 12 Suppl | pages = S14–S21 | date = December 2009 | pmid = 19962492 | doi = 10.1016/j.amjmed.2009.09.007 | type = Review }}{{cite journal | vauthors = Marchesoni A, De Marco G, Merashli M, McKenna F, Tinazzi I, Marzo-Ortega H, McGonagle DG | title = The problem in differentiation between psoriatic-related polyenthesitis and fibromyalgia | journal = Rheumatology | volume = 57 | issue = 1 | pages = 32–40 | date = January 2018 | pmid = 28387854 | doi = 10.1093/rheumatology/kex079 | type = Review }}{{cite journal | vauthors = Palazzi C, D'Amico E, D'Angelo S, Gilio M, Olivieri I | title = Rheumatic manifestations of hepatitis C virus chronic infection: Indications for a correct diagnosis | journal = World Journal of Gastroenterology | volume = 22 | issue = 4 | pages = 1405–1410 | date = January 2016 | pmid = 26819509 | pmc = 4721975 | doi = 10.3748/wjg.v22.i4.1405 | type = Review | doi-access = free }} Common tests that are conducted include complete blood count, comprehensive metabolic panel, erythrocyte sedimentation rate, C-reactive protein, and thyroid function test.

Possible misdiagnoses are

• early undiagnosed rheumatic diseases such as preclinical rheumatoid arthritis, early stages of inflammatory spondyloarthritis, polymyalgia rheumatica, myofascial pain syndromes and hypermobility syndrome.{{cite journal | vauthors = Häuser W, Sarzi-Puttini P, Fitzcharles MA | title = Fibromyalgia syndrome: under-, over- and misdiagnosis | journal = Clinical and Experimental Rheumatology | volume = 37 | issue = 1 Suppl 116 | pages = 90–97 | date = 2019 | pmid = 30747096 }}{{cite journal | vauthors = Häuser W, Perrot S, Sommer C, Shir Y, Fitzcharles MA | title = Diagnostic confounders of chronic widespread pain: not always fibromyalgia | journal = Pain Reports | volume = 2 | issue = 3 | pages = e598 | date = May 2017 | pmid = 29392213 | pmc = 5741304 | doi = 10.1097/PR9.0000000000000598 }}
• Neurological diseases that can have important pain and fatigue components include multiple sclerosis, Parkinson's disease and peripheral neuropathy.
• Other medical illnesses that should be ruled out are endocrine disease or metabolic disorder (hypothyroidism, hyperparathyroidism, acromegaly, vitamin D deficiency), gastro-intestinal disease (celiac and non-celiac gluten sensitivity), infectious diseases (Lyme disease, hepatitis C and immunodeficiency disease) and the early stages of a malignancy such as multiple myeloma, metastatic cancer and leukemia/lymphoma.
• Other systemic, inflammatory, endocrine, rheumatic, infectious, and neurologic disorders may cause fibromyalgia-like symptoms, such as systemic lupus erythematosus, Sjögren syndrome, ankylosing spondylitis, Ehlers-Danlos syndromes, psoriatic-related polyenthesitis, a nerve compression syndrome (such as carpal tunnel syndrome), and myasthenia gravis.{{cite journal |last1=Rossi |first1=Alessandra |last2=Di Lollo |first2=Anna Chiara |last3=Guzzo |first3=Maria Paola |last4=Giacomelli |first4=Camillo |last5=Atzeni |first5=Fabiola |last6=Bazzichi |first6=Laura |last7=Di Franco |first7=Manuela |title=Fibromyalgia and nutrition: what news? |journal=Clinical and Experimental Rheumatology |date=2015 |volume=33 |issue=1 Suppl 88 |pages=S117–125 |pmid=25786053 |url=http://www.clinexprheumatol.org/pubmed/find-pii.asp?pii=25786053 }}
• Several medications can evoke pain (statins, aromatase inhibitors, bisphosphonates, and opioids).

As of 2009, it was judged that as many as two out of every three people who were told that they have fibromyalgia by a rheumatologist may have had some other medical condition instead.

Fibromyalgia is estimated to affect 1.8% of the population.{{cite journal |last1=Heidari |first1=Fatemeh |last2=Afshari |first2=Mahdi |last3=Moosazadeh |first3=Mahmood |title=Prevalence of fibromyalgia in general population and patients, a systematic review and meta-analysis |journal=Rheumatology International |date=September 2017 |volume=37 |issue=9 |pages=1527–1539 |doi=10.1007/s00296-017-3725-2 |pmid=28447207 }} German Federal Ministry of Health guidance is that about 2% of adults in Germany suffer from fibromyalgia. Information about FM prevalence in many parts of the world is limited by lack of information and by differing diagnosis standards.{{cite journal |last1=Soroosh |first1=Soosan |title=Epidemiology of Fibromyalgia: East Versus West |journal=International Journal of Rheumatic Diseases |date=December 2024 |volume=27 |issue=12 |pages=e15428 |doi=10.1111/1756-185X.15428 |pmid=39618110 }}

Historically diagnosed FM cases have been between 80–96% female.{{Cite journal|title=Fibromyalgia Syndrome Pain in Men and Women: A Scoping Review|first1=Ilga|last1=Ruschak|first2=Pilar|last2=Montesó-Curto|first3=Lluís|last3=Rosselló|first4=Carina|last4=Aguilar Martín|first5=Laura|last5=Sánchez-Montesó|first6=Loren|last6=Toussaint|date=11 January 2023|journal=Healthcare|volume=11|issue=2|page=223|doi=10.3390/healthcare11020223|doi-access=free |pmid=36673591 |pmc=9859454 }} As a result historically most FM research has focused on women.

However a 2018 review said that males make up 40% of people with fibromyalgia symptoms in the general population.{{cite journal | vauthors = Wolfe F, Walitt B, Perrot S, Rasker JJ, Häuser W | title = Fibromyalgia diagnosis and biased assessment: Sex, prevalence and bias | journal = PLOS ONE | volume = 13 | issue = 9 | pages = e0203755 | date = 2018-09-13 | pmid = 30212526 | pmc = 6136749 | doi = 10.1371/journal.pone.0203755 | bibcode = 2018PLoSO..1303755W | doi-access = free | veditors = Sommer C }} As of 2024, estimates are that female/male split within fibromyalgia incidence is 60/40.{{Cite web|url=https://curearthritis.org/fibromyalgia/|title=What is Fibromyalgia? | ANRF}}{{Cite web|url=https://www.fibromyalgiafund.org/fibromyalgia-in-men/|title=Fibromyalgia in Men|website=American Fibromyalgia Syndrome Association (AFSA)|access-date=24 February 2025|archive-date=30 January 2025|archive-url=https://web.archive.org/web/20250130152122/https://www.fibromyalgiafund.org/fibromyalgia-in-men/|url-status=live}}

Men have experienced difficulties in accepting and communicating about FM as it was sometimes seen as a "woman's disease" and could thus impact their self-image.{{Cite web|url=https://ukfibromyalgia.com/blog/fibromyalgia-and-men|title=Fibromyalgia and Men|website=UK Fibromyalgia Magazine}}{{cite journal | vauthors = Ruschak I, Montesó-Curto P, Rosselló L, Aguilar Martín C, Sánchez-Montesó L, Toussaint L | title = Fibromyalgia Syndrome Pain in Men and Women: A Scoping Review | journal = Healthcare | volume = 11 | issue = 2 | page = 223 | date = January 2023 | pmid = 36673591 | pmc = 9859454 | doi = 10.3390/healthcare11020223 | doi-access = free }}

There has been debate about whether men experience differences in FM symptoms compared to women.{{Cite web|url=https://creakyjoints.org/about-arthritis/fibromyalgia/fibromyalgia-overview/fibromyalgia-in-men/|title=Fibromyalgia in Men: Important Facts About an Overlooked and Misunderstood Condition|vauthors=Dumain T|date=14 October 2020|access-date=21 February 2025|archive-date=15 January 2025|archive-url=https://web.archive.org/web/20250115194856/https://creakyjoints.org/about-arthritis/fibromyalgia/fibromyalgia-overview/fibromyalgia-in-men/|url-status=live}}

Two small studies found that males with FM had lower intensity of FM than females with FM, but n were small and differences may be subjective.{{cite journal |last1=Liu |first1=Min |last2=Harris |first2=Stephany |last3=Andreou |first3=Anna P. |last4=Bo |first4=Xuenong |last5=Al-Kaisy |first5=Adnan |title=Gender differences in clinical presentations and sensory profiles in patients with fibromyalgia: implications of peripheral and central mechanisms |journal=PAIN Reports |date=February 2025 |volume=10 |issue=1 |pages=e1229 |doi=10.1097/PR9.0000000000001229 |pmid=39816906 |pmc=11732657 }}{{Cite journal|title=Evaluating Gender Differences in Egyptian Fibromyalgia Patients Using the 1990, 2011, and 2016 ACR Criteria|first1=Abdelhfeez|last1=Moshrif|first2=Mohamed Z.|last2=Shoaeir|first3=Awad Saad|last3=Abbas|first4=Tarek M.|last4=Abdel-Aziz|first5=Wesam|last5=Gouda|date=27 February 2022|journal=Open Access Rheumatology: Research and Reviews|volume=14|pages=67–74|doi=10.2147/OARRR.S358255|doi-access=free |pmid=35492891|pmc=9046688}} Evidence suggests that men are generally less sensitive to pain than women,{{cite journal |last1=Bartley |first1=E.J. |last2=Fillingim |first2=R.B. |title=Sex differences in pain: a brief review of clinical and experimental findings |journal=British Journal of Anaesthesia |date=July 2013 |volume=111 |issue=1 |pages=52–58 |doi=10.1093/bja/aet127 |pmid=23794645 |pmc=3690315 }} perhaps due to differences in brain activity and structure.

Symptoms of fibromyalgia are regarded as persistent in nearly all patients.{{Cite journal|url=https://pubmed.ncbi.nlm.nih.gov/9324010|title=Health status and disease severity in fibromyalgia: results of a six-center longitudinal study|first1=F.|last1=Wolfe|first2=J.|last2=Anderson|first3=D.|last3=Harkness|first4=R. M.|last4=Bennett|first5=X. J.|last5=Caro|first6=D. L.|last6=Goldenberg|first7=I. J.|last7=Russell|first8=M. B.|last8=Yunus|date=20 September 1997|journal=Arthritis and Rheumatism|volume=40|issue=9|pages=1571–1579|via=PubMed|doi=10.1002/art.1780400905|pmid=9324010}}{{Cite journal|url=https://pubmed.ncbi.nlm.nih.gov/21765102|title=The longitudinal outcome of fibromyalgia: a study of 1555 patients|first1=Brian|last1=Walitt|first2=Mary-Ann|last2=Fitzcharles|first3=Afton L.|last3=Hassett|first4=Robert S.|last4=Katz|first5=Winfried|last5=Häuser|first6=Frederick|last6=Wolfe|date=20 October 2011|journal=The Journal of Rheumatology|volume=38|issue=10|pages=2238–2246|via=PubMed|doi=10.3899/jrheum.110026|pmid=21765102}} The German Federal Ministry of Health guidance on FM refers to a longitudinal study (n = 1555) in which 10% of patients had substantial improvement in pain, 15% had moderate improvement, and 39% worsened. FM severity worsened in 36%. No average meaningful change in symptoms was found, and high levels of self-reported symptoms and distress continued for most patients.{{Cite web|url=https://gesund.bund.de/en/fibromyalgia#outlook|title=Fibromyalgia: causes and treatment|date=21 October 2022|website=gesund.bund.de}}{{MEDRS|date=March 2022}} {{cite journal | vauthors = Walitt B, Fitzcharles MA, Hassett AL, Katz RS, Häuser W, Wolfe F | title = The longitudinal outcome of fibromyalgia: a study of 1555 patients | journal = The Journal of Rheumatology | volume = 38 | issue = 10 | pages = 2238–2246 | date = October 2011 | pmid = 21765102 | doi = 10.3899/jrheum.110026 | doi-access = free }}{{cite journal |last1=Donnachie |first1=Ewan |last2=Schneider |first2=Antonius |last3=Enck |first3=Paul |title=Comorbidities of Patients with Functional Somatic Syndromes Before, During and After First Diagnosis: A Population-based Study using Bavarian Routine Data |journal=Scientific Reports |date=17 June 2020 |volume=10 |issue=1 |page=9810 |doi=10.1038/s41598-020-66685-4 |pmid=32555301 |bibcode=2020NatSR..10.9810D |pmc=7299983 }}

Levels of pain can vary significantly over time, from severe pain to almost symptom-free phases.

A 2023 meta-analysis found that FM people were at a standardized mortality ratio (i.e. observed mortality rates in the study population, compared to expected levels based on a standard population) of 3.37 (95% CI 1.52 to 7.50) for mortality due to suicide.{{cite journal | vauthors = Treister-Goltzman Y, Peleg R | title = Fibromyalgia and mortality: a systematic review and meta-analysis | journal = RMD Open | volume = 9 | issue = 3 | pages = e003005 | date = July 2023 | pmid = 37429737 | pmc = 10335452 | doi = 10.1136/rmdopen-2023-003005 }} A 2021 review found that people with FM had suicide ideation OR 9.12, suicide attempt OR 3.12, suicide risk OR 36.77 and suicide events HR 1.38, but commented that FM impact could not be separated from the effects of comorbidities and sleep deprivation.{{Cite journal|title=Suicidal Behavior in Fibromyalgia Patients: Rates and Determinants of Suicide Ideation, Risk, Suicide, and Suicidal Attempts-A Systematic Review of the Literature and Meta-Analysis of Over 390,000 Fibromyalgia Patients|first1=Mohammad|last1=Adawi|first2=Wen|last2=Chen|first3=Nicola Luigi|last3=Bragazzi|first4=Abdulla|last4=Watad|first5=Dennis|last5=McGonagle|first6=Yarden|last6=Yavne|first7=Adi|last7=Kidron|first8=Hadas|last8=Hodadov|first9=Daniela|last9=Amital|first10=Howard|last10=Amital|date=24 March 2021|journal=Frontiers in Psychiatry|volume=12|page=629417|doi=10.3389/fpsyt.2021.629417|doi-access=free |pmid=34867495|pmc=8640182}} A 2020 review found that FM was associated with significantly higher risks for suicidal ideations, suicide attempts and death by suicide compared to the general population.{{cite journal |last1=Gill |first1=Hartej |last2=Perez |first2=Carlos D. |last3=Gill |first3=Barjot |last4=El-Halabi |first4=Sabine |last5=Lee |first5=Yena |last6=Lipsitz |first6=Orly |last7=Park |first7=Caroline |last8=Mansur |first8=Rodrigo B. |last9=Rodrigues |first9=Nelson B. |last10=McIntyre |first10=Roger S. |last11=Rosenblat |first11=Joshua D. |title=The Prevalence of Suicidal Behaviour in Fibromyalgia Patients |journal=Progress in Neuro-Psychopharmacology and Biological Psychiatry |date=8 June 2021 |volume=108 |page=110078 |doi=10.1016/j.pnpbp.2020.110078 |pmid=32853715 }}

A meta-analysis found that FM people were at a standardized mortality ratio of 1.95 (95% CI 0.97 to 3.92) due to accidents, and 1.66 (95% CI 1.15 to 2.38) due to infections. SMR due to cancer was a decreased rate of 0.82 (95% CI 0.69 to 0.97), perhaps because greater interaction with the health systems of people with FM leads to earlier cancer detection. The studies showed significant heterogeneity.

Management of FM symptoms, to improve quality of life,{{cite journal | vauthors = Arnold LM, Gebke KB, Choy EH | title = Fibromyalgia: management strategies for primary care providers | journal = International Journal of Clinical Practice | volume = 70 | issue = 2 | pages = 99–112 | date = February 2016 | pmid = 26817567 | pmc = 6093261 | doi = 10.1111/ijcp.12757 }} often use integrated pharmacological and non-pharmacological approaches. There is no single intervention shown to be effective for all patients.{{cite journal | vauthors = Okifuji A, Hare BD | title = Management of fibromyalgia syndrome: review of evidence | journal = Pain and Therapy | volume = 2 | issue = 2 | pages = 87–104 | date = December 2013 | pmid = 25135147 | pmc = 4107911 | doi = 10.1007/s40122-013-0016-9 }}{{cite journal | vauthors = Prabhakar A, Kaiser JM, Novitch MB, Cornett EM, Urman RD, Kaye AD | title = The Role of Complementary and Alternative Medicine Treatments in Fibromyalgia: a Comprehensive Review | journal = Current Rheumatology Reports | volume = 21 | issue = 5 | page = 14 | date = March 2019 | pmid = 30830504 | doi = 10.1007/s11926-019-0814-0 }} A personalized, multidisciplinary approach to treatment that includes pharmacologic considerations and begins with effective patient education is most beneficial. Self-help can play a role.{{Cite web|url=https://www.nhs.uk/conditions/fibromyalgia/|title=Fibromyalgia|date=20 October 2017|website=nhs.uk}}

Several associations have published guidelines for the diagnosis and management of fibromyalgia. These include:

• In 2022 the German Federal Ministry of Health updated guidance and advice on FM. This included the view that people with FM differ significantly in what they find beneficial.{{Cite web|url=https://gesund.bund.de/en/fibromyalgia#treatment|title=Fibromyalgia: causes and treatment|date=21 October 2022|website=gesund.bund.de}}
• In 2021 Italian guidelines were published, based on recent international guidelines.{{Cite journal|url=https://www.reumatismo.org/index.php/reuma/article/view/1362|title=The Italian Society for Rheumatology clinical practice guidelines for the diagnosis and management of fibromyalgia. Best practices based on current scientific evidence|first1=A.|last1=Ariani|first2=L.|last2=Bazzichi|first3=P.|last3=Sarzi-Puttini|first4=F.|last4=Salaffi|first5=M.|last5=Manara|first6=I.|last6=Prevete|first7=A.|last7=Bortoluzzi|first8=G.|last8=Carrara|first9=C. A.|last9=Scirè|first10=N.|last10=Ughi|first11=S.|last11=Parisi|date=3 August 2021|journal=Reumatismo|volume=73|issue=2|pages=89–105|via=www.reumatismo.org|doi=10.4081/reumatismo.2021.1362|pmid=34342210 |hdl=10281/367284|hdl-access=free}}
• The European League Against Rheumatism (EULAR; 2017){{cite journal | vauthors = Macfarlane GJ, Kronisch C, Atzeni F, Häuser W, Choy EH, Amris K, Branco J, Dincer F, Leino-Arjas P, Longley K, McCarthy G, Makri S, Perrot S, Sarzi Puttini P, Taylor A, Jones GT | title = EULAR recommendations for management of fibromyalgia | journal = Annals of the Rheumatic Diseases | volume = 76 | issue = 12 | pages = e54 | date = December 2017 | pmid = 28476880 | doi = 10.1136/annrheumdis-2017-211587 | url = https://orca.cardiff.ac.uk/id/eprint/123698/ }} recommended a multidisciplinary approach.This allowed a quick diagnosis and patient education. Initial management should be non-pharmacological, later pharmacological treatment can be added.
• The strongest recommendations were for aerobic and strengthening exercise.
• Weak recommendations were for Qigong, yoga, and tai chi for improving sleep and quality of life, for mindfulness for improving pain and quality of life, for acupuncture and hydrotherapy for improving pain, and psychotherapy as more suitable for patients with mood disorders or unhelpful coping strategies.
• Chiropractic was strongly recommended against, due to safety concerns.
• Medications weakly recommended for severe pain were (duloxetine, pregabalin, tramadol) or sleep disturbance (amitriptyline, cyclobenzaprine, pregabalin).
• Medications not recommended due to a lack of efficacy were (nonsteroidal anti-inflammatory drugs, monoamine oxidase inhibitors and selective serotonin reuptake inhibitors).
• Medications strongly recommended against, due to lack of efficacy and side effects, were growth hormone, sodium oxybate, opioids, and steroids.
• In 2012 the Canadian Pain Society published guidelines for the diagnosis and management of fibromyalgia.{{Cite web|url=http://fmguidelines.ca/?page_id=21|archive-url=https://web.archive.org/web/20130611010115/http://fmguidelines.ca/?page_id=21|title=Management | Canadian Guidelines for the Diagnosis and Management of Fibromyalgia|archive-date=11 June 2013}}{{Cite web|url=https://fmguidelines.ca/?page_id=25|title=Conclusion | Canadian Guidelines for the Diagnosis and Management of Fibromyalgia}}

German guidance encourages FM patients to focus on coping with symptoms (instead of fighting the syndrome), on aspects of life which are important to them, on ceasing perfectionism, and on establishing and respecting their own limits. Aspects of coping with FM include achieving acceptance of FM, and making adjustments to lifestyle.{{Cite journal|title=Coping with fibromyalgia - a focus group study|first1=Liat|last1=Hamama|first2=Michal|last2=Itzhaki|date=27 December 2023|journal=International Journal of Qualitative Studies on Health and Well-being|volume=18|issue=1|page=2204622|doi=10.1080/17482631.2023.2204622|pmid=37074672|pmc=10120560 }}

FM can cause negative mental effects.{{Cite journal|title=Psychological impact of fibromyalgia: current perspectives|first1=Carmen M.|last1=Galvez-Sánchez|first2=Stefan|last2=Duschek|first3=Gustavo A. Reyes del|last3=Paso|date=13 February 2019|journal=Psychology Research and Behavior Management|volume=12|pages=117–127|doi=10.2147/PRBM.S178240|doi-access=free |pmid=30858740|pmc=6386210}}

FM patients can adopt passive or active approaches to their situation.{{Cite journal|url=https://onlinelibrary.wiley.com/doi/10.1111/sjop.12325|title=A comparison of coping strategies in patients with fibromyalgia, chronic neuropathic pain, and pain-free controls|first1=Sidsel|last1=Baastrup|first2=Rikke|last2=Schultz|first3=Inger|last3=Brødsgaard|first4=Rod|last4=Moore|first5=Troels S.|last5=Jensen|first6=Lene|last6=Vase Toft|first7=Flemming W.|last7=Bach|first8=Raben|last8=Rosenberg|first9=Lise|last9=Gormsen|date=16 May 2016|journal=Scandinavian Journal of Psychology|volume=57|issue=6|pages=516–522|via=Wiley Online Library|doi=10.1111/sjop.12325|pmid=27558974 }}{{Cite journal|title=Active or passive pain coping: Which predicts daily physical and psychosocial functioning in people with chronic pain and spinal cord injury?|first1=Duygu|last1=Kuzu|first2=Samsuk|last2=Kim|first3=Anna L.|last3=Kratz|date=16 August 2022|journal=Rehabilitation Psychology|volume=67|issue=3|pages=304–314|doi=10.1037/rep0000457|pmid=35834204|pmc=10518854}} One analysis divided FM patients into maladaptive, adaptive (using tools and positive mindsets), vulnerable and resilient (naturally able to continue living well) clusters.

Resilience may be increased by using problem- and emotion-focused coping strategies, keeping anxiety low, acceptance of the situation, and persistence.

Possible active pain management approaches in FM include diverting attention (such as by increasing activity), reinterpreting or reframing pain,{{Cite journal|title=Clustering fibromyalgia patients: A combination of psychosocial and somatic factors leads to resilient coping in a subgroup of fibromyalgia patients|first1=Alexandra|last1=Braun|first2=Dimitar|last2=Evdokimov|first3=Johanna|last3=Frank|first4=Paul|last4=Pauli|first5=Nurcan|last5=Üçeyler|first6=Claudia|last6=Sommer|date=28 December 2020|journal=PLOS ONE|volume=15|issue=12|pages=e0243806|doi=10.1371/journal.pone.0243806|doi-access=free |pmid=33370324|pmc=7769259|bibcode=2020PLoSO..1543806B }} coping self-statements and ignoring pain sensations.{{Cite journal|url=https://pubmed.ncbi.nlm.nih.gov/27558974|title=A comparison of coping strategies in patients with fibromyalgia, chronic neuropathic pain, and pain-free controls|first1=Sidsel|last1=Baastrup|first2=Rikke|last2=Schultz|first3=Inger|last3=Brødsgaard|first4=Rod|last4=Moore|first5=Troels S.|last5=Jensen|first6=Lene|last6=Vase Toft|first7=Flemming W.|last7=Bach|first8=Raben|last8=Rosenberg|first9=Lise|last9=Gormsen|date=16 December 2016|journal=Scandinavian Journal of Psychology|volume=57|issue=6|pages=516–522|via=PubMed|doi=10.1111/sjop.12325|pmid=27558974}}

The quality of life of FM people can be effected by the quality of their spousal relationship (congruent, engaged, not overprotective).{{Cite journal|title=The role of spousal relationships in fibromyalgia patients' quality of life|first1=Ellen R.|last1=Huang|first2=Kim D.|last2=Jones|first3=Rob M.|last3=Bennett|first4=Gordon C. Nagayama|last4=Hall|first5=Karen S.|last5=Lyons|date=16 September 2018|journal=Psychology, Health & Medicine|volume=23|issue=8|pages=987–995|doi=10.1080/13548506.2018.1444183|pmid=29471682|pmc=6152921}}

In a 2020 Cochrane review, cognitive behavioral therapy (CBT) was found to have a small but beneficial effect for reducing pain and distress but adverse events were not well evaluated.{{cite journal | vauthors = Williams AC, Fisher E, Hearn L, Eccleston C | title = Psychological therapies for the management of chronic pain (excluding headache) in adults | journal = The Cochrane Database of Systematic Reviews | volume = 8 | issue = 8 | pages = CD007407 | date = August 2020 | pmid = 32794606 | pmc = 7437545 | doi = 10.1002/14651858.CD007407.pub4 }} CBT and related psychological and behavioral therapies have a small to moderate effect in reducing symptoms of fibromyalgia.{{cite journal | vauthors = Bernardy K, Klose P, Busch AJ, Choy EH, Häuser W | title = Cognitive behavioural therapies for fibromyalgia | journal = The Cochrane Database of Systematic Reviews | volume = 2013 | issue = 9 | pages = CD009796 | date = September 2013 | pmid = 24018611 | pmc = 6481397 | doi = 10.1002/14651858.CD009796.pub2 }}{{cite journal | vauthors = Glombiewski JA, Sawyer AT, Gutermann J, Koenig K, Rief W, Hofmann SG | title = Psychological treatments for fibromyalgia: a meta-analysis | journal = Pain | volume = 151 | issue = 2 | pages = 280–295 | date = November 2010 | pmid = 20727679 | doi = 10.1016/j.pain.2010.06.011 }} Effect sizes tend to be small when cognitive behavioral therapy is used as a stand-alone treatment for patients with fibromyalgia, but these improve significantly when it is part of a wider multidisciplinary treatment program.

Several reviews have found that CBT has no significant effect in pain reduction,{{cite journal |last1=Pathak |first1=Anna |last2=Kelleher |first2=Eoin M |last3=Brennan |first3=Isabelle |last4=Amarnani |first4=Raj |last5=Wall |first5=Amanda |last6=Murphy |first6=Robert |last7=Lee |first7=Hopin |last8=Fordham |first8=Beth |last9=Irani |first9=Anushka |title=Treatments for enhancing sleep quality in fibromyalgia: a systematic review and meta-analysis |journal=Rheumatology |date=14 March 2025 |doi=10.1093/rheumatology/keaf147 |pmid=40084994 }}{{cite journal |vauthors=Bernardy K, Füber N, Köllner V, Häuser W |date=October 2010 |title=Efficacy of cognitive-behavioral therapies in fibromyalgia syndrome - a systematic review and metaanalysis of randomized controlled trials |journal=The Journal of Rheumatology |volume=37 |issue=10 |pages=1991–2005 |doi=10.3899/jrheum.100104 |pmid=20682676 |doi-access=free}} although it does improve sleep quality.{{cite journal | vauthors = Whale K, Dennis J, Wylde V, Beswick A, Gooberman-Hill R | title = The effectiveness of non-pharmacological sleep interventions for people with chronic pain: a systematic review and meta-analysis | journal = BMC Musculoskeletal Disorders | volume = 23 | issue = 1 | page = 440 | date = May 2022 | pmid = 35546397 | pmc = 9092772 | doi = 10.1186/s12891-022-05318-5 | doi-access = free }} Acceptance and commitment therapy, a type of cognitive behavioral therapy, has also proven effective.{{cite journal | vauthors = Eastwood F, Godfrey E | title = The efficacy, acceptability and safety of acceptance and commitment therapy for fibromyalgia - a systematic review and meta-analysis | journal = British Journal of Pain | volume = 18 | issue = 3 | pages = 243–256 | date = June 2024 | pmid = 38751564 | pmc = 11092929 | doi = 10.1177/20494637231221451 | doi-access = free }}

A small 2024 study found that thinking patterns such as catastrophic thinking and self-efficacy correlated with daily functioning and physical and mental health status in FM patients.{{Cite web|url=https://www.clinexprheumatol.org/abstract.asp?a=21224|title=Beyond pain: the influence of psychological factors on functional status in fibromyalgia|website=Clin Exp Rheumatol}}

Sleep hygiene interventions show low effectiveness in improving insomnia in people with chronic pain.

A small study in 2025 found unclear impacts of mindfulness over 24 months.{{Cite journal|title=Can mindfulness have long-term impact on patients with fibromyalgia? A two-year prospective follow-up study of a mindfulness-based intervention|first1=Heidi A.|last1=Zangi|first2=Trond|last2=Haugmark|first3=Sella Aarrestad|last3=Provan|date=7 January 2025|journal=Rheumatology International|volume=45|issue=1|pages=19|doi=10.1007/s00296-024-05778-z|pmid=39775918|pmc=11706837}}

In 2017 exercise was the only fibromyalgia treatment given a strong recommendation by the European Alliance of Associations for Rheumatology (EULAR).{{Cite web |title=Managing fibromyalgia |url=https://www.eular.org/document/download/251/cfc1fc15-1cab-4262-b7f8-4d50cb60be84/267 |website=www.eular.org}} There is strong evidence indicating that exercise improves fitness, sleep and quality of life and may reduce pain and fatigue for people with fibromyalgia.{{cite journal | vauthors = Busch AJ, Barber KA, Overend TJ, Peloso PM, Schachter CL | title = Exercise for treating fibromyalgia syndrome | journal = The Cochrane Database of Systematic Reviews | issue = 4 | pages = CD003786 | date = October 2007 | pmid = 17943797 | doi = 10.1002/14651858.CD003786.pub2 }}{{cite journal | vauthors = Andrade A, Dominski FH, Sieczkowska SM | title = What we already know about the effects of exercise in patients with fibromyalgia: An umbrella review | journal = Seminars in Arthritis and Rheumatism | volume = 50 | issue = 6 | pages = 1465–1480 | date = December 2020 | pmid = 32147091 | doi = 10.1016/j.semarthrit.2020.02.003 }} Exercise has an added benefit in that it does not cause any serious adverse effects.

There are a number of hypothesized biological mechanisms for exercise benefits in FM.{{MEDRS|date=March 2022}} {{cite journal | vauthors = Masquelier E, D'haeyere J | title = Physical activity in the treatment of fibromyalgia | journal = Joint Bone Spine | volume = 88 | issue = 5 | page = 105202 | date = October 2021 | pmid = 33962033 | doi = 10.1016/j.jbspin.2021.105202 }} Exercise may improve pain modulation{{cite journal | vauthors = McLoughlin MJ, Stegner AJ, Cook DB | title = The relationship between physical activity and brain responses to pain in fibromyalgia | journal = The Journal of Pain | volume = 12 | issue = 6 | pages = 640–651 | date = June 2011 | pmid = 21330218 | pmc = 3111901 | doi = 10.1016/j.jpain.2010.12.004 }}{{cite journal | vauthors = Valim V, Natour J, Xiao Y, Pereira AF, Lopes BB, Pollak DF, Zandonade E, Russell IJ | title = Effects of physical exercise on serum levels of serotonin and its metabolite in fibromyalgia: a randomized pilot study | language = es | journal = Revista Brasileira de Reumatologia | volume = 53 | issue = 6 | pages = 538–541 | date = November 2013 | pmid = 24477734 | doi = 10.1016/j.rbr.2013.02.001 | doi-access = free }} through serotoninergic pathways. It may reduce pain by altering the hypothalamic-pituitary-adrenal axis and reducing cortisol levels.{{cite journal | vauthors = Genc A, Tur BS, Aytur YK, Oztuna D, Erdogan MF | title = Does aerobic exercise affect the hypothalamic-pituitary-adrenal hormonal response in patients with fibromyalgia syndrome? | journal = Journal of Physical Therapy Science | volume = 27 | issue = 7 | pages = 2225–2231 | date = July 2015 | pmid = 26311959 | pmc = 4540854 | doi = 10.1589/jpts.27.2225 }} It also has anti-inflammatory effects that may improve fibromyalgia symptoms.{{cite journal | vauthors = Andrade A, Vilarino GT, Sieczkowska SM, Coimbra DR, Steffens RA, Vietta GG | title = Acute effects of physical exercises on the inflammatory markers of patients with fibromyalgia syndrome: A systematic review | journal = Journal of Neuroimmunology | volume = 316 | pages = 40–49 | date = March 2018 | pmid = 29254627 | doi = 10.1016/j.jneuroim.2017.12.007 }} Aerobic exercise can improve muscle metabolism and pain through mitochondrial pathways.

Despite its benefits, exercise is a challenge for patients with fibromyalgia, due to the chronic fatigue and pain they experience.{{cite journal | vauthors = McVeigh JG, Lucas A, Hurley DA, Basford JR, Baxter GD | title = Patients' perceptions of exercise therapy in the treatment of fibromyalgia syndrome: a survey | journal = Musculoskeletal Care | volume = 1 | issue = 2 | pages = 98–107 | date = September 2003 | pmid = 20217670 | doi = 10.1002/msc.45 }} They may also feel that those who recommend or deliver exercise interventions do not fully understand the possible negative impact of exercise on fatigue and pain. This is especially true for non-personalized exercise programs. Adherence is higher when the exercise program is recommended by doctors or supervised by nurses.{{cite journal | vauthors = Sanz-Baños Y, Pastor-Mira MÁ, Lledó A, López-Roig S, Peñacoba C, Sánchez-Meca J | title = Do women with fibromyalgia adhere to walking for exercise programs to improve their health? Systematic review and meta-analysis | journal = Disability and Rehabilitation | volume = 40 | issue = 21 | pages = 2475–2487 | date = October 2018 | pmid = 28687050 | doi = 10.1080/09638288.2017.1347722 }}

Sufferers perceive exercise as more effortful than healthy adults.{{cite journal | vauthors = Barhorst EE, Andrae WE, Rayne TJ, Falvo MJ, Cook DB, Lindheimer JB | title = Elevated Perceived Exertion in People with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Fibromyalgia: A Meta-analysis | journal = Medicine and Science in Sports and Exercise | volume = 52 | issue = 12 | pages = 2615–2627 | date = December 2020 | pmid = 32555018 | doi = 10.1249/MSS.0000000000002421 | pmc = 10200687 }} Depression and higher pain intensity serve as barriers to physical activity.{{cite journal | vauthors = Vancampfort D, McGrath RL, Hemmings L, Gillis V, Bernar K, Van Damme T | title = Physical activity correlates in people with fibromyalgia: a systematic review | journal = Disability and Rehabilitation | pages = 4165–4174 | date = November 2022 | volume = 45 | issue = 25 | pmid = 36398698 | doi = 10.1080/09638288.2022.2146911 }} Exercise may intimidate them, in fear that they will be asked to do more than they are capable of.{{cite journal | vauthors = Russell D, Álvarez Gallardo IC, Wilson I, Hughes CM, Davison GW, Sañudo B, McVeigh JG | title = 'Exercise to me is a scary word': perceptions of fatigue, sleep dysfunction, and exercise in people with fibromyalgia syndrome-a focus group study | journal = Rheumatology International | volume = 38 | issue = 3 | pages = 507–515 | date = March 2018 | pmid = 29340774 | doi = 10.1007/s00296-018-3932-5 }}

A recommended approach to a graded exercise program begins with small, frequent exercise periods and builds up from there.{{cite journal | vauthors = Ryan S | title = Care of patients with fibromyalgia: assessment and management | journal = Nursing Standard | volume = 28 | issue = 13 | pages = 37–43 | year = 2013 | pmid = 24279570 | doi = 10.7748/ns2013.11.28.13.37.e7722 }} In order to reduce pain the use of an exercise program of 13 to 24 weeks is recommended, with each session lasting 30 to 60 minutes.{{cite journal | vauthors = Albuquerque ML, Monteiro D, Marinho DA, Vilarino GT, Andrade A, Neiva HP | title = Effects of different protocols of physical exercise on fibromyalgia syndrome treatment: systematic review and meta-analysis of randomized controlled trials | journal = Rheumatology International | volume = 42 | issue = 11 | pages = 1893–1908 | date = November 2022 | pmid = 35604435 | doi = 10.1007/s00296-022-05140-1 | hdl-access = free | hdl = 10400.8/7188 }}

When different exercise programs are compared, aerobic exercise is capable of modulating the autonomic nervous function of fibromyalgia patients, whereas resistance exercise does not show such effects. A 2022 meta-analysis found that aerobic training showed a high effect size while strength interventions showed moderate effects. Meditative exercise seems preferable for improving sleep,{{cite journal |vauthors=Estévez-López F, Maestre-Cascales C, Russell D, Álvarez-Gallardo IC, Rodriguez-Ayllon M, Hughes CM, Davison GW, Sañudo B, McVeigh JG |date=April 2021 |title=Effectiveness of Exercise on Fatigue and Sleep Quality in Fibromyalgia: A Systematic Review and Meta-analysis of Randomized Trials |journal=Archives of Physical Medicine and Rehabilitation |volume=102 |issue=4 |pages=752–761 |doi=10.1016/j.apmr.2020.06.019 |pmid=32721388 |doi-access=free |hdl-access=free |hdl=10481/68683}}{{cite journal |vauthors=Cuenca-Martínez F, Suso-Martí L, Fernández-Carnero J, Muñoz-Alarcos V, Sempere-Rubio N |date=August 2023 |title=Exercise-based interventions on sleep quality in patients with fibromyalgia syndrome: An umbrella and mapping review with meta-analysis |journal=Seminars in Arthritis and Rheumatism |volume=61 |page=152216 |doi=10.1016/j.semarthrit.2023.152216 |pmid=37229847 |doi-access=free}} with no differences between resistance, flexibility, and aquatic exercise in their favorable effects on fatigue.

Aerobic exercise for fibromyalgia patients is the most investigated type of exercise. It includes activities such as walking, jogging, spinning, cycling, dancing and exercising in water, with walking being named as one of the best methods.{{cite journal | vauthors = Majdoub F, Ben Nessib D, Ferjani HL, Kaffel D, Triki W, Maatallah K, Hamdi W | title = Non-pharmacological therapies in Fibromyalgia: New horizons for physicians, new hopes for patients | journal = Musculoskeletal Care | pages = 603–610 | date = February 2023 | volume = 21 | issue = 3 | pmid = 36757930 | doi = 10.1002/msc.1741 }} A 2017 Cochrane summary concluded that aerobic exercise probably improves quality of life, slightly decreases pain and improves physical function and makes no difference in fatigue and stiffness.{{cite journal | vauthors = Bidonde J, Busch AJ, Schachter CL, Overend TJ, Kim SY, Góes SM, Boden C, Foulds HJ | title = Aerobic exercise training for adults with fibromyalgia | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | issue = 6 | pages = CD012700 | date = June 2017 | pmid = 28636204 | pmc = 6481524 | doi = 10.1002/14651858.cd012700 }} A 2019 meta-analysis showed that exercising aerobically can reduce autonomic dysfunction and increase heart rate variability.{{cite journal | vauthors = Andrade A, Vilarino GT, Serafim TT, Pereira Júnior AA, de Souza CA, Sieczkowska SM | title = Modulation of Autonomic Function by Physical Exercise in Patients with Fibromyalgia Syndrome: A Systematic Review | journal = PM&R | volume = 11 | issue = 10 | pages = 1121–1131 | date = October 2019 | pmid = 30900831 | doi = 10.1002/pmrj.12158 }} This happens when patients exercise at least twice a week, for 45–60 minutes at about 60%–80% of the maximum heart rate. Aerobic exercise also decreases anxiety and depression, and improves the quality of life. Exercising aerobically 2–3 times a week has been shown to alleviate pain.{{Cite journal |last1=Casanova-Rodríguez |first1=David |last2=Ranchal-Sánchez |first2=Antonio |last3=Rodríguez |first3=Rodrigo Bertoletti |last4=Jurado-Castro |first4=Jose Manuel |date=2025 |title=Aerobic Exercise Prescription for Pain Reduction in Fibromyalgia: A Systematic Review and Meta-Analysis |journal=European Journal of Pain |language=en |volume=29 |issue=2 |pages=e4783 |doi=10.1002/ejp.4783 |pmc=11730678 |pmid=39805734}}

Combinations of different exercises such as flexibility and aerobic training may improve stiffness.{{cite journal | vauthors = Bidonde J, Busch AJ, Schachter CL, Webber SC, Musselman KE, Overend TJ, Góes SM, Dal Bello-Haas V, Boden C | title = Mixed exercise training for adults with fibromyalgia | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 5 | pages = CD013340 | date = May 2019 | pmid = 31124142 | pmc = 6931522 | doi = 10.1002/14651858.cd013340 }} However, the evidence is of low-quality. It is not clear if flexibility training alone compared to aerobic training is effective at reducing symptoms or has any adverse effects.{{cite journal | vauthors = Kim SY, Busch AJ, Overend TJ, Schachter CL, van der Spuy I, Boden C, Góes SM, Foulds HJ, Bidonde J | title = Flexibility exercise training for adults with fibromyalgia | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 9 | pages = CD013419 | date = September 2019 | pmid = 31476271 | pmc = 6718217 | doi = 10.1002/14651858.CD013419 }}

In resistance exercise, participants apply a load to their body using weights, elastic bands, body weight, or other measures.

Two meta-analyses on fibromyalgia have shown that resistance training can reduce anxiety and depression,{{cite journal | vauthors = Vilarino GT, Andreato LV, de Souza LC, Branco JH, Andrade A | title = Effects of resistance training on the mental health of patients with fibromyalgia: a systematic review | journal = Clinical Rheumatology | volume = 40 | issue = 11 | pages = 4417–4425 | date = November 2021 | pmid = 33987785 | doi = 10.1007/s10067-021-05738-z }} one found that it decreases pain and disease severity{{cite journal | vauthors = Rodríguez-Domínguez ÁJ, Rebollo-Salas M, Chillón-Martínez R, Rosales-Tristancho A, Jiménez-Rejano JJ | title = Clinical relevance of resistance training in women with fibromyalgia: A systematic review and meta-analysis | journal = European Journal of Pain | volume = 28 | issue = 1 | pages = 21–36 | date = January 2024 | pmid = 37458315 | doi = 10.1002/ejp.2161 | doi-access = free }} and one found that it improves quality of life. Resistance training may also improve sleep, with a greater effect than that of flexibility training and a similar effect to that of aerobic exercise.{{cite journal | vauthors = Bastos AC, Vilarino GT, de Souza LC, Dominski FH, Branco JH, Andrade A | title = Effects of resistance training on sleep of patients with fibromyalgia: A systematic review | journal = Journal of Health Psychology | volume = 28 | issue = 11 | pages = 1072–1084 | date = September 2023 | pmid = 37183814 | doi = 10.1177/13591053231172288 }}

The dosage of resistance exercise for women with fibromyalgia was studied in a 2022 meta-analysis.{{cite journal | vauthors = da Silva JM, de Barros BS, Almeida GJ, O'Neil J, Imoto AM | title = Dosage of resistance exercises in fibromyalgia: evidence synthesis for a systematic literature review up-date and meta-analysis | journal = Rheumatology International | volume = 42 | issue = 3 | pages = 413–429 | date = March 2022 | pmid = 34652480 | doi = 10.1007/s00296-021-05025-9 }} Effective dosages were found when exercising twice a week, for at least eight weeks. Symptom improvement was found for even low dosages such as 1–2 sets of 4–20 repetitions. Most studies use moderate exercise intensity of 40% to 85% one-repetition maximum. This intensity was effective in reducing pain. Some treatment regimes increase the intensity over time (from 40% to 80%), whereas others increase it when the participant can perform 12 repetitions. High-intensity exercises may cause lower treatment adherence.

A 2021 meta-analysis found that meditative exercise programs (tai chi, yoga, qigong) were superior to other forms of exercise (aerobic, flexibility, resistance) in improving sleep quality. Other meta-analyses also found positive effects of tai chi for sleep,{{cite journal | vauthors = Li H, Chen J, Xu G, Duan Y, Huang D, Tang C, Liu J | title = The Effect of Tai Chi for Improving Sleep Quality: A Systematic Review and Meta-analysis | journal = Journal of Affective Disorders | volume = 274 | pages = 1102–1112 | date = September 2020 | pmid = 32663938 | doi = 10.1016/j.jad.2020.05.076 }} fibromyalgia symptoms,{{cite journal | vauthors = Vasileios P, Styliani P, Nifon G, Pavlos S, Aris F, Ioannis P | title = Managing fibromyalgia with complementary and alternative medical exercise: a systematic review and meta-analysis of clinical trials | journal = Rheumatology International | volume = 42 | issue = 11 | pages = 1909–1923 | date = November 2022 | pmid = 35796820 | doi = 10.1007/s00296-022-05151-y }} and pain, fatigue, depression and quality of life.{{cite journal | vauthors = Cheng CA, Chiu YW, Wu D, Kuan YC, Chen SN, Tam KW | title = Effectiveness of Tai Chi on fibromyalgia patients: A meta-analysis of randomized controlled trials | journal = Complementary Therapies in Medicine | volume = 46 | pages = 1–8 | date = October 2019 | pmid = 31519264 | doi = 10.1016/j.ctim.2019.07.007 }} These tai chi interventions frequently included 1-hour sessions practiced 1–3 times a week for 12 weeks. Meditative exercises, as a whole, may achieve desired outcomes through biological mechanisms such as antioxidation, anti-inflammation, reduction in sympathetic activity and modulation of glucocorticoid receptor sensitivity.

Several reviews and meta-analyses suggest that aquatic training can improve symptoms and wellness in people with fibromyalgia.{{cite journal | vauthors = Bidonde J, Busch AJ, Webber SC, Schachter CL, Danyliw A, Overend TJ, Richards RS, Rader T | title = Aquatic exercise training for fibromyalgia | journal = The Cochrane Database of Systematic Reviews | issue = 10 | pages = CD011336 | date = October 2014 | volume = 2014 | pmid = 25350761 | doi = 10.1002/14651858.cd011336 | pmc = 10638613 }}{{cite journal | vauthors = Lima TB, Dias JM, Mazuquin BF, da Silva CT, Nogueira RM, Marques AP, Lavado EL, Cardoso JR | title = The effectiveness of aquatic physical therapy in the treatment of fibromyalgia: a systematic review with meta-analysis | journal = Clinical Rehabilitation | volume = 27 | issue = 10 | pages = 892–908 | date = October 2013 | pmid = 23818412 | doi = 10.1177/0269215513484772 }}{{cite journal | vauthors = Perraton L, Machotka Z, Kumar S | title = Components of effective randomized controlled trials of hydrotherapy programs for fibromyalgia syndrome: A systematic review | journal = Journal of Pain Research | volume = 2 | pages = 165–173 | date = November 2009 | pmid = 21197303 | pmc = 3004626 | doi = 10.2147/JPR.S8052 | doi-access = free }}{{cite journal | vauthors = Galvão-Moreira LV, de Castro LO, Moura EC, de Oliveira CM, Nogueira Neto J, Gomes LM, Leal PD | title = Pool-based exercise for amelioration of pain in adults with fibromyalgia syndrome: A systematic review and meta-analysis | journal = Modern Rheumatology | volume = 31 | issue = 4 | pages = 904–911 | date = July 2021 | pmid = 32990113 | doi = 10.1080/14397595.2020.1829339 }}{{cite journal | vauthors = Calles Plata I, Ortiz-Rubio A, Torres Sánchez I, Cabrera Martos I, Calvache Mateo A, Heredia-Ciuró A, Valenza MC | title = Effectiveness of aquatic therapy on sleep in persons with fibromyalgia. A meta-analysis | journal = Sleep Medicine | volume = 102 | pages = 76–83 | date = February 2023 | pmid = 36603514 | doi = 10.1016/j.sleep.2022.12.016 }}{{cite journal | vauthors = Ma J, Zhang T, Li X, Chen X, Zhao Q | title = Effects of aquatic physical therapy on clinical symptoms, physical function, and quality of life in patients with fibromyalgia: A systematic review and meta-analysis | journal = Physiotherapy Theory and Practice | pages = 205–223 | date = September 2022 | volume = 40 | issue = 2 | pmid = 36062580 | doi = 10.1080/09593985.2022.2119906 }} It is recommended to practice aquatic therapy at least twice a week using a low to moderate intensity. However, aquatic therapy does not appear to be superior to other types of exercise.{{cite journal | vauthors = Correyero-León M, Medrano-de-la-Fuente R, Hernando-Garijo I, Jiménez-Del-Barrio S, Hernández-Lázaro H, Ceballos-Laita L, Mingo-Gómez MT | title = Effectiveness of aquatic training based on aerobic and strengthening exercises in patients with fibromyalgia: systematic review with meta-analysis | journal = Explore | volume = 20 | issue = 1 | pages = 27–38 | date = July 2023 | pmid = 37460329 | doi = 10.1016/j.explore.2023.07.003 }}

Limited evidence suggests vibration training in combination with exercise may improve pain, fatigue, and stiffness.{{cite journal |vauthors=Bidonde J, Busch AJ, van der Spuy I, Tupper S, Kim SY, Boden C |date=September 2017 |title=Whole body vibration exercise training for fibromyalgia |journal=The Cochrane Database of Systematic Reviews |volume=2017 |issue=9 |pages=CD011755 |doi=10.1002/14651858.cd011755.pub2 |pmc=6483692 |pmid=28950401}}

A 2024 review found that fecal microbiota transplantation may reduce pain intensity and improve fatigue and quality of life in patients with fibromyalgia.{{cite journal |last1=Martín Pérez |first1=Sebastián Eustaquio |last2=Abdel Lah |first2=Hakim Al Lal |last3=García |first3=Nelson Hernández |last4=Reyes Carreño |first4=Umabel Aaron |last5=Martín Pérez |first5=Isidro Miguel |title=Effectiveness of Fecal Microbiota Transplantation in Nociplastic Pain Management: A Systematic Review |journal=Gastrointestinal Disorders |date=8 January 2025 |volume=7 |issue=1 |pages=5 |doi=10.3390/gidisord7010005 |doi-access=free }}{{Creative Commons text attribution notice|cc=by4|from this source=yes}}{{cite journal |last1=Fang |first1=Hongwei |last2=Hou |first2=Qianhao |last3=Zhang |first3=Wei |last4=Su |first4=Zehua |last5=Zhang |first5=Jinyuan |last6=Li |first6=Jingze |last7=Lin |first7=Jiaqi |last8=Wang |first8=Zetian |last9=Yu |first9=Xiuqin |last10=Yang |first10=Yu |last11=Wang |first11=Qing |last12=Li |first12=Xin |last13=Li |first13=Yuling |last14=Hu |first14=Lungui |last15=Li |first15=Shun |last16=Wang |first16=Xiangrui |last17=Liao |first17=Lijun |title=Fecal Microbiota Transplantation Improves Clinical Symptoms of Fibromyalgia: An Open-Label, Randomized, Nonplacebo-Controlled Study |journal=The Journal of Pain |date=September 2024 |volume=25 |issue=9 |pages=104535 |doi=10.1016/j.jpain.2024.104535 |pmid=38663650 }}{{cite journal |last1=Minerbi |first1=Amir |last2=Khoutorsky |first2=Arkady |last3=Shir |first3=Yoram |title=Decoding the connection: unraveling the role of gut microbiome in fibromyalgia |journal=PAIN Reports |date=February 2025 |volume=10 |issue=1 |pages=e1224 |doi=10.1097/PR9.0000000000001224 |pmid=39726854 |pmc=11671092 }}

Studies have shown that not being overweight is helpful for reducing FM impact.{{cite journal |last1=Atzeni |first1=Fabiola |last2=Alciati |first2=Alessandra |last3=Salaffi |first3=Fausto |last4=Di Carlo |first4=Marco |last5=Bazzichi |first5=Laura |last6=Govoni |first6=Marcello |last7=Biasi |first7=Giovanni |last8=Di Franco |first8=Manuela |last9=Mozzani |first9=Flavio |last10=Gremese |first10=Elisa |last11=Dagna |first11=Lorenzo |last12=Batticciotto |first12=Alberto |last13=Fischetti |first13=Fabio |last14=Giacomelli |first14=Roberto |last15=Guiducci |first15=Serena |date=25 January 2021 |title=The association between body mass index and fibromyalgia severity: data from a cross-sectional survey of 2339 patients |journal=Rheumatology Advances in Practice |volume=5 |issue=1 |pages=rkab015 |doi=10.1093/rap/rkab015 |pmc=8324026 |pmid=34345760 |last16=Guggino |first16=Giuliana |last17=Bentivegna |first17=Mario |last18=Gerli |first18=Roberto |last19=Salvarani |first19=Carlo |last20=Bajocchi |first20=Gianluigi |last21=Ghini |first21=Marco |last22=Iannone |first22=Florenzo |last23=Giorgi |first23=Valeria |last24=Farah |first24=Sonia |last25=Bonazza |first25=Sara |last26=Barbagli |first26=Stefano |last27=Gioia |first27=Chiara |last28=Marino |first28=Noemi Giuliana |last29=Capacci |first29=Annunziata |last30=Cavalli |first30=Giulio |last31=Cappelli |first31=Antonella |last32=Carubbi |first32=Francesco |last33=Nacci |first33=Francesca |last34=Riccucci |first34=Ilenia |last35=Cutolo |first35=Maurizio |last36=Sinigaglia |first36=Luigi |last37=Sarzi-Puttini |first37=Piercarlo}}{{cite journal |vauthors=Kadayifci FZ, Bradley MJ, Onat AM, Shi HN, Zheng S |date=November 2022 |title=Review of nutritional approaches to fibromyalgia |journal=Nutrition Reviews |volume=80 |issue=12 |pages=2260–2274 |doi=10.1093/nutrit/nuac036 |pmid=35674686}} A 2018 study (n=40) found that obese female FM patients had slightly higher levels of pain, tender point count, disease activity and depression than controls.{{Cite journal|title=The relationship between body mass index and pain, disease activity, depression and anxiety in women with fibromyalgia|first1=Burhan Fatih|last1=Koçyiğit|first2=Ramazan Azim|last2=Okyay|date=20 May 2018|journal=PeerJ|volume=6|pages=e4917|doi=10.7717/peerj.4917|doi-access=free |pmid=29868295|pmc=5978395}}

A 2024 review found that currently available pharmacological options appeared to be limited in efficacy for FM.{{Cite journal |last1=Metyas |first1=Caroline |last2=Aung |first2=Tun Tun |last3=Cheung |first3=Jennifer |last4=Joseph |first4=Marina |last5=Ballester |first5=Andrew M. |last6=Metyas |first6=Samy |date=8 September 2024 |title=Diet and Lifestyle Modifications for Fibromyalgia |journal=Current Rheumatology Reviews |volume=20 |issue=4 |pages=405–413 |doi=10.2174/0115733971274700231226075717 |pmc=11107431 |pmid=38279728}}

A few countries have published guidelines for the management and treatment of fibromyalgia. As of 2018, all of them emphasize that medications are not required. However, medications, though imperfect, continue to be a component of treatment strategy for fibromyalgia patients. The German guidelines outlined parameters for drug therapy termination and recommended considering drug holidays after six months.

Health Canada and the US Food and Drug Administration (FDA) have approved pregabalin{{cite press release |title=FDA Approves First Drug for Treating Fibromyalgia |date=21 June 2007 |publisher=U.S. Food and Drug Administration |url=https://www.fda.gov/bbs/topics/NEWS/2007/NEW01656.html |access-date=14 January 2008 |url-status=live |archive-url=https://web.archive.org/web/20080221172848/https://www.fda.gov/bbs/topics/NEWS/2007/NEW01656.html |archive-date=21 February 2008}}{{cite journal |last1=Martinez |first1=José Eduardo |last2=Guimarães |first2=Izabela |date=March 2024 |title=Fibromyalgia – are there any new approaches? |journal=Best Practice & Research Clinical Rheumatology |volume=38 |issue=1 |page=101933 |doi=10.1016/j.berh.2024.101933 |pmid=38355316}} (an anticonvulsant) and duloxetine (a serotonin–norepinephrine reuptake inhibitor) for the management of fibromyalgia. The FDA also approved milnacipran (another serotonin–norepinephrine reuptake inhibitor), but the European Medicines Agency refused marketing authority.{{cite web |last=European Medicines Agency |title=Questions and answers on the recommendation for the refusal of the marketing authorisation for Milnacipran Pierre Fabre Médicament/Impulsor |url=http://www.ema.europa.eu/docs/en_GB/document_library/Summary_of_opinion_-_Initial_authorisation/human/001034/WC500089875.pdf |url-status=live |archive-url=https://web.archive.org/web/20140222154105/http://www.ema.europa.eu/docs/en_GB/document_library/Summary_of_opinion_-_Initial_authorisation/human/001034/WC500089875.pdf |archive-date=22 February 2014 |access-date=30 May 2013 |publisher=European Medicines Agency}}

A 2024 overview of Cochrane reviews concluded that the FDA approved medications: duloxetine, milnacipran, or pregabalin were the only ones with evidence of efficacy. About 10% of patients with moderate or severe pain using them experienced a reduction of at least 50% in their pain.{{cite journal |last1=Moore |first1=Andrew |last2=Bidonde |first2=Julia |last3=Fisher |first3=Emma |last4=Häuser |first4=Winfried |last5=Bell |first5=Rae Frances |last6=Perrot |first6=Serge |last7=Makri |first7=Souzi |last8=Straube |first8=Sebastian |title=Effectiveness of pharmacological therapies for fibromyalgia syndrome in adults: an overview of Cochrane Reviews |journal=Rheumatology |date=20 December 2024 |volume=64 |issue=5 |pages=2385–2394 |doi=10.1093/rheumatology/keae707 |pmid=39705187 |pmc=12048062 }}

The length of time that medications take to be effective at reducing symptoms can vary. Any potential benefits from the antidepressant amitriptyline may take up to three months to take effect and it may take between three and six months for duloxetine, milnacipran, and pregabalin to be effective at improving symptoms.{{cite journal |vauthors=Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ |date=May 2019 |title=Amitriptyline for fibromyalgia in adults |journal=The Cochrane Database of Systematic Reviews |volume=5 |issue=7 |pages=CD011824 |doi=10.1002/14651858.CD011824 |pmc=6485478 |pmid=35658166}} Some medications have the potential to cause withdrawal symptoms when stopping so gradual discontinuation may be warranted particularly for antidepressants and pregabalin.

Antidepressants are one of the common drugs for fibromyalgia. Antidepressants can improve the quality of life for fibromyalgia patients in the medium term. Duloxetine and milnacipran have good evidence of substantial pain relief, with no increased risk for serious adverse effects. However, there is no good evidence showing that amitriptyline, milnacipran or duloxetine improve sleep quality.

A 2023 meta-analysis found that duloxetine improved fibromyalgia symptoms, regardless of the dosage.{{cite journal |vauthors=Migliorini F, Maffulli N, Eschweiler J, Baroncini A, Bell A, Colarossi G |date=July 2023 |title=Duloxetine for fibromyalgia syndrome: a systematic review and meta-analysis |journal=Journal of Orthopaedic Surgery and Research |volume=18 |issue=1 |page=504 |doi=10.1186/s13018-023-03995-z |pmc=10351165 |pmid=37461044 |doi-access=free}} SSRIs may be also be used to treat depression in people diagnosed with fibromyalgia.{{cite journal |vauthors=Walitt B, Urrútia G, Nishishinya MB, Cantrell SE, Häuser W |date=June 2015 |title=Selective serotonin reuptake inhibitors for fibromyalgia syndrome |journal=The Cochrane Database of Systematic Reviews |volume=2015 |issue=6 |pages=CD011735 |doi=10.1002/14651858.cd011735 |pmc=4755337 |pmid=26046493}}

While amitriptyline has been used as a first-line treatment, the quality of evidence to support this use and comparison between different medications is poor.{{cite journal |vauthors=Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ |date=July 2015 |title=Amitriptyline for neuropathic pain in adults |journal=The Cochrane Database of Systematic Reviews |volume=2015 |issue=7 |pages=CD008242 |doi=10.1002/14651858.CD011824 |pmc=6485478 |pmid=26146793}}{{cite journal |vauthors=Welsch P, Üçeyler N, Klose P, Walitt B, Häuser W |date=February 2018 |title=Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia |journal=The Cochrane Database of Systematic Reviews |volume=2 |issue=2 |pages=CD010292 |doi=10.1002/14651858.CD010292.pub2 |pmc=5846183 |pmid=29489029}} Very weak evidence indicates that a very small number of people may benefit from treatment with the tetracyclic antidepressant mirtazapine, however, for most, the potential benefits are not great and the risk of adverse effects and potential harm outweighs any potential for benefit.{{cite journal |vauthors=Welsch P, Bernardy K, Derry S, Moore RA, Häuser W |date=August 2018 |title=Mirtazapine for fibromyalgia in adults |journal=The Cochrane Database of Systematic Reviews |volume=8 |issue=8 |pages=CD012708 |doi=10.1002/14651858.CD012708.pub2 |pmc=6513659 |pmid=30080242}} As of 2018, the only tricyclic antidepressant that has sufficient evidence is amitriptyline.

Tentative evidence suggests that monoamine oxidase inhibitors (MAOIs) such as pirlindole and moclobemide are moderately effective for reducing pain.{{cite journal |vauthors=Tort S, Urrútia G, Nishishinya MB, Walitt B |date=April 2012 |title=Monoamine oxidase inhibitors (MAOIs) for fibromyalgia syndrome |journal=The Cochrane Database of Systematic Reviews |issue=4 |pages=CD009807 |doi=10.1002/14651858.cd009807 |pmc=11729144 |pmid=22513976}} Very low-quality evidence suggests pirlindole as more effective at treating pain than moclobemide. Side effects of MAOIs may include nausea and vomiting.

Central nervous system depressants include drug categories such as sedatives, tranquilizers, and hypnotics. A 2021 meta-analysis concluded that such drugs can improve the quality of life for fibromyalgia patients in the medium term.

The anti-convulsant medications gabapentin and pregabalin may be used to reduce pain.{{cite journal |vauthors=Cooper TE, Derry S, Wiffen PJ, Moore RA |date=January 2017 |title=Gabapentin for fibromyalgia pain in adults |journal=The Cochrane Database of Systematic Reviews |volume=1 |issue=1 |pages=CD012188 |doi=10.1002/14651858.CD012188.pub2 |pmc=6465053 |pmid=28045473}} There is tentative evidence that gabapentin may be of benefit for pain in about 18% of people with fibromyalgia. It is not possible to predict who will benefit, and a short trial may be recommended to test the effectiveness of this type of medication. Approximately 6/10 people who take gabapentin to treat pain related to fibromyalgia experience unpleasant side effects such as dizziness, abnormal walking, or swelling from fluid accumulation.{{cite journal |vauthors=Wiffen PJ, Derry S, Bell RF, Rice AS, Tölle TR, Phillips T, Moore RA |date=June 2017 |title=Gabapentin for chronic neuropathic pain in adults |journal=The Cochrane Database of Systematic Reviews |volume=6 |issue=6 |pages=CD007938 |doi=10.1002/14651858.CD007938.pub4 |pmc=6452908 |pmid=28597471}} Pregabalin demonstrates a benefit in about 9% of people,{{cite journal |vauthors=Derry S, Cording M, Wiffen PJ, Law S, Phillips T, Moore RA |date=September 2016 |title=Pregabalin for pain in fibromyalgia in adults |journal=The Cochrane Database of Systematic Reviews |volume=9 |issue=9 |pages=CD011790 |doi=10.1002/14651858.CD011790.pub2 |pmc=6457745 |pmid=27684492}} it may also enhance sleep quality. Pregabalin reduced time off work by 0.2 days per week.{{cite journal |vauthors=Straube S, Moore RA, Paine J, Derry S, Phillips CJ, Hallier E, McQuay HJ |date=June 2011 |title=Interference with work in fibromyalgia: effect of treatment with pregabalin and relation to pain response |journal=BMC Musculoskeletal Disorders |volume=12 |page=125 |doi=10.1186/1471-2474-12-125 |pmc=3118156 |pmid=21639874 |doi-access=free}} A 2025 review found that, for enhancing sleep quality in FM, pregabalin might be beneficial but had potential risks.{{cite journal |last1=Pathak |first1=Anna |last2=Kelleher |first2=Eoin M |last3=Brennan |first3=Isabelle |last4=Amarnani |first4=Raj |last5=Wall |first5=Amanda |last6=Murphy |first6=Robert |last7=Lee |first7=Hopin |last8=Fordham |first8=Beth |last9=Irani |first9=Anushka |date=14 March 2025 |title=Treatments for enhancing sleep quality in fibromyalgia: a systematic review and meta-analysis |journal=Rheumatology |doi=10.1093/rheumatology/keaf147 |pmid=40084994}}

Melatonin has shown potential therapeutic value in managing fibromyalgia symptoms, including improvements in pain, sleep, anxiety levels, and quality of life.{{cite journal |last1=Gulzar |first1=Abu Huraira Bin |last2=Koppanatham |first2=Aishwarya |last3=Arshad |first3=Mirza Ammar |last4=Yasmeen |first4=Samina |last5=Ahmed |first5=Umair |last6=Makita |first6=Luana |last7=Varkey |first7=Thomas |title=Exploring the Therapeutic Potential of Melatonin in Managing Fibromyalgia: A Systematic Review of Current Evidence (P5-7.009) |journal=Neurology |date=8 April 2025 |volume=104 |issue=7_Supplement_1 |doi=10.1212/WNL.0000000000211204 }}{{cite journal |vauthors=Hemati K, Amini Kadijani A, Sayehmiri F, Mehrzadi S, Zabihiyeganeh M, Hosseinzadeh A, Mirzaei A |date=February 2020 |title=Melatonin in the treatment of fibromyalgia symptoms: A systematic review |journal=Complementary Therapies in Clinical Practice |volume=38 |pages=101072 |doi=10.1016/j.ctcp.2019.101072 |pmid=31783341 }}{{cite journal |last1=de Carvalho |first1=Jozélio Freire |last2=Skare |first2=Thelma L. |title=Melatonin supplementation improves rheumatological disease activity: A systematic review |journal=Clinical Nutrition ESPEN |date=June 2023 |volume=55 |pages=414–419 |doi=10.1016/j.clnesp.2023.04.011 |pmid=37202076 }} Melatonin is considered to be generally safe, hence it may be a promising supplementary treatment for fibromyalgia.

Cannabinoids may have some benefits for people with fibromyalgia. However, as of 2022, the data on the topic is still limited.{{cite journal |vauthors=Nowell WB, Gavigan K, L Silverman S |date=May 2022 |title=Cannabis for Rheumatic Disease Pain: a Review of Current Literature |journal=Current Rheumatology Reports |volume=24 |issue=5 |pages=119–131 |doi=10.1007/s11926-022-01065-7 |pmid=35486218}}{{cite journal |vauthors=Boehnke KF, Häuser W, Fitzcharles MA |date=July 2022 |title=Cannabidiol (CBD) in Rheumatic Diseases (Musculoskeletal Pain) |journal=Current Rheumatology Reports |volume=24 |issue=7 |pages=238–246 |doi=10.1007/s11926-022-01077-3 |pmc=9062628 |pmid=35503198}}{{cite journal |vauthors=Bourke SL, Schlag AK, O'Sullivan SE, Nutt DJ, Finn DP |date=December 2022 |title=Cannabinoids and the endocannabinoid system in fibromyalgia: A review of preclinical and clinical research |journal=Pharmacology & Therapeutics |volume=240 |page=108216 |doi=10.1016/j.pharmthera.2022.108216 |pmid=35609718 |doi-access=free}} Cannabinoids may also have adverse effects and may negatively interact with common rheumatological drugs.{{cite journal |vauthors=Jain N, Moorthy A |date=June 2022 |title=Cannabinoids in rheumatology: Friend, foe or a bystander? |journal=Musculoskeletal Care |volume=20 |issue=2 |pages=416–428 |doi=10.1002/msc.1636 |pmc=9322323 |pmid=35476898}}

Nefopam is sometimes used for chronic pain when common alternatives are contraindicated or ineffective, or as an add-on therapy.{{Cite web | title = Use of nefopam for chronic pain | date = January 5, 2024 | url = https://www.sps.nhs.uk/articles/use-of-nefopam-for-chronic-pain/ | website = SPS - Specialist Pharmacy Service }}

The use of opioids is controversial. As of 2015, no opioid is approved for use in this condition by the FDA.{{cite journal |vauthors=MacLean AJ, Schwartz TL |date=May 2015 |title=Tramadol for the treatment of fibromyalgia |journal=Expert Review of Neurotherapeutics |volume=15 |issue=5 |pages=469–475 |doi=10.1586/14737175.2015.1034693 |pmid=25896486}} A 2016 Cochrane review concluded that there is no good evidence to support or refute the suggestion that oxycodone, alone or in combination with naloxone, reduces pain in fibromyalgia.{{cite journal |vauthors=Gaskell H, Moore RA, Derry S, Stannard C |date=September 2016 |title=Oxycodone for pain in fibromyalgia in adults |journal=The Cochrane Database of Systematic Reviews |volume=2016 |issue=9 |pages=CD012329 |doi=10.1002/14651858.CD012329 |pmc=6457853 |pmid=27582266 |collaboration=Cochrane Pain, Palliative and Supportive Care Group}} The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) in 2014 stated that there was a lack of evidence for opioids for most people.{{cite web |date=July 2014 |title=Questions and Answers about Fibromyalgia |url=http://www.niams.nih.gov/health_info/fibromyalgia/ |archive-url=https://web.archive.org/web/20160315112712/http://www.niams.nih.gov/health_info/fibromyalgia/ |archive-date=15 March 2016 |access-date=15 March 2016 |website=NIAMS}} The Association of the Scientific Medical Societies in Germany in 2012 made no recommendation either for or against the use of weak opioids because of the limited amount of scientific research addressing their use in the treatment of fibromyalgia. They strongly advise against using strong opioids.{{cite journal |vauthors=Sommer C, Häuser W, Alten R, Petzke F, Späth M, Tölle T, Uçeyler N, Winkelmann A, Winter E, Bär KJ |date=June 2012 |title=[Drug therapy of fibromyalgia syndrome. Systematic review, meta-analysis and guideline] |journal=Schmerz |volume=26 |issue=3 |pages=297–310 |doi=10.1007/s00482-012-1172-2 |pmid=22760463}} The Canadian Pain Society in 2012 said that opioids, starting with a weak opioid like tramadol, can be tried but only for people with moderate to severe pain that is not well-controlled by non-opioid painkillers. They discourage the use of strong opioids and only recommend using them while they continue to provide improved pain and functioning. Healthcare providers should monitor people on opioids for ongoing effectiveness, side effects, and possible unwanted drug behaviors.

A 2015 review found fair evidence to support tramadol use if other medications do not work. A 2018 review found little evidence to support the combination of paracetamol (acetaminophen) and tramadol over a single medication.{{cite journal |vauthors=Thorpe J, Shum B, Moore RA, Wiffen PJ, Gilron I |date=February 2018 |title=Combination pharmacotherapy for the treatment of fibromyalgia in adults |journal=The Cochrane Database of Systematic Reviews |volume=2 |issue=2 |pages=CD010585 |doi=10.1002/14651858.CD010585.pub2 |pmc=6491103 |pmid=29457627}} Goldenberg et al suggest that tramadol works via its serotonin and norepinephrine reuptake inhibition, rather than via its action as a weak opioid receptor agonist.{{cite journal |vauthors=Goldenberg DL, Clauw DJ, Palmer RE, Clair AG |date=May 2016 |title=Opioid Use in Fibromyalgia: A Cautionary Tale |journal=Mayo Clinic Proceedings |type=Review |volume=91 |issue=5 |pages=640–648 |doi=10.1016/j.mayocp.2016.02.002 |pmid=26975749 |doi-access=free}}

A large study of US people with fibromyalgia found that between 2005 and 2007 37.4% were prescribed short-acting opioids and 8.3% were prescribed long-acting opioids,{{cite journal |vauthors=Ngian GS, Guymer EK, Littlejohn GO |date=February 2011 |title=The use of opioids in fibromyalgia |journal=International Journal of Rheumatic Diseases |volume=14 |issue=1 |pages=6–11 |doi=10.1111/j.1756-185X.2010.01567.x |pmid=21303476}} with around 10% of those prescribed short-acting opioids using tramadol;Berger A. [https://web.archive.org/web/20130606030416/http://abstract.mci-group.com/cgi-bin/mc/printabs.pl?APP=EULAR2009SCIE-abstract&TEMPLATE=&keyf=2307&showHide=show&client= Patterns of use of opioids in patients with fibromyalgia] In: EULAR; 2009:SAT0461 and a 2011 Canadian study of 457 people with fibromyalgia found 32% used opioids and two-thirds of those used strong opioids.

Capsaicin has been suggested as a topical pain reliever. Preliminary results suggest that it may improve sleep quality and fatigue, but there are not enough studies to support this claim.{{cite journal |vauthors=Elijah J, Powell K, Smith MA |date=June 2022 |title=The Efficacy of Capsaicin on Sleep Quality and Fatigue in Fibromyalgia |journal=Journal of Pain & Palliative Care Pharmacotherapy |volume=36 |issue=2 |pages=112–116 |doi=10.1080/15360288.2022.2063468 |pmid=35471125}}

Sodium oxybate increases growth hormone production levels through increased slow-wave sleep patterns. However, this medication was not approved by the FDA for the indication for use in people with fibromyalgia due to the concern for abuse.{{cite journal |vauthors=Staud R |date=August 2011 |title=Sodium oxybate for the treatment of fibromyalgia |journal=Expert Opinion on Pharmacotherapy |volume=12 |issue=11 |pages=1789–1798 |doi=10.1517/14656566.2011.589836 |pmid=21679091}}

The muscle relaxants cyclobenzaprine, carisoprodol with acetaminophen and caffeine, and tizanidine are sometimes used to treat fibromyalgia; however, as of 2015 they are not approved for this use in the United States.{{cite journal |last1=See |first1=Sharon |last2=Ginzburg |first2=Regina |date=August 2008 |title=Choosing a skeletal muscle relaxant |url=https://www.aafp.org/link_out?pmid=18711953 |journal=American Family Physician |volume=78 |issue=3 |pages=365–370 |pmid=18711953}}{{cite book |last1=Kaltsas |first1=Gregory |title=Endotext |last2=Tsiveriotis |first2=Konstantinos |date=2000 |publisher=MDText.com, Inc. |chapter=Fibromyalgia |pmid=25905317 |access-date=20 February 2017 |chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK279092/ |archive-url=https://web.archive.org/web/20200806021142/https://www.ncbi.nlm.nih.gov/books/NBK279092/ |archive-date=6 August 2020 |url-status=live}} The use of nonsteroidal anti-inflammatory drugs is not recommended as first-line therapy.{{cite journal |vauthors=Heymann RE, Paiva ED, Helfenstein M, Pollak DF, Martinez JE, Provenza JR, Paula AP, Althoff AC, Souza EJ, Neubarth F, Lage LV, Rezende MC, de Assis MR, Lopes ML, Jennings F, Araújo RL, Cristo VV, Costa ED, Kaziyama HH, Yeng LT, Iamamura M, Saron TR, Nascimento OJ, Kimura LK, Leite VM, Oliveira J, de Araújo GT, Fonseca MC |year=2010 |title=Brazilian consensus on the treatment of fibromyalgia |journal=Revista Brasileira de Reumatologia |volume=50 |issue=1 |pages=56–66 |doi=10.1590/S0482-50042010000100006 |pmid=21125141 |doi-access=free}} Moreover, nonsteroidal anti-inflammatory drugs cannot be considered as useful in the management of fibromyalgia.{{cite journal |vauthors=Derry S, Wiffen PJ, Häuser W, Mücke M, Tölle TR, Bell RF, Moore RA |date=March 2017 |title=Oral nonsteroidal anti-inflammatory drugs for fibromyalgia in adults |journal=The Cochrane Database of Systematic Reviews |volume=3 |issue=3 |pages=CD012332 |doi=10.1002/14651858.CD012332.pub2 |pmc=6464559 |pmid=28349517}}

Very low-quality evidence suggests quetiapine may be effective in fibromyalgia.{{cite journal |vauthors=Walitt B, Klose P, Üçeyler N, Phillips T, Häuser W |date=June 2016 |title=Antipsychotics for fibromyalgia in adults |journal=The Cochrane Database of Systematic Reviews |volume=2016 |issue=6 |pages=CD011804 |doi=10.1002/14651858.cd011804.pub2 |pmc=6457603 |pmid=27251337}}

No high-quality evidence exists that suggests synthetic THC (nabilone) helps with fibromyalgia.{{cite journal |vauthors=Walitt B, Klose P, Fitzcharles MA, Phillips T, Häuser W |date=July 2016 |title=Cannabinoids for fibromyalgia |journal=The Cochrane Database of Systematic Reviews |volume=7 |issue=7 |pages=CD011694 |doi=10.1002/14651858.cd011694.pub2 |pmc=6457965 |pmid=27428009}}

Reviews in 2023 and 2020 found only limited or no evidence existed to recommend any specific diet to people with FM.{{Cite journal|title=Dietary Effects on Pain Symptoms in Patients with Fibromyalgia Syndrome: Systematic Review and Future Directions|first1=Emma K.|last1=Maddox|first2=Shawn C.|last2=Massoni|first3=Cara M.|last3=Hoffart|first4=Yumie|last4=Takata|date=31 January 2023|journal=Nutrients|volume=15|issue=3|page=716|doi=10.3390/nu15030716|doi-access=free |pmid=36771421 |pmc=9921865 }}{{Cite journal|title=Dietary Interventions in the Management of Fibromyalgia: A Systematic Review and Best-Evidence Synthesis|first1=Ethan|last1=Lowry|first2=Joanne|last2=Marley|first3=Joseph G.|last3=McVeigh|first4=Emeir|last4=McSorley|first5=Philip|last5=Allsopp|first6=Daniel|last6=Kerr|date=31 August 2020|journal=Nutrients|volume=12|issue=9|pages=2664|doi=10.3390/nu12092664|doi-access=free |pmid=32878326|pmc=7551150}}

Nutrition is related to fibromyalgia in several ways. Some nutritional risk factors for fibromyalgia complications are obesity, nutritional deficiencies, food allergies and consuming food additives. The consumption of fruits and vegetables, low-processed foods, high-quality proteins, and healthy fats may have some benefits. Low-quality evidence found some benefits of a vegetarian or vegan diet.{{cite journal |vauthors=Nadal-Nicolás Y, Miralles-Amorós L, Martínez-Olcina M, Sánchez-Ortega M, Mora J, Martínez-Rodríguez A |date=May 2021 |title=Vegetarian and Vegan Diet in Fibromyalgia: A Systematic Review |journal=International Journal of Environmental Research and Public Health |volume=18 |issue=9 |pages=4955 |doi=10.3390/ijerph18094955 |pmc=8125538 |pmid=34066603 |doi-access=free}}

Although dietary supplements have been widely investigated concerning fibromyalgia, most of the evidence, as of 2021, is of poor quality. It is therefore difficult to reach conclusive recommendations.{{cite journal | vauthors = Haddad HW, Mallepalli NR, Scheinuk JE, Bhargava P, Cornett EM, Urits I, Kaye AD | title = The Role of Nutrient Supplementation in the Management of Chronic Pain in Fibromyalgia: A Narrative Review | journal = Pain and Therapy | volume = 10 | issue = 2 | pages = 827–848 | date = December 2021 | pmid = 33909266 | pmc = 8586285 | doi = 10.1007/s40122-021-00266-9 }} It appears that Q10 coenzyme and vitamin D supplements can reduce pain and improve quality of life for fibromyalgia patients.{{Cite journal| vauthors = Ibáñez-Vera AJ, Alvero-Cruz JR, García-Romero JC |date=2018|title=Therapeutic physical exercise and supplements to treat fibromyalgia |journal=Apunts. Medicina de l'Esport|volume=53|issue=197|pages=33–41|doi=10.1016/j.apunts.2017.07.001}}{{cite journal | vauthors = Qu K, Li MX, Zhou YL, Yu P, Dong M | title = The efficacy of vitamin D in treatment of fibromyalgia: a meta-analysis of randomized controlled studies and systematic review | journal = Expert Review of Clinical Pharmacology | volume = 15 | issue = 4 | pages = 433–442 | date = April 2022 | pmid = 35596576 | doi = 10.1080/17512433.2022.2081151 }} Q10 coenzyme has beneficial effects on fatigue in fibromyalgia patients, with most studies using doses of 300 mg per day for three months.{{cite journal | vauthors = Mehrabani S, Askari G, Miraghajani M, Tavakoly R, Arab A | title = Effect of coenzyme Q10 supplementation on fatigue: A systematic review of interventional studies | journal = Complementary Therapies in Medicine | volume = 43 | pages = 181–187 | date = April 2019 | pmid = 30935528 | doi = 10.1016/j.ctim.2019.01.022 }} Q10 coenzyme is hypothesized to improve mitochondrial activity and decrease inflammation.{{cite book |doi=10.1007/978-3-030-55035-6_5 |chapter=Targeted Treatment of Age-Related Fibromyalgia with Supplemental Coenzyme Q10 |title=Reviews on New Drug Targets in Age-Related Disorders |series=Advances in Experimental Medicine and Biology |date=2021 |volume=1286 |pages=77–85 |pmid=33725346 |isbn=978-3-030-55034-9 | vauthors = Hargreaves IP, Mantle D }} Vitamin D has been shown to improve some fibromyalgia measures, but not others.{{cite journal | vauthors = Erkilic B, Dalgic GS | title = The preventive role of vitamin D in the prevention and management of Fibromyalgia syndrome | journal = Nutrition and Health | pages = 223–229 | date = January 2023 | volume = 29 | issue = 2 | pmid = 36591895 | doi = 10.1177/02601060221144801 }}

Patient understanding of FM can be low.{{Cite journal|title=Investigation of patients' understanding of fibromyalgia: Results from an online qualitative survey|first1=Lora L.|last1=Black|first2=William R.|last2=Black|first3=Andrea|last3=Chadwick|first4=Jennifer L.|last4=Christofferson|first5=Hannah|last5=Katz|first6=Monica|last6=Kragenbrink|date=20 May 2024|journal=Patient Education and Counseling|volume=122|pages=108156|doi=10.1016/j.pec.2024.108156|pmid=38242011|pmc=10923085}}

Patient education is recommended by the European League Against Rheumatism (EULAR) as an important treatment component. As of 2022, there is only low-quality evidence showing that patient education can decrease pain and fibromyalgia impact.{{cite journal | vauthors = Suso-Martí L, Cuenca-Martínez F, Alba-Quesada P, Muñoz-Alarcos V, Herranz-Gómez A, Varangot-Reille C, Domínguez-Navarro F, Casaña J | title = Effectiveness of Pain Neuroscience Education in Patients with Fibromyalgia: A Systematic Review and Meta-Analysis | journal = Pain Medicine | volume = 23 | issue = 11 | pages = 1837–1850 | date = October 2022 | pmid = 35587171 | doi = 10.1093/pm/pnac077 }}{{cite journal | vauthors = Duhn PH, Wæhrens EE, Pedersen MB, Nielsen SM, Locht H, Bliddal H, Christensen R, Amris K | title = Effectiveness of patient education as a stand-alone intervention for patients with chronic widespread pain and fibromyalgia: a systematic review and meta-analysis of randomized trials | journal = Scandinavian Journal of Rheumatology | volume = 52 | issue = 6 | pages = 654–663 | date = November 2023 | pmid = 37162478 | doi = 10.1080/03009742.2023.2192450 | url = https://figshare.com/articles/journal_contribution/22795654 }}

Patients with chronic pain, including those with fibromyalgia, can benefit from techniques such as manual therapy, cryotherapy, and balneotherapy.{{cite journal | vauthors = Navarro-Ledesma S, Hamed-Hamed D, Gonzalez-Muñoz A, Pruimboom L | title = Impact of physical therapy techniques and common interventions on sleep quality in patients with chronic pain: A systematic review | journal = Sleep Medicine Reviews | volume = 76 | page = 101937 | date = August 2024 | pmid = 38669729 | doi = 10.1016/j.smrv.2024.101937 | hdl-access = free | doi-access = free | hdl = 10481/92720 }} These can lessen the experience of chronic pain and increase both the amount and quality of sleep. Patients' quality of life is also improved by decreasing pain mechanisms and increasing sleep quality, particularly during the REM phase, sleep efficiency, and alertness.

A 2021 meta-analysis concluded that massage and myofascial release diminish pain in the medium term. As of 2015, there was no good evidence for the benefit of other mind-body therapies.{{cite journal | vauthors = Theadom A, Cropley M, Smith HE, Feigin VL, McPherson K | title = Mind and body therapy for fibromyalgia | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 4 | pages = CD001980 | date = April 2015 | pmid = 25856658 | pmc = 8409283 | doi = 10.1002/14651858.CD001980.pub3 }}

A 2013 review found moderate-level evidence on the usage of acupuncture with electrical stimulation for improvement of overall well-being. Acupuncture alone will not have the same effects, but will enhance the influence of exercise and medication in pain and stiffness.{{cite journal | vauthors = Deare JC, Zheng Z, Xue CC, Liu JP, Shang J, Scott SW, Littlejohn G | title = Acupuncture for treating fibromyalgia | journal = The Cochrane Database of Systematic Reviews | volume = 2013 | issue = 5 | pages = CD007070 | date = May 2013 | pmid = 23728665 | pmc = 4105202 | doi = 10.1002/14651858.CD007070.pub2 }}

Several forms of electrical neuromodulation, including transcutaneous electrical nerve stimulation (TENS) and transcranial direct current stimulation (tDCS), have been used to treat fibromyalgia. In general, they help reduce pain and depression and improve functioning.{{cite journal | vauthors = Cheng YC, Hsiao CY, Su MI, Chiu CC, Huang YC, Huang WL | title = Treating fibromyalgia with electrical neuromodulation: A systematic review and meta-analysis | journal = Clinical Neurophysiology | volume = 148 | pages = 17–28 | date = April 2023 | pmid = 36774784 | doi = 10.1016/j.clinph.2023.01.011 }}{{cite journal | vauthors = Gikaro JM, Bigambo FM, Minde VM, Swai EA | title = Efficacy of electrophysical agents in fibromyalgia: A systematic review and network meta-analysis | journal = Clinical Rehabilitation | volume = 37 | issue = 10 | pages = 1295–1310 | date = October 2023 | pmid = 37082791 | doi = 10.1177/02692155231170450 }}

Transcutaneous electrical nerve stimulation (TENS) is the delivery of pulsed electrical currents to the skin to stimulate peripheral nerves. TENS is widely used to treat pain and is considered to be a low-cost, safe, and self-administered treatment.{{cite journal | vauthors = Johnson MI, Claydon LS, Herbison GP, Jones G, Paley CA | title = Transcutaneous electrical nerve stimulation (TENS) for fibromyalgia in adults | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | issue = 10 | pages = CD012172 | date = October 2017 | pmid = 28990665 | pmc = 6485914 | doi = 10.1002/14651858.CD012172.pub2 | collaboration = Cochrane Pain, Palliative and Supportive Care Group }} As such, it is commonly recommended by clinicians to people suffering from pain.{{cite journal | vauthors = Gibson W, Wand BM, Meads C, Catley MJ, O'Connell NE | title = Transcutaneous electrical nerve stimulation (TENS) for chronic pain - an overview of Cochrane Reviews | journal = The Cochrane Database of Systematic Reviews | volume = 4 | issue = 4 | pages = CD011890 | date = April 2019 | pmid = 30941745 | pmc = 6446021 | doi = 10.1002/14651858.CD011890.pub3 }} On 2019, an overview of eight Cochrane reviews was conducted, covering 51 TENS-related randomized controlled trials. The review concluded that the quality of the available evidence was insufficient to make any recommendations. A later review concluded that transcutaneous electrical nerve stimulation may diminish pain in the short term, but there was uncertainty about the relevance of the results.

Preliminary findings suggest that electrically stimulating the vagus nerve through an implanted device can potentially reduce fibromyalgia symptoms.{{cite journal | vauthors = Lange G, Janal MN, Maniker A, Fitzgibbons J, Fobler M, Cook D, Natelson BH | title = Safety and efficacy of vagus nerve stimulation in fibromyalgia: a phase I/II proof of concept trial | journal = Pain Medicine | volume = 12 | issue = 9 | pages = 1406–1413 | date = September 2011 | pmid = 21812908 | pmc = 3173600 | doi = 10.1111/j.1526-4637.2011.01203.x }} However, there may be adverse reactions to the procedure.

Noninvasive brain stimulation includes methods such as transcranial direct current stimulation and high-frequency repetitive transcranial magnetic stimulation (TMS). Both methods have been found to improve pain scores in neuropathic pain and fibromyalgia.{{cite journal | vauthors = Gao C, Zhu Q, Gao Z, Zhao J, Jia M, Li T | title = Can noninvasive Brain Stimulation Improve Pain and Depressive Symptoms in Patients With Neuropathic Pain? A Systematic Review and Meta-Analysis | journal = Journal of Pain and Symptom Management | volume = 64 | issue = 4 | pages = e203–e215 | date = October 2022 | pmid = 35550165 | doi = 10.1016/j.jpainsymman.2022.05.002 }}

A 2023 meta-analysis of 16 RCTs found that transcranial direct current stimulation (tDCS) of over 4 weeks can decrease pain in patients with fibromyalgia.{{cite journal | vauthors = Teixeira PE, Pacheco-Barrios K, Branco LC, de Melo PS, Marduy A, Caumo W, Papatheodorou S, Keysor J, Fregni F | title = The Analgesic Effect of Transcranial Direct Current Stimulation in Fibromyalgia: A Systematic Review, Meta-Analysis, and Meta-Regression of Potential Influencers of Clinical Effect | journal = Neuromodulation | pages = 715–727 | date = November 2022 | volume = 26 | issue = 4 | pmid = 36435660 | doi = 10.1016/j.neurom.2022.10.044 | pmc = 10203058 }}

A 2021 meta-analysis of multiple intervention types concluded that magnetic field therapy and transcranial magnetic stimulation may diminish pain in the short-term, but conveyed an uncertainty about the relevance of the result. Several 2022 meta-analyses focusing on transcranial magnetic stimulation found positive effects on fibromyalgia.{{cite journal | vauthors = Fernandes AM, Graven-Nielsen T, de Andrade DC | title = New updates on transcranial magnetic stimulation in chronic pain | journal = Current Opinion in Supportive and Palliative Care | volume = 16 | issue = 2 | pages = 65–70 | date = June 2022 | pmid = 35639571 | doi = 10.1097/SPC.0000000000000591 | url = https://vbn.aau.dk/da/publications/ff6d7a58-1cad-42a8-b36e-1a46384a7382 }} Repetitive transcranial magnetic stimulation improved pain in the short-term{{cite journal | vauthors = Sun P, Fang L, Zhang J, Liu Y, Wang G, Qi R | title = Repetitive Transcranial Magnetic Stimulation for Patients with Fibromyalgia: A Systematic Review with Meta-Analysis | journal = Pain Medicine | volume = 23 | issue = 3 | pages = 499–514 | date = March 2022 | pmid = 34542624 | doi = 10.1093/pm/pnab276 }} and quality of life after 5–12 weeks. Repetitive transcranial magnetic stimulation did not improve anxiety, depression, and fatigue. Transcranial magnetic stimulation to the left dorsolateral prefrontal cortex was also ineffective.{{cite journal | vauthors = Choo YJ, Kwak SG, Chang MC | title = Effectiveness of Repetitive Transcranial Magnetic Stimulation on Managing Fibromyalgia: A Systematic Meta-Analysis | journal = Pain Medicine | volume = 23 | issue = 7 | pages = 1272–1282 | date = July 2022 | pmid = 34983056 | doi = 10.1093/pm/pnab354 }}

A systematic review of EEG neurofeedback for the treatment of fibromyalgia found most treatments showed significant improvements of the main symptoms of the disease.{{cite journal | vauthors= Torres CB, Barona E, Manso J | title=A systematic review of EEG neurofeedback in fibromyalgia to treat psychological variables, chronic pain and general health | journal=European Archives of Psychiatry and Clinical Neuroscience | year=2023 | volume=274 | issue=4 | pages=981–999 | doi = 10.1007/s00406-023-01612-y | pmid=37179502| doi-access=free | pmc=11127810 }} However, the protocols were so different, and the lack of controls or randomization impede drawing conclusive results.

Hyperbaric oxygen therapy (HBOT) has shown beneficial effects in treating chronic pain by reducing inflammation and oxidative stress. However, treating fibromyalgia with hyperbaric oxygen therapy is still controversial, in light of the scarcity of large-scale clinical trials. In addition, hyperbaric oxygen therapy raises safety concerns due to the oxidative damage that may follow it.{{cite journal | vauthors = El-Shewy KM, Kunbaz A, Gad MM, Al-Husseini MJ, Saad AM, Sammour YM, Abdel-Daim MM | title = Hyperbaric oxygen and aerobic exercise in the long-term treatment of fibromyalgia: A narrative review | journal = Biomedicine & Pharmacotherapy | volume = 109 | pages = 629–638 | date = January 2019 | pmid = 30399600 | doi = 10.1016/j.biopha.2018.10.157 | doi-access = free }}

An evaluation of nine trials with 288 patients in total found that HBOT was more effective at relieving fibromyalgia patients' pain than the control intervention. In most of the trials, HBOT improved sleep disturbance, multidimensional function, patient satisfaction, and tender spots. Negative outcomes (predominantly mild barotrauma (air pressure effect on ear or lung) that could be resolved spontaneously) were experienced by 24% of the patients, but they were not prevented from completing the treatment regimen, and no serious side effects, complications or deaths were reported.{{cite journal | vauthors = Chen X, You J, Ma H, Zhou M, Huang C | title = Efficacy and safety of hyperbaric oxygen therapy for fibromyalgia: a systematic review and meta-analysis | journal = BMJ Open | volume = 13 | issue = 1 | pages = e062322 | date = January 2023 | pmid = 36690401 | pmc = 9872467 | doi = 10.1136/bmjopen-2022-062322 }}

People with fibromyalgia generally have higher healthcare costs and utilization rates. A review of 36 studies found that fibromyalgia causes a significant economic burden on healthcare systems.{{cite journal |vauthors=D'Onghia M, Ciaffi J, Ruscitti P, Cipriani P, Giacomelli R, Ablin JN, Ursini F |title=The economic burden of fibromyalgia: A systematic literature review |journal=Seminars in Arthritis and Rheumatism |volume=56 |page=152060 |date=October 2022 |pmid=35849890 |doi=10.1016/j.semarthrit.2022.152060}} Annual costs per patient were estimated to be up to $35,920 in the US and $8,504 in Europe.

Well-known people with FM include

• Lady Gaga{{cite web | url=https://www.womansday.com/health-fitness/wellness/g3329/celebrities-with-fibromyalgia/ | title=We Bet You Never Knew These Celebrities Have Fibromyalgia | date=17 January 2018 }}
• Sinead O'Connor
• Mary McDonough{{cite web | url=https://edition.cnn.com/2017/08/01/health/gallery/famous-people-with-fibromyalgia/index.html | title=Fibromyalgia: Celebrities face fibromyalgia | date=August 2017 }}
• Janeane Garofalo
• Rosie Hamlin{{Cite web|url=https://edition.cnn.com/2017/08/01/health/gallery/famous-people-with-fibromyalgia/index.html|title=Fibromyalgia: Celebrities face fibromyalgia|date=1 August 2017|website=CNN}}
• Kirsty Young{{Cite web|url=https://www.bbc.co.uk/news/articles/cljydnx13g7o|title=Kirsty Young: Presenter reveals 'loneliness' of chronic pain|date=8 August 2024|website=BBC News}}{{Cite web|url=https://www.theguardian.com/media/article/2024/aug/08/kirsty-young-says-doctor-snorted-at-her-self-diagnosis-of-chronic-pain#:~:text=She+said+that+fibromyalgia+causes,to+you+today+about+it.%E2%80%9D|title=Kirsty Young says doctor 'snorted' at her self-diagnosis of chronic pain|first=Amelia|last=Hill|work=The Guardian |date=8 August 2024}}
• Lena Dunham{{Cite web|url=https://www.independent.co.uk/life-style/health-and-families/lena-dunham-fibromyalgia-chronic-pain-condition-lady-gaga-endometriosis-instagram-a8573266.html|title=Lena Dunham opens up about suffering from chronic pain|date=7 October 2018|website=The Independent}}{{Cite web|url=https://www.theguardian.com/lifeandstyle/shortcuts/2018/oct/08/trauma-fibromyalgia-kavanaugh-triggered-lena-dunham-flare-up|title=Trauma and fibromyalgia: could Kavanaugh have triggered Lena Dunham's flare-up?|first=Luisa|last=Dillner|work=The Guardian |date=8 October 2018}}
• Morgan Freeman{{cite web | url=https://www.esquire.com/entertainment/movies/interviews/a14768/morgan-freeman-interview-0812/ | title=The Morgan Freeman Story, by Tom Chiarella | date=10 July 2012 | access-date=12 March 2025 | archive-date=25 January 2020 | archive-url=https://web.archive.org/web/20200125033932/https://www.esquire.com/entertainment/movies/interviews/a14768/morgan-freeman-interview-0812/ | url-status=live }}{{cite web | url=https://ukfibromyalgia.com/blog/x3hc7rshzu384wpq3m6fdv7i0ego34 | title=Celebrities with Fibromyalgia: Morgan Freeman }}
• Michael James Hastings{{cite web | url=https://ukfibromyalgia.com/blog/celebrities-living-with-fibromyalgia | title=Celebrities Living with Fibromyalgia }}{{Cite web|url=https://livingwithfibromyalgia.org/michael-james-hastings-celebrities-with-fibromyalgia/|title=Michael James Hastings – Celebrities With Fibromyalgia - Livingwithfibromyalgia.org|date=11 March 2024}}

Chronic widespread pain had been described in the literature in the 19th century. Fibromyalgia was first recognized in the 1950s.

Many names, including muscular rheumatism, fibrositis, psychogenic rheumatism, and neurasthenia had been applied historically to symptoms resembling those of fibromyalgia.{{Cite web |last=Health Information Team |date=February 2004 |title=Fibromyalgia |url=http://hcd2.bupa.co.uk/fact_sheets/mosby_factsheets/fibromyalgia.html |archive-url=https://web.archive.org/web/20060622064234/http://hcd2.bupa.co.uk/fact_sheets/mosby_factsheets/fibromyalgia.html |archive-date=22 June 2006 |access-date=24 August 2006 |publisher=BUPA insurance}} The term fibromyalgia was first used in 1976, when Phillip Kahler Hench used it to describe widespread pain symptoms, and it was used by researcher Mohammed Yunus in a scientific publication in 1981.{{Cite journal |vauthors=Yunus M, Masi AT, Calabro JJ, Miller KA, Feigenbaum SL |date=August 1981 |title=Primary fibromyalgia (fibrositis): clinical study of 50 patients with matched normal controls |journal=Seminars in Arthritis and Rheumatism |volume=11 |issue=1 |pages=151–171 |doi=10.1016/0049-0172(81)90096-2 |pmid=6944796}}

A 1977 paper on fibrositis by Smythe and Moldofsky was important in the development of the fibromyalgia concept.{{Cite journal |vauthors=Smythe HA, Moldofsky H |year=1977 |title=Two contributions to understanding of the "fibrositis" syndrome |journal=Bulletin on the Rheumatic Diseases |volume=28 |issue=1 |pages=928–931 |pmid=199304}} The first clinical, controlled study of the characteristics of fibromyalgia syndrome was published in 1981,{{Cite journal |vauthors=Winfield JB |date=June 2007 |title=Fibromyalgia and related central sensitivity syndromes: twenty-five years of progress |journal=Seminars in Arthritis and Rheumatism |volume=36 |issue=6 |pages=335–338 |doi=10.1016/j.semarthrit.2006.12.001 |pmid=17303220}} providing support for symptom associations. In 1984, an interconnection between fibromyalgia syndrome and other similar conditions was proposed,{{Cite journal |vauthors=Inanici F, Yunus MB |date=October 2004 |title=History of fibromyalgia: past to present |journal=Current Pain and Headache Reports |volume=8 |issue=5 |pages=369–378 |doi=10.1007/s11916-996-0010-6 |pmid=15361321 }} and in 1986, trials of the first proposed medications for fibromyalgia were published.

A 1987 article in the Journal of the American Medical Association used the term 'fibromyalgia syndrome', while saying it was a "controversial condition".{{Cite journal |vauthors=Goldenberg DL |date=May 1987 |title=Fibromyalgia syndrome. An emerging but controversial condition |journal=JAMA |volume=257 |issue=20 |pages=2782–2787 |doi=10.1001/jama.257.20.2782 |pmid=3553636}} The American College of Rheumatology (ACR) published its first classification criteria for fibromyalgia in 1990.{{Cite journal |vauthors=Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P |date=February 1990 |title=The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee |journal=Arthritis and Rheumatism |volume=33 |issue=2 |pages=160–172 |doi=10.1002/art.1780330203 |pmid=2306288}} Later revisions were made in 2010, 2016, and 2019.

In the past fibromyalgia was a disputed diagnosis. Rheumatologist Frederick Wolfe, lead author of the 1990 paper that first defined the diagnostic guidelines for fibromyalgia, stated in 2008 that he believed it "clearly" not to be a disease but instead a physical response to depression and stress.{{cite news| vauthors = Berenson A |title=Drug Approved. Is Disease Real?|url=https://www.nytimes.com/2008/01/14/health/14pain.html|newspaper=The New York Times|access-date=26 March 2014|url-status=live|archive-url=https://web.archive.org/web/20150510060103/http://www.nytimes.com/2008/01/14/health/14pain.html|archive-date=10 May 2015|date=2008-01-14}} In 2013, Wolfe added that its causes "are controversial in a sense" and "there are many factors that produce these symptoms – some are psychological and some are physical and it does exist on a continuum".{{cite web |url=http://www.news-medical.net/news/20130322/Fibromyalgia-an-interview-with-Dr-Frederick-Wolfe-University-of-Kansas-School-of-Medicine.aspx |title=Fibromyalgia: An interview with Dr Frederick Wolfe, University of Kansas School of Medicine |access-date=2014-05-28 |url-status=live |archive-url=https://web.archive.org/web/20140529065741/http://www.news-medical.net/news/20130322/Fibromyalgia-an-interview-with-Dr-Frederick-Wolfe-University-of-Kansas-School-of-Medicine.aspx |archive-date=29 May 2014 |date=2013-03-22 }} Some members of the medical community did not consider fibromyalgia a disease because of a lack of abnormalities on physical examination and the absence of objective diagnostic tests.{{cite journal | vauthors = Wolfe F | title = Fibromyalgia wars | journal = The Journal of Rheumatology | volume = 36 | issue = 4 | pages = 671–678 | date = April 2009 | pmid = 19342721 | doi = 10.3899/jrheum.081180 | doi-access = free }}{{cite journal | vauthors = Goldenberg DL | title = Fibromyalgia: why such controversy? | journal = Annals of the Rheumatic Diseases | volume = 54 | issue = 1 | pages = 3–5 | date = January 1995 | pmid = 7880118 | pmc = 1005499 | doi = 10.1136/ard.54.1.3 }}

In the past, some psychiatrists viewed fibromyalgia as a type of affective disorder, or a somatic symptom disorder. These controversies did not engage healthcare specialists alone; some patients objected to fibromyalgia being described in purely somatic terms.{{cite journal | vauthors = Hadlandsmyth K, Dailey DL, Rakel BA, Zimmerman MB, Vance CG, Merriwether EN, Chimenti RL, Geasland KM, Crofford LJ, Sluka KA | title = Somatic symptom presentations in women with fibromyalgia are differentially associated with elevated depression and anxiety | journal = Journal of Health Psychology | volume = 25 | issue = 6 | pages = 819–829 | date = May 2020 | pmid = 29076404 | pmc = 6287969 | doi = 10.1177/1359105317736577 }}

As of 2022, neurologists and pain specialists tended to view fibromyalgia as a real pathology.{{Cite web|url=https://www.health.harvard.edu/diseases-and-conditions/is-fibromyalgia-real|title=Is fibromyalgia real?|date=1 August 2018|website=Harvard Health}} It is mostly seen as due to dysfunction of muscles and connective tissue as well as functional abnormalities in the central nervous system. Rheumatologists define the syndrome in the context of "central sensitization" – heightened brain response to normal stimuli in the absence of disorders of the muscles, joints, or connective tissues. Because of this symptomatic overlap, some researchers have proposed that fibromyalgia and other analogous syndromes be classified together as central sensitivity syndromes.{{cite journal | vauthors = Yunus MB | title = Fibromyalgia and overlapping disorders: the unifying concept of central sensitivity syndromes | journal = Seminars in Arthritis and Rheumatism | volume = 36 | issue = 6 | pages = 339–356 | date = June 2007 | pmid = 17350675 | doi = 10.1016/j.semarthrit.2006.12.009 }}

File:Tender points fibromyalgia.svg diagnostic criteria for fibromyalgia]]

The first widely accepted set of classification criteria for research purposes was elaborated in 1990 by the Multicenter Criteria Committee of the American College of Rheumatology. These criteria, which are known informally as "the ACR 1990", defined fibromyalgia according to the presence of the following criteria:

• A history of widespread pain lasting more than three months – affecting all four quadrants of the body, i.e., both sides and above and below the waist.
• Tender points – there are 18 designated possible tender points (although a person with the disorder may feel pain in other areas as well).

The ACR criteria for the classification of patients were originally established as inclusion criteria for research purposes and were not intended for clinical diagnosis but have later become the de facto diagnostic criteria in the clinical setting. A controversial study was done by a legal team looking to prove their client's disability based primarily on tender points and their widespread presence in non-litigious communities prompted the lead author of the ACR criteria to question now the useful validity of tender points in diagnosis.{{cite journal |last1=Wolfe |first1=Frederick |title=Stop using the American College of Rheumatology criteria in the clinic |journal=The Journal of Rheumatology |date=August 2003 |volume=30 |issue=8 |pages=1671–1672 |pmid=12913920 |url=http://www.jrheum.org/lookup/pmidlookup?view=long&pmid=12913920 }} Use of control points has been used to cast doubt on whether a person has fibromyalgia, and to claim the person is malingering.{{cite journal | vauthors = Häuser W, Eich W, Herrmann M, Nutzinger DO, Schiltenwolf M, Henningsen P | title = Fibromyalgia syndrome: classification, diagnosis, and treatment | journal = Deutsches Ärzteblatt International | volume = 106 | issue = 23 | pages = 383–391 | date = June 2009 | pmid = 19623319 | pmc = 2712241 | doi = 10.3238/arztebl.2009.0383 }}

In 2010, the American College of Rheumatology approved provisional revised diagnostic criteria for fibromyalgia that eliminated the 1990 criteria's reliance on tender point testing.{{cite journal | vauthors = Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB | title = The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity | journal = Arthritis Care & Research | volume = 62 | issue = 5 | pages = 600–610 | date = May 2010 | pmid = 20461783 | doi = 10.1002/acr.20140 | hdl-access = free | hdl = 2027.42/75772 }} The revised criteria used a widespread pain index (WPI) and symptom severity scale (SSS) in place of tender point testing under the 1990 criteria. The WPI counts up to 19 general body areas{{efn|Shoulder girdle (left & right), upper arm (left & right), lower arm (left & right), hip/buttock/trochanter (left & right), upper leg (left & right), lower leg (left & right), jaw (left & right), chest, abdomen, back (upper & lower), and neck.{{rp|607}}}} in which the person has experienced pain in the preceding week. The SSS rates the severity of the person's fatigue, unrefreshed waking, cognitive symptoms, and general somatic symptoms,{{efn|Somatic symptoms include, but are not limited to muscle pain, irritable bowel syndrome, fatigue or tiredness, problems thinking or remembering, muscle weakness, headache, pain or cramps in the abdomen, numbness or tingling, dizziness, insomnia, depression, constipation, pain in the upper abdomen, nausea, nervousness, chest pain, blurred vision, fever, diarrhea, dry mouth, itching, wheezing, Raynaud's phenomenon, hives or welts, ringing in the ears, vomiting, heartburn, oral ulcers, loss of or changes in taste, seizures, dry eyes, shortness of breath, loss of appetite, rash, sun sensitivity, hearing difficulties, easy bruising, hair loss, frequent or painful urination, and bladder spasms.{{rp|607}}}} each on a scale from 0 to 3, for a composite score ranging from 0 to 12. The revised criteria for diagnosis were:

• WPI ≥ 7 and SSS ≥ 5 OR WPI 3–6 and SSS ≥ 9,
• Symptoms have been present at a similar level for at least three months, and
• No other diagnosable disorder otherwise explains the pain.{{rp|607}}

{{notelist}}

{{Reflist}}

{{Commons}}

• [https://www.cdc.gov/arthritis/basics/fibromyalgia.htm Arthritis – Types – Fibromyalgia] by the CDC
• [https://www.niams.nih.gov/health-topics/fibromyalgia Fibromyalgia] by the National Institute of Arthritis and Musculoskeletal and Skin Diseases
• [https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Fibromyalgia Fibromyalgia] by the American College of Rheumatology
• [https://www.nhs.uk/conditions/fibromyalgia/ Fibromyalgia] by the NHS

{{Medical condition classification and resources

| DiseasesDB =

| ICD10 = {{ICD10|M79.7}}

| ICD9 = {{ICD9|729.1}}

| ICDO =

| OMIM =

| MedlinePlus = 000427

| eMedicineSubj = med

| eMedicineTopic = 790

| eMedicine_mult = {{eMedicine2|med|2934}} {{eMedicine2|ped|777}} {{eMedicine2|pmr|47}}

| MeshID = D005356

|ICD11={{ICD11|MG30.01}}}}

{{Myopathy}}

{{Neuropathy}}

{{Authority control}}

Category:Ailments of unknown cause

Category:Chronic pain syndromes

Category:Rheumatology

Category:Wikipedia medicine articles ready to translate

Category:Wikipedia neurology articles ready to translate

Category:1981 neologisms