View source for Fibromyalgia

{{Short description|Chronic pain of unknown cause}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
<!--CFS/ME is often misremembered in conflation with FM because both involve themes of "chronic fatigue + hard to DDx + nosologic contentiousness", and MF is sometimes misremembered in conflation with FM because of the -my- and -fibr- syllables of the names plus symptom overlap (e.g., pain, fatigue).-->
{{Use dmy dates|date=April 2021}}
{{Infobox medical condition
| name = Fibromyalgia
| image = Widespread Pain Index Areas.svg
| caption = Possible pain areas in the most used [[Fibromyalgia#Diagnosis|fibromyalgia diagnosis criteria (ACR 2016)]]
| field = [[rheumatology]], [[neurology]]<ref>{{Cite magazine |url=https://www.brainandlife.org/articles/is-fibromyalgia-real |title=Is Fibromyalgia a Real Thing? Or Should You Be Skeptical? |first=Gina |last=Shaw |magazine=Brain&Life<!--Formerly Neurology Now--> |publisher=[[American Academy of Neurology]] |date=October 2009 |access-date=22 August 2025}}</ref>
| pronounce = {{IPAc-en|ˌ|f|aɪ|b|r|oʊ|m|aɪ|ˈ|æ|l|dʒ|ə}}<ref>{{Cite web |title=fibromyalgia |url=http://www.collinsdictionary.com/dictionary/american/fibromyalgia |url-status=live |archive-url=https://web.archive.org/web/20151004020527/http://www.collinsdictionary.com/dictionary/american/fibromyalgia |archive-date=4 October 2015 |access-date=16 March 2016 |website=Collins Dictionaries}}</ref>
| synonyms = Fibromyalgia syndrome
| symptoms = Widespread pain, fatigue, sleep problems<ref name="pmid21303476"/><ref name=JAMA2014/>
| complications = 
| onset = Early–middle age<ref name=NIH2014Tx/>
| duration = Long term<ref name="pmid21303476"/>
| causes = Uncertain<ref name=JAMA2014/><ref name=NIH2014Tx/>
| risks = 
| diagnosis = Based on symptoms after ruling out other potential causes<ref name=JAMA2014/><ref name=NIH2014Tx/>
| differential = [[Anemia]], [[Autoimmune disease|autoimmune disorders]] (such as [[ankylosing spondylitis]], [[polymyalgia rheumatica]], [[rheumatoid arthritis]], [[scleroderma]], or [[multiple sclerosis]]), [[Lyme disease]], [[osteoarthritis]], [[thyroid disease]]<ref>"Fibromyalgia" in: {{cite book |doi=10.1016/B978-0-323-07699-9.50010-4 |chapter=F |title=Ferri's Differential Diagnosis |date=2011 |pages=177–191 |isbn=978-0-323-07699-9 | vauthors = Ferri FF }}</ref><ref>{{Cite journal |vauthors=Schneider MJ, Brady DM, Perle SM |date=2006 |title=Commentary: differential diagnosis of fibromyalgia syndrome: proposal of a model and algorithm for patients presenting with the primary symptom of chronic widespread pain |journal=Journal of Manipulative and Physiological Therapeutics |volume=29 |issue=6 |pages=493–501 |doi=10.1016/j.jmpt.2006.06.010 |pmid=16904498}}</ref>
| prevention = 
| treatment = Sufficient sleep and exercise, medication<ref name=NIH2014Tx/>
| medication = [[Cyclobenzaprine]], [[duloxetine]], [[milnacipran]], [[pregabalin]]<ref name=":9" />
| prognosis = Normal life expectancy<ref name=NIH2014Tx/>
| frequency = 2%<ref name=JAMA2014/>
| deaths = 
}}
<!-- Definition and symptoms -->

'''Fibromyalgia''' ('''FM''') is a long-term adverse health condition<ref name="auto16">{{Cite web|url=https://www.nhs.uk/conditions/fibromyalgia/|title=Fibromyalgia|date=20 October 2017|website=nhs.uk}}</ref> characterised by widespread [[chronic pain]]. Current [[Fibromyalgia#Diagnosis|diagnosis]] also requires an above-threshold severity score from among six other symptoms: [[fatigue]], trouble thinking or remembering, [[non-restorative sleep|waking up tired (unrefreshed)]], pain or cramps in the lower abdomen, depression, or headache. Other symptoms may also be experienced.<!--Cause, mechanism, and diagnosis --> The causes of fibromyalgia are unknown, with several pathophysiologies proposed.<ref>{{Cite web|url=https://www.gesundheitsinformation.de/was-weiss-man-ueber-die-entstehung-von-fibromyalgie.html|title=Was weiß man über die Entstehung von Fibromyalgie?|website=gesundheitsinformation.de}}</ref>

<!--Epidemiology, and history -->Fibromyalgia is estimated to affect 2 to 4% of the population.<ref name="Fitz2021">{{Cite journal |vauthors=Fitzcharles MA, Cohen SP, Clauw DJ, Littlejohn G, Usui C, Häuser W |date=May 2021 |title=Nociplastic pain: towards an understanding of prevalent pain conditions |journal=Lancet |volume=397 |issue=10289 |pages=2098–2110 |doi=10.1016/s0140-6736(21)00392-5 |pmid=34062144 }}</ref> Women are affected at a higher rate than men.<ref name="JAMA2014" /><ref name="Fitz2021" /> Rates appear similar across areas of the world and among varied cultures.<ref name="JAMA2014" /> Fibromyalgia was first recognised in the 1950s,<ref name="auto14"/> and defined in 1990, with updated criteria in 2011,<ref name="JAMA2014">{{Cite journal |vauthors=Clauw DJ |date=April 2014 |title=Fibromyalgia: a clinical review |journal=JAMA |volume=311 |issue=15 |pages=1547–1555 |doi=10.1001/jama.2014.3266 |pmid=24737367 }}</ref> 2016,<ref name="Wolfe2016">{{Cite journal |vauthors=Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Häuser W, Katz RL, Mease PJ, Russell AS, Russell IJ, Walitt B |date=December 2016 |title=2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria |journal=Seminars in Arthritis and Rheumatism |volume=46 |issue=3 |pages=319–329 |doi=10.1016/j.semarthrit.2016.08.012 |pmid=27916278}}</ref> and 2019.<ref name="Arnold-2019" />

<!-- Prevention, treatment, and prognosis -->
The treatment of fibromyalgia is [[Symptomatic treatment|symptomatic]]<ref name="Prab2019" /> and [[multidisciplinary]].<ref name="Macfarlane-2017" /> [[Aerobic exercise|Aerobic]] and [[Strength training|strengthening exercise]] is recommended.<ref name="Macfarlane-2017" /> [[Duloxetine]], [[milnacipran]], and [[pregabalin]] can give short-term pain relief to some people with FM.<ref name=":9" /> Symptoms of fibromyalgia persist long-term in most patients.<ref name="Hauser2018" /><!-- Society and culture -->

Fibromyalgia is associated with a significant economic and social burden, and it can cause substantial functional impairment among people with the condition.<ref name=":11" /> People with fibromyalgia can be subjected to significant [[Social stigma|stigma]] and doubt about the legitimacy of their symptoms, including in the [[healthcare system]].<ref name="auto14">{{Cite web|url=https://gesund.bund.de/en/fibromyalgia#definition|title=Fibromyalgia: causes and treatment|date=21 October 2022|website=gesund.bund.de}}</ref><ref name=":12" /> FM is associated with relatively high suicide rates.<ref name="The Prevalence of Suicidal Behaviou">{{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 |article-number=110078 |doi=10.1016/j.pnpbp.2020.110078 |pmid=32853715 }}</ref>

==Terminology==
The term "fibromyalgia" was derived from [[Neo-Latin]] {{lang|la|fibro-}}, meaning 'fibrous tissues';<ref>{{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}}</ref> [[Ancient Greek|Greek]] {{lang|grc|μυο-}} ({{translit|grc|myo-}}, 'muscle');<ref>{{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}}</ref> and Greek {{lang|grc|άλγος}} ({{translit|grc|algos}}, 'pain');<ref>{{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}}</ref> thus, the term literally means '[[muscle]] and [[fibrous connective tissue]] pain'.<ref>{{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}}</ref> Thus, this term is inaccurate and misleading, as it only reflects a part of the symptom set.<ref>{{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 }}</ref>

The term FM is increasingly used.<ref name="auto7">{{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}}</ref><ref name="Hauser2018"/><ref>{{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|article-number=12106|doi=10.3390/ijerph191912106|doi-access=free |pmid=36231406 |pmc=9566124 }}</ref>

==Classification==
===ICD-11===
Fibromyalgia is not listed as a code in the [[ICD-11]]. 

"Fibromyalgia syndrome" is listed as an inclusion<ref>Inclusions in ICD-11 are terms or conditions which are judged important or commonly used in relation to a code.{{Cite web |url=https://icd.who.int/icdapi/docs/ContentModelGuide.pdf |title=WHO-FIC Content Model Reference Guide |publisher=[[World Health Organization|WHO]] |year=2021 |access-date=22 August 2025}}{{Creative Commons text attribution notice|cc=by3}}</ref> in the ICD-11 code of "Chronic widespread pain" (CWP) (code MG30.01).<ref>{{Cite web |url=https://cdn.who.int/media/docs/default-source/classification/cat-webinars/unlocking-the-potential-of-icd-11-for-chronic-pain/introduction-to-the-icd-11-chronic-pain-classification.pdf |title=Introduction to the ICD-11 chronic pain classification |first=Beatrice |last=Korwisi |publisher=[[International Association for the Study of Pain|IASP]] |access-date=22 August 2025}}</ref> (No other [[signs and symptoms|signs or symptoms]] of fibromyalgia are mentioned.)<ref>{{cite web | url=https://icd.who.int/browse/2025-01/mms/en#849253504 | title=MG30.01 Chronic widespread pain | website=ICD-11 for Mortality and Morbidity Statistics | access-date=22 August 2025}}</ref><ref>(In [[ICD-10]], FM had been given its own code under soft tissue disorders.{{cite web | title=M79.7 - Fibromyalgia | website=ICD-10 Version:2019 | url=https://icd.who.int/browse10/2019/en#/M79.7 | access-date=22 August 2025}}</ref>

===Other classifications===
Research seeing FM as a subset of chronic widespread pain has estimated the population prevalence of chronic widespread pain as 11% and of fibromyalgia as 2–6%.<ref>{{cite journal |last1=Rahman |first1=Anisur |title=Chronic widespread pain and the fibromyalgia syndrome |journal=Medicine |date=March 2022 |volume=50 |issue=3 |pages=184–188 |doi=10.1016/j.mpmed.2021.12.009 }}</ref><ref>{{cite journal |last1=Häuser |first1=Winfried |last2=Perrot |first2=Serge |last3=Sommer |first3=Claudia |last4=Shir |first4=Yoram |last5=Fitzcharles |first5=Mary-Ann |title=Diagnostic confounders of chronic widespread pain: not always fibromyalgia |journal=Pain Reports |date=May 2017 |volume=2 |issue=3 |article-number=e598 |doi=10.1097/PR9.0000000000000598 |pmid=29392213 |pmc=5741304 }}</ref>

FM has been seen as a [[functional somatic syndrome]] condition,<ref>{{cite journal |last1=Roenneberg |first1=Casper |last2=Sattel |first2=Heribert |last3=Schaefert |first3=Rainer |last4=Henningsen |first4=Peter |last5=Hausteiner-Wiehle |first5=Constanze |title=Functional Somatic Symptoms |journal=Deutsches Ärzteblatt International |date=19 August 2019 |volume=116 |issue=33–34 |pages=553–560 |doi=10.3238/arztebl.2019.0553 |pmid=31554544 |pmc=6794707 }}</ref> although this term does not appear in the [[ICD-11]].

===Subgroups or clusters within FM ===
There may be clusters of symptom characteristics within fibromyalgia.<ref name=":10">{{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 }}</ref> A 2024 [[systematic review]] found that fibromyalgia could be clustered according to symptom severity, adjustment to the condition, thermal pain sensitivity, personality, and response to treatment. However it stated there was a need for more objective measures, and for more validation and replication of clusters.<ref name=":10" /> Clustering has also been undertaken based on psychological and coping characteristics of FM people.<ref>https://pmc.ncbi.nlm.nih.gov/articles/PMC10604090/</ref><ref>https://pubmed.ncbi.nlm.nih.gov/40863271/</ref>

==Signs and symptoms==
Fibromyalgia has no medical [[signs and symptoms|sign]]. The characteristic symptom of fibromyalgia is chronic widespread [[pain]]. The current prevalent [[Fibromyalgia#Diagnosis|diagnosis]] method also requires an above threshold severity score from among six other symptoms; [[fatigue]], trouble thinking or remembering, [[non-restorative sleep|waking up tired (unrefreshed)]], pain or cramps in lower abdomen, depression and headache. Many other symptoms can be present. The key symptoms of fibromyalgia often present concurrently, in varying severity, and are intertwined with and influence each other.<ref name="auto22">{{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|page=221|doi=10.1186/ar4395|doi-access=free |pmid=24289848|pmc=3978642}}</ref>

=== Chronic pain ===
[[Chronic pain]] continues to be regarded as the core characteristic of fibromyalgia.<ref name="Arnold-2019" /> According to the [[National Health Service|NHS]], widespread pain is a major symptom, which could feel like an ache, a burning sensation, or a sharp, stabbing pain. Patients are also susceptible to pain, and the slightest touch can cause pain. Pain also tends to linger for a longer period when a patient experiences it.<ref name="auto8">{{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}}</ref> 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.<ref name="auto4">{{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}}</ref>

Pain in fibromyalgia may include contributions from central pain, peripheral musculoskeletal pain generators, neuropathic pain, and other pathways.<ref name="auto22"/>

Men may be affected by FM pain differently to women.<ref name="auto" /><ref name="auto20">{{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}}</ref><ref name="auto5">{{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}}</ref>

=== Fatigue ===
[[Fatigue]] is a common symptom of fibromyalgia.<ref name="Arnold-2019" /> Patients may experience physical or mental fatigue. Physical fatigue can present as a feeling of exhaustion after [[exercise]] or limitation in daily activities.<ref name="Arnold-2019" /> 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.<ref name="auto8"/> The impact of fatigue can be severe and pose more of a problem than the pain.<ref>{{Cite web|url=https://www.arthritis.org/diseases/fibromyalgia|title=Fibromyalgia &#124; Arthritis Foundation|website=www.arthritis.org|date=7 September 2023 |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}}</ref> Fatigue is a complicated, multifactorial, and vexing symptom that is highly prevalent (76%) and stubbornly persistent, as evidenced by longitudinal studies over 5 years.<ref>{{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 }}</ref> Fatigue does not improve with sleep or rest.<ref>{{Cite web|url=https://www.versusarthritis.org/about-arthritis/conditions/fibromyalgia|title=Fibromyalgia|website=Versus Arthritis}}</ref> Medication seems to have little impact on FM fatigue.<ref>{{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 |article-number=e003056 |doi=10.1136/rmdopen-2023-003056 |pmid=37541741 |pmc=10407379 }}</ref>

=== Sleep problems ===
Sleep problems are a common symptom of fibromyalgia.<ref name="Arnold-2019" /> [[Non-restorative sleep|Waking up feeling unrefreshed]] is used in fibromyalgia diagnosis.<ref name=Wolfe2010 />{{rp|607}} People with FM may also experience [[Insomnia|difficulty falling or staying asleep]].<ref name="Arnold-2019" /><ref>{{cite journal |last1=Climent-Sanz |first1=Carolina |last2=Gea-Sánchez |first2=Montserrat |last3=Fernández-Lago |first3=Helena |last4=Mateos-García |first4=José Tomás |last5=Rubí-Carnacea |first5=Francesc |last6=Briones-Vozmediano |first6=Erica |title=Sleeping is a nightmare: A qualitative study on the experience and management of poor sleep quality in women with fibromyalgia |journal=Journal of Advanced Nursing |date=November 2021 |volume=77 |issue=11 |pages=4549–4562 |doi=10.1111/jan.14977 |pmid=34268797 |hdl=10459.1/71787 |hdl-access=free }}</ref>

A [[meta-analysis]] compared [[Quantitative property|quantitative]] and [[Qualitative property|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.<ref name="Wu-2017">{{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}}</ref>

Improving sleep quality can help people with fibromyalgia manage pain.<ref>{{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}}</ref><ref name="bradley">{{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}}</ref>

=== Cognitive problems (fibro fog) ===
Many people with fibromyalgia experience [[Cognitive deficit|cognitive problems]] often known as fibro fog.<ref>{{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}}</ref><ref name="auto4"/> The [[CDC]] and the [[American Pain Society]] recognize these problems as a major feature of fibromyalgia.<ref name="CDC Fibromyalgia">{{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}}</ref><ref name="Arnold-2019" />

About 75% of people with fibromyalgia report significant problems with concentration, memory, and multitasking.<ref name="Bell2018">{{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}}</ref><ref name="CDC Fibromyalgia"/><ref>{{Cite web|url=https://www.arthritis.org/diseases/more-about/fibro-fog|title=Fibro Fog|website=www.arthritis.org|date=18 December 2019 }}</ref> A 2018 meta-analysis found that the largest differences between people with fibromyalgia and healthy subjects were in [[inhibitory control]], memory, and [[Mental chronometry|processing speed]].<ref name=Bell2018/> A 2023 scoping review grouped effects into subjective cognitive dysfunction, perceived variability, changes in functional activities and participation limitations.<ref>{{cite journal |last1=Dass |first1=Ronessa |last2=Kalia |first2=Mohini |last3=Harris |first3=Jocelyn |last4=Packham |first4=Tara |title=Understanding the Experience and Impacts of Brain Fog in Chronic Pain: A Scoping Review |journal=Canadian Journal of Pain |date=31 December 2023 |volume=7 |issue=1 |article-number=2217865 |doi=10.1080/24740527.2023.2217865 |pmid=37441085 |pmc=10334862}}</ref>

A 2017 review found that the neuropsychological mechanisms underlying brain fog may be similar to those in isolated functional cognitive disorders.<ref>{{cite journal |last1=Teodoro |first1=Tiago |last2=Edwards |first2=Mark J |last3=Isaacs |first3=Jeremy |title=25 A systematic review of 'brain fogs': are these functional cognitive disorders? |journal=Journal of Neurology, Neurosurgery & Psychiatry |date=August 2017 |volume=88 |issue=8 |pages=A23.1–A23 |doi=10.1136/jnnp-2017-BNPA.49 }}</ref> One hypothesis is that chronic pain in fibromyalgia compromises attention systems, resulting in cognitive problems.<ref name=Bell2018/>

=== Other signs and symptoms ===
People with fibromyalgia may experience [[hyperalgesia]] (abnormally increased sensitivity to [[pain]])<ref name="auto17">{{Cite web|url=https://www.nhs.uk/conditions/fibromyalgia/symptoms/|title=Fibromyalgia - Symptoms|date=20 October 2017|website=nhs.uk}}</ref><ref name="CDC Fibromyalgia"/> and [[allodynia]] (pain from a stimulus that does not normally elicit pain).<ref name="auto17"/><ref>{{Cite web|url=https://my.clevelandclinic.org/health/symptoms/21570-allodynia#possible-causes|title=Allodynia: Why Does Everything Hurt?|website=Cleveland Clinic}}</ref> People with FM may be intolerant to bright lights, loud noises,<ref>{{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}}</ref> perfumes, and [[Cold sensitivity|cold]].<ref name="Arnold-2019" /><ref>{{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}}</ref><ref name="Hauser2019" /><ref>{{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 }}</ref><ref>{{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}}</ref>
Other symptoms may be [[musculoskeletal]] stiffness,<ref name="Arnold-2019" /> [[environmental sensitivity]],<ref name="Arnold-2019" /> [[hypervigilance]],<ref name="Arnold-2019" /> [[sexual dysfunction]],<ref>{{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 }}</ref> and visual symptoms.<ref>{{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 }}</ref> Nocturnal [[myoclonus]] can be present in people with fibromyalgia.<ref>{{cite book |last1=Kaltsas |first1=Gregory |last2=Tsiveriotis |first2=Konstantinos |title=Endotext |date=2000 |publisher=MDText.com, Inc. |chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK279092/ |chapter=Fibromyalgia |pmid=25905317 }}</ref> A 2021 review found that fibromyalgia caused ocular discomfort (foreign body sensation and irritation) and visual disturbances (blurred vision).<ref>{{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 }}</ref>

== Comorbidity ==
Fibromyalgia as a stand-alone diagnosis is uncommon, as most fibromyalgia patients often have other chronic overlapping pain problems, [[mental disorder]]s<ref name=Hauser2019/> or physical conditions.<ref>{{cite journal | title=The Relation of Physical Comorbidity and Multimorbidity to Fibromyalgia, Widespread Pain, and Fibromyalgia-related Variables | journal=The Journal of Rheumatology | date=2020 | volume=47 | issue=4 | pages=624–631 | doi=10.3899/jrheum.190149 | pmid=31371651 | vauthors = Wolfe F, Ablin J, Guymer EK, Littlejohn GO, Rasker JJ }}</ref>

Comorbidities can give higher levels of pain and other symptoms.<ref>{{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}}</ref>

Fibromyalgia is associated with [[mental health]] issues including [[Anxiety]],<ref name="Kleykamp-2021">{{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 }}</ref> [[Posttraumatic stress disorder|Post-traumatic stress disorder]]<ref name="JAMA2014" /><ref name="Kleykamp-2021" /> – Approximately one third of patients presenting with an FM diagnosis also meet criteria for [[posttraumatic stress disorder]] (PTSD),<ref name="Kleykamp-2021" /> [[Bipolar disorder]],<ref name="Kleykamp-2021" /> [[Alexithymia]],<ref>{{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 }}</ref> and [[depression (mood)|Depression]]<ref name="Kleykamp-2021" /><ref name="Fitz2018">{{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 }}</ref><ref>{{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 | article-number = e24909 | date = May 2022 | pmid = 35698706 | pmc = 9187156 | doi = 10.7759/cureus.24909 | doi-access = free }}</ref> – Patients with fibromyalgia are five times more likely to have major depression than the general population.<ref>{{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 }}</ref>

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.<ref>{{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}}</ref> Separation of symptoms due to depression or FM can be difficult.<ref>{{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|article-number=21501319241281221|doi=10.1177/21501319241281221|pmid=39279389|pmc=11409298}}</ref>

Numerous [[chronic pain]] conditions are often comorbid with fibromyalgia.<ref name="Fitz2018" /> These include Chronic [[tension headache]]s,<ref name="Kleykamp-2021" /> [[Myofascial pain syndrome]],<ref name="Kleykamp-2021" /> and [[Temporomandibular joint dysfunction|Temporomandibular disorders]].<ref name="Kleykamp-2021" />

[[Neurological disorder]]s that have been linked to pain or fibromyalgia include, [[Multiple sclerosis]], [[Post-polio syndrome]], [[Neuropathic pain]], [[Parkinson's disease]].<ref name="Fitz2018" />

Fibromyalgia largely overlaps with several syndromes that may share the same pathogenetic mechanisms.<ref name="Ramírez-Morales-2022" /><ref name=":3">{{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 | article-number = 152455 | date = August 2024 | pmid = 38761526 | doi = 10.1016/j.semarthrit.2024.152455 }}</ref> These include [[myalgic encephalomyelitis/chronic fatigue syndrome]]<ref name="Anderson_2020">{{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 =  | article-number = 109976 | date = December 2020 | pmid = 32470498 | doi = 10.1016/j.pnpbp.2020.109976 }}</ref><ref name="Ramírez-Morales-2022">{{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 | article-number = 103129 | date = August 2022 | pmid = 35690247 | doi = 10.1016/j.autrev.2022.103129 | doi-access = free }}</ref> and [[irritable bowel syndrome]].<ref name=":3" />

[[Comorbidity|Comorbid]] fibromyalgia has been reported to occur in 20–30% of individuals with [[Rheumatism|rheumatic diseases]],<ref name="Fitz2018" /><ref>{{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 | article-number = 19 | date = 20 May 2019 | pmid = 31143851 | pmc = 6532149 | doi = 10.1186/s41927-019-0066-7 | doi-access = free }}</ref> including [[rheumatoid arthritis]] (RA).<ref>{{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}}</ref> It has been reported in people with noninflammatory [[Musculoskeletal disorder|musculoskeletal diseases]].<ref name="Fitz2018" />

The prevalence of fibromyalgia in [[gastrointestinal disease]] has been described mostly for [[Coeliac disease|celiac disease]]<ref name="Fitz2018" /> and [[irritable bowel syndrome]] (IBS).<ref name="Fitz2018" /><ref name="Kleykamp-2021" /> IBS and fibromyalgia share similar pathogenic mechanisms, involving immune system [[mast cell]]s, inflammatory biomarkers, [[hormone]]s, and [[neurotransmitter]]s such as [[serotonin]]. [[Dysbiosis|Changes in the gut biome]] alter serotonin levels, leading to [[autonomic nervous system]] hyperstimulation.<ref>{{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 | article-number = e29923 | date = October 2022 | pmid = 36381861 | pmc = 9635936 | doi = 10.7759/cureus.29923 | doi-access = free }}</ref>

Other conditions that are associated with fibromyalgia include [[obesity]],<ref>{{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}}</ref> [[Connective tissue disease|connective tissue disorders]],<ref>{{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 | article-number = 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 }}</ref> cardiovascular autonomic abnormalities,<ref>{{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 }}</ref> [[obstructive sleep apnea]]-hypopnea syndrome,<ref>{{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 | article-number = 1394865 | date = 2024 | pmid = 38831795 | pmc = 11144865 | doi = 10.3389/fphys.2024.1394865 | doi-access = free }}</ref> [[Restless legs syndrome|restless leg syndrome]]<ref>{{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 }}</ref> and an [[overactive bladder]].<ref>{{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 }}</ref>

==Causal and risk factors==
The cause of fibromyalgia is unknown.<ref>{{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 }}</ref><ref name="auto9">{{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 }}</ref> However, several risk factors, genetic and environmental, have been identified.<ref>https://pmc.ncbi.nlm.nih.gov/articles/PMC11818761</ref>

Fibromyalgia may have a variety of [[etiologies|causal factors]],<ref>https://doi.org/10.1016/j.neubiorev.2023.105235</ref> including disease, trauma, psychological and social emotional factors. Thus more than one pathophysiological state may cause fibromyalgia.<ref>https://www.nature.com/articles/s41598-024-60993-9</ref><ref>https://pmc.ncbi.nlm.nih.gov/articles/PMC11818761</ref>

===Genetics===
Genetics plays a major role in fibromyalgia and may explain up to 50% of the disease's susceptibility.<ref name="D'Agnelli-2019">{{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 | article-number = 1744806918819944 | date = January 2019 | pmid = 30486733 | pmc = 6322092 | doi = 10.1177/1744806918819944 }}</ref> Fibromyalgia is potentially associated with [[Polymorphism (biology)|polymorphisms]] of genes in the [[Serotonin|serotonergic]],<ref name="Ablin-2015">{{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 }}</ref> [[dopaminergic]]<ref name="Ablin-2015" /> and [[catecholaminergic]] systems.<ref name="Ablin-2015" /> Several genes have been suggested as candidates for susceptibility to fibromyalgia. These include [[Serotonin transporter|SLC6A4]],<ref name="D'Agnelli-2019" /> [[TRPV2]],<ref name="D'Agnelli-2019" /> [[MYT1L]],<ref name="D'Agnelli-2019" /> [[NRXN3]],<ref name="D'Agnelli-2019" /> and the [[5-HT2A receptor]] 102T/C polymorphism.<ref name="pmid21120487">{{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 }}</ref> The [[heritability]] of fibromyalgia is estimated to be higher in patients younger than 50.<ref>{{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 }}</ref>

Nearly all the genes suggested as potential risk factors for fibromyalgia are associated with neurotransmitters and their receptors.<ref name=":1" /> [[Neuropathic pain]] and [[major depressive disorder]] often co-occur with fibromyalgia — the reason for this [[comorbidity]] appears to be due to shared [[Genetics|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 [[neuron]]s leading to the establishment of fibromyalgia and sometimes a [[mood disorder]].<ref name="Maletic-2009">{{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 }}</ref>

=== Stress and adverse life experiences===
[[Stress (medicine)|Stress]] may be a precipitating factor in the development of fibromyalgia.<ref name="Martins-2021">{{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 }}</ref> A 2018 systematic review found low quality evidence supporting an association between fibromyalgia and traumatic events, and noted a lack of [[prospective studies]].<ref>{{Cite journal |last1=Yavne |first1=Yarden |last2=Amital |first2=Daniela |last3=Watad |first3=Abdulla |last4=Tiosano |first4=Shmuel |last5=Amital |first5=Howard |date=August 2018 |title=A systematic review of precipitating physical and psychological traumatic events in the development of fibromyalgia |url=https://linkinghub.elsevier.com/retrieve/pii/S004901721730481X |journal=Seminars in Arthritis and Rheumatism |language=en |volume=48 |issue=1 |pages=121–133 |doi=10.1016/j.semarthrit.2017.12.011 |pmid=29428291 |url-access=subscription }}</ref> A 2021 [[meta-analysis]] of [[case-control studies]] found abuse and other lifetime [[stressor]]s to be strongly associated with fibromyalgia.<ref name="Kaleycheva-2021">{{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 }}</ref><ref name="Jung-2021">{{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 | article-number = 17448069211012833 | date = January 2021 | pmid = 33940974 | pmc = 8113919 | doi = 10.1177/17448069211012833 }}</ref> People with fibromyalgia had approximately three times the odds of reporting any type of abuse, and approximately twice the odds of reporting medical trauma or other stressors.<ref name="Kaleycheva-2021" /> A 2024 review of violence and chronic pain in women found "strong associations between an adult history of violent victimization and chronic pain" and that "the impact of violence on fibromyalgia was significant."<ref>{{cite journal | title=The association between violence against women and chronic pain: A systematic review and meta-analysis | journal=BMC Women's Health | date=2024 | volume=24 | issue=1 | article-number=321 | doi=10.1186/s12905-024-03097-w | doi-access=free | pmid=38834977 | pmc=11149284 | vauthors = Uvelli A, Ribaudo C, Gualtieri G, Coluccia A, Ferretti F }}</ref> A 2014 review argued that existing evidence entailed too many methodological limitations, such as [[Recall bias|reliance on recollections]] and [[confounding]], to support that [[physical trauma]] could cause fibromyalgia.<ref>{{cite journal |last1=Wolfe |first1=Frederick |last2=Häuser |first2=Winfried |last3=Walitt |first3=Brian T. |last4=Katz |first4=Robert S. |last5=Rasker |first5=Johannes J. |last6=Russell |first6=Anthony S. |title=Fibromyalgia and Physical Trauma: The Concepts We Invent |journal=The Journal of Rheumatology |date=September 2014 |volume=41 |issue=9 |pages=1737–1745 |doi=10.3899/jrheum.140268 |pmid=25086080 }}</ref>

Some of the other FM risk markers below may include stress elements.

===Other risk markers ===
FM prevalence rates appear higher when [[COVID-19]] infections have occurred.<ref>{{cite journal |last1=Ursini |first1=Francesco |last2=Ciaffi |first2=Jacopo |last3=Mancarella |first3=Luana |last4=Lisi |first4=Lucia |last5=Brusi |first5=Veronica |last6=Cavallari |first6=Carlotta |last7=D'Onghia |first7=Martina |last8=Mari |first8=Anna |last9=Borlandelli |first9=Elena |last10=Faranda Cordella |first10=Jacopo |last11=La Regina |first11=Micaela |last12=Viola |first12=Pasquale |last13=Ruscitti |first13=Piero |last14=Miceli |first14=Marco |last15=De Giorgio |first15=Roberto |last16=Baldini |first16=Nicola |last17=Borghi |first17=Claudio |last18=Gasbarrini |first18=Alessandro |last19=Iagnocco |first19=Annamaria |last20=Giacomelli |first20=Roberto |last21=Faldini |first21=Cesare |last22=Landini |first22=Maria Paola |last23=Meliconi |first23=Riccardo |title=Fibromyalgia: a new facet of the post-COVID-19 syndrome spectrum? Results from a web-based survey |journal=RMD Open |date=August 2021 |volume=7 |issue=3 |article-number=e001735 |doi=10.1136/rmdopen-2021-001735 |pmid=34426540 |pmc=8384499 }}</ref><ref>{{cite journal |last1=Savin |first1=Einat |last2=Rosenn |first2=Gali |last3=Tsur |first3=Avishai M. |last4=Hen |first4=Or |last5=Ehrenberg |first5=Scott |last6=Gendelman |first6=Omer |last7=Buskila |first7=Dan |last8=Halpert |first8=Gilad |last9=Amital |first9=Daniela |last10=Amital |first10=Howard |title=The possible onset of fibromyalgia following acute COVID-19 infection |journal=PLOS ONE |date=10 February 2023 |volume=18 |issue=2 |article-number=e0281593 |doi=10.1371/journal.pone.0281593 |pmid=36763625 |bibcode=2023PLoSO..1881593S |doi-access=free |pmc=9916594 }}</ref><ref>{{cite journal |last1=Plaut |first1=Shiloh |title='Long COVID-19' and viral 'fibromyalgia-ness': Suggesting a mechanistic role for fascial myofibroblasts (Nineveh, the shadow is in the fascia) |journal=Frontiers in Medicine |date=2023 |volume=10 |article-number=952278 |doi=10.3389/fmed.2023.952278 |pmid=37089610 |doi-access=free |pmc=10117846 }}</ref><ref>{{cite journal |last1=Senara |first1=Soha |last2=Salah |first2=Hisham |last3=Wahed |first3=Wafaa Abdel |last4=Yehia |first4=Ahmed |title=Frequency of fibromyalgia syndrome and anxiety post-corona virus disease-2019 (COVID-19) in patients attending the rheumatology clinic |journal=The Egyptian Rheumatologist |date=April 2023 |volume=45 |issue=2 |pages=127–131 |doi=10.1016/j.ejr.2022.11.007 |doi-access=free }}</ref>

Other risk markers for fibromyalgia include or potentially include [[premature birth]], [[female sex]], childhood cognitive and psychosocial problems, primary pain disorders, multiregional pain, infectious illness, [[Hypermobility (joints)|hypermobility of joints]], [[iron deficiency]], and [[Small fiber neuropathy|small-fiber polyneuropathy]].<ref name="Tan-2019">{{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 |article-number=6584753 |doi=10.1155/2019/6584753 |pmc=6525804 |pmid=31191788 |doi-access=free}}</ref> Fibromyalgia has also been linked with [[Metal allergy|metal-induced allergic inflammation]], especially in response to [[nickel]] but also inorganic [[Mercury (element)|mercury]], [[cadmium]], and [[lead]].<ref>{{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 }}</ref> 

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.<ref>{{cite journal |vauthors=Cohen SP, Wang EJ, Doshi TL, Vase L, Cawcutt KA, Tontisirin N |date=2022 |title=Chronic pain and infection: Mechanisms, causes, conditions, treatments, and controversies |journal=BMJ Medicine |volume=1 |issue=1 |article-number=e000108 |doi=10.1136/bmjmed-2021-000108 |pmc=10012866 |pmid=36936554}}</ref>

===Factors found not to correlate with fibromyalgia===
Studies on personality and fibromyalgia have shown inconsistent results.<ref name=":7" /> 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 [[Control variable (statistics)|statistically controlled]] for{{Snd}}personality has less relevance, and does not differ from healthy controls.<ref name=":7">{{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.}}</ref>

==Pathophysiology==
As of 2023, the [[pathophysiology]] of fibromyalgia had not yet been elucidated.<ref>{{Cite journal|title=Fibromyalgia Pathophysiology|first1=Gyorfi|last1=Michael|first2=Rupp|last2=Adam|first3=Abd-Elsayed|last3=Alaa|date=29 November 2022|journal=Biomedicines|volume=10|issue=12|page=3070|doi=10.3390/biomedicines10123070|doi-access=free|pmid=36551826|pmc=9776089}}</ref><ref>{{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 }}</ref> The prevailing view was that the fibromyalgia condition resulted from an amplification of pain by the central nervous system,<ref name=":1">{{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 | article-number = 105235 | date = August 2023 | pmid = 37207842 | doi = 10.1016/j.neubiorev.2023.105235 | hdl-access = free | hdl = 1874/429361 }}</ref> but other theories have also been suggested.<ref>https://pmc.ncbi.nlm.nih.gov/articles/PMC11818761</ref> 

=== Nervous system ===
[[Chronic pain]] can be divided into three categories. [[Pain|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.<ref name="Central sensitivity and fibromyalgi">{{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 }}</ref><ref name=Fitz2021/><ref>{{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 }}</ref> Because the three forms of pain can overlap, fibromyalgia patients may experience [[Nociception|nociceptive]] (e.g., [[Rheumatology|rheumatic]] illnesses) and [[Peripheral neuropathy|neuropathic]] (e.g., [[Small fiber peripheral neuropathy|small fiber neuropathy]]) pain, in addition to nociplastic pain.<ref name=Fitz2021/>

==== Central nervous system ====
{{Main|Nociplastic pain}}
Fibromyalgia can be viewed as a condition of nociplastic pain.<ref>{{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 }}</ref> Nociplastic pain is caused by an altered function of pain-related sensory pathways in the [[Peripheral nervous system|periphery]] and the [[central nervous system]], resulting in hypersensitivity.<ref>{{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 }}</ref> As of 2023, the underlying processes of nociplastic pain remain poorly understood.<ref name=":1" /> Nociplastic pain may be caused by either (1) increased processing of [[Pain stimulus|pain stimuli]] or (2) decreased suppression of pain stimuli at several levels in the [[nervous system]], or both.<ref name=Fitz2021/> Nociplastic pain has been referred to as "Nociplastic pain syndrome" because it is coupled with other symptoms including [[fatigue]], [[Sleep disorder|sleep disturbance]], [[Cognitive deficit|cognitive disturbance]], [[Hypersensitivity (disambiguation)|hypersensitivity]] to environmental stimuli, anxiety, and depression.<ref name=Fitz2021/> Nociplastic pain states can be triggered by a variety of stressors such as trauma, infections, and chronic stressors.<ref>{{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 }}</ref> 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.<ref>{{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 }}</ref>

In 2023, the Fibromyalgia: Imbalance of Threat and Soothing Systems (FITSS) model was suggested as a [[working hypothesis]].<ref name="Pinto-2023">{{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 }}</ref> According to the FITSS model, the [[salience network]] (also known as the midcingulo-insular network) may remain continuously hyperactive due to an imbalance in [[Emotional self-regulation|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.<ref name="Pinto-2023" />

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 cortex|cingulate gyrus]], right paracingulate gyrus, left [[cerebellum]], and left [[Straight gyrus|gyrus rectus]].<ref name=":0">{{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 | article-number = 1164145 | date = 2023-05-09 | pmid = 37229427 | pmc = 10203234 | doi = 10.3389/fnins.2023.1164145 | doi-access = free }}</ref> These regions are associated with affective and cognitive functions and with motor adaptations to pain processing.<ref name=":0" /> Other studies have documented decreased grey matter of the [[default mode network]] in people with fibromyalgia.<ref name="Lin-2016">{{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 | article-number = 7296125 | date = 1 January 2016 | pmid = 28105430 | pmc = 5220433 | doi = 10.1155/2016/7296125 | doi-access = free }}</ref> These deficits are associated with pain processing.<ref name="Lin-2016" />

==== Peripheral and autonomic nervous systems ====
An alternative hypothesis to [[nociplastic pain]] views fibromyalgia as a [[Stress (biology)|stress]]-related [[dysautonomia]] with neuropathic pain features.<ref name=Martinez2018>{{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 }}</ref> This view highlights the role of [[Autonomic nervous system|autonomic]] and [[Peripheral nervous system|peripheral]] [[Nociceptor|nociceptive]] nervous systems in the generation of widespread pain, [[fatigue]], and [[insomnia]].<ref>{{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 }}</ref> The description of [[Small fiber peripheral neuropathy|small fiber neuropathy]] in a subgroup of fibromyalgia patients supports the disease [[Peripheral neuropathy|neuropathic]]-[[Autonomic nervous system|autonomic]] underpinning.<ref name=Martinez2018/><ref name="auto6">{{Cite journal |last1=Aster |first1=Hans-Christoph |last2=Evdokimov |first2=Dimitar |last3=Braun |first3=Alexandra |last4=Üçeyler |first4=Nurcan |last5=Kampf |first5=Thomas |last6=Pham |first6=Mirko |last7=Homola |first7=György A |last8=Sommer |first8=Claudia |date=25 April 2022 |title=CNS imaging characteristics in fibromyalgia patients with and without peripheral nerve involvement |journal=Scientific Reports |volume=12 |issue=1 |page=6707 |bibcode=2022NatSR..12.6707A |doi=10.1038/s41598-022-10489-1 |pmc=9038916 |pmid=35469050}}</ref> However, others claim that [[Small fiber peripheral neuropathy|small fiber neuropathy]] occurs only in small groups of those with fibromyalgia.<ref name=Hauser2018>{{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 }}</ref>

Some suggest that fibromyalgia is caused or maintained by a decreased vagal tone, which is indicated by low levels of heart rate variability,<ref name="Martins-2021" /> signaling a heightened [[Sympathetic nervous system|sympathetic]] response.<ref name="Martinez-Lavin-2021">{{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 }}</ref> Accordingly, several studies show that clinical improvement is associated with an increase in heart rate variability.<ref>{{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 }}</ref><ref name="Martinez-Lavin-2021" /><ref>{{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 }}</ref> Some examples of interventions that increase the heart rate variability and vagal tone are meditation, yoga, mindfulness, and exercise.<ref name="Martins-2021" />

==== Neurochemical and neuroendocrine ====
Some neurochemical abnormalities that occur in fibromyalgia also regulate mood, [[sleep]], and energy, thus explaining why mood, sleep, and [[fatigue]] problems are commonly [[Comorbidity|co-morbid]] with fibromyalgia.<ref name="Clauw-2011">{{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}}</ref> Serotonin is the most widely studied neurotransmitter in fibromyalgia. It is hypothesized that an imbalance in the serotonergic system may lead to the development of fibromyalgia.<ref name="Singh-2019">{{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 }}</ref> There is also some data that suggests altered dopaminergic and noradrenergic signaling in fibromyalgia.<ref name="bellato">{{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 }}</ref> Supporting the monoamine related theories is the efficacy of monoaminergic [[antidepressant]]s in fibromyalgia.<ref name="Mascarenhas-2021">{{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}}</ref> 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.<ref name="Jung-2021" /><ref name="Feraco-2011">{{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 }}</ref> 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.<ref name="pmid362464011">{{cite journal | vauthors= Assavarittirong C, Samborski W, Grygiel-Górniak B | title=Oxidative Stress in Fibromyalgia: From Pathology to Treatment| journal=[[List of Hindawi academic journals#O|Oxidative Medicine and Cellular Longevity]] | volume=2022 | article-number=1582432 | year=2022 | doi = 10.1155/2022/1582432 | pmc=9556195 | pmid=36246401| doi-access=free}}</ref>

=== Metabolic and proteomic evidence ===
Pro-oxidative processes correlate with pain in fibromyalgia patients.<ref name="pmid362464011"/> Decreased [[Chemiosmosis|mitochondrial membrane potential]], increased [[superoxide]] activity, and increased [[lipid peroxidation]] production are observed.<ref name="pmid362464011"/> The high proportion of lipids in the central nervous system (CNS) makes the CNS especially vulnerable to [[Radical (chemistry)|free radical]] damage. Levels of lipid peroxidation products correlate with fibromyalgia symptoms.<ref name="pmid362464011"/> Fibromyalgia is associated with the deregulation of [[protein]]s related to [[Complement system|complement]] and [[coagulation]] cascades, as well as to [[Human iron metabolism|iron metabolism]].<ref name=":4">{{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 }}</ref> An excessive [[oxidative stress]] response may cause dysregulation of many proteins.<ref name=":4" />

=== Immune system ===
[[Inflammation]] has been suggested to have a role in the pathogenesis of fibromyalgia.<ref>{{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 }}</ref> People with fibromyalgia tend to have higher levels of inflammatory [[cytokine]]s [[Interleukin 6|IL-6]],<ref name="Singh-2019" /><ref name="Uçeyler-2011" /><ref name="cytokines" /> and [[Interleukin 8|IL-8]].<ref name="Singh-2019" /><ref name="Uçeyler-2011">{{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 | article-number = 245 | date = October 2011 | pmid = 22034969 | pmc = 3234198 | doi = 10.1186/1471-2474-12-245 | doi-access = free }}</ref><ref name="cytokines">{{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 }}</ref> There are also increased levels of the pro-inflammatory cytokines [[Interleukin 1 receptor antagonist|IL-1 receptor antagonist]].<ref name="Uçeyler-2011" /><ref name="cytokines" /> Increased levels of pro-inflammatory cytokines may increase sensitivity to pain, and contribute to mood problems.<ref name="sickness behavior">{{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 }}</ref> Anti-inflammatory interleukins such as [[IL-10 family|IL-10]] have also been associated with fibromyalgia.<ref name="Singh-2019" /> [[Neurogenic inflammation]] has been proposed as a contributing factor to fibromyalgia.<ref>{{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 }}</ref> A repeated observation shows that [[autoimmunity]] triggers, such as traumas and [[infection]]s, are among the most frequent events preceding the onset of fibromyalgia.<ref name=Bazzichi2020>{{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 }}</ref>  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.<ref name="Clauw Sarzi-Puttini autoimmune disorder">{{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 |article-number=103424 |doi=10.1016/j.autrev.2023.103424 |pmid=37634681 |hdl=2434/1032448 |hdl-access=free }}</ref>

=== Digestive system ===
Though there is a lack of evidence in this area, it is hypothesized that [[Gut microbiota|gut microbiome]] may play a role in fibromyalgia.<ref>{{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 | article-number = 181 | date = March 2020 | pmid = 32192466 | pmc = 7083062 | doi = 10.1186/s12891-020-03201-9 | doi-access = free }}</ref> People with fibromyalgia are more likely to show [[dysbiosis]], a decrease in microbiota diversity.<ref>{{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 | article-number = 104055 | date = June 2022 | pmid = 35594658 | pmc = 9120231 | doi = 10.1016/j.ebiom.2022.104055 }}</ref> 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|hypothalamic pituitary adrenal axis]] are directed to intestinal functional [[effector cell]]s, which in turn are under the influence of the gut microbiota.<ref>{{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 }}</ref>

The [[Gut–brain axis|gut-brain axis]], which connects the gut microbiota to the [[brain]] via the [[enteric nervous system]], is another area of research. Fibromyalgia patients have less varied [[Gut microbiota|gut flora]] and altered [[Serum Metabolome Database|serum metabolome]] levels of [[Glutamic acid|glutamate]] and [[serine]],<ref>{{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 }}</ref> implying abnormalities in [[neurotransmitter]] [[metabolism]].<ref name=Bazzichi2020/>

== Diagnosis ==
Diagnosis of fibromyalgia is hampered by the lack of any single pathological feature, laboratory finding, or biomarker.<ref name="Tan-2019" /><ref name=":6">{{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; despite that practice not being recommended because of its lack of precision and the high possibility of misdiagnosis. |doi-access=free}}</ref> 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.<ref name=Hauser2018/>

Specific diagnostic criteria for fibromyalgia have evolved.<ref name=Hauser2018 />

=== Diagnostic criteria===
The 2016 diagnostic criteria of the American College of Rheumatology<ref name=Wolfe2016/> require all of the following:
# ''"Generalized pain, defined as pain in at least 4 of 5 regions, is present."''
# ''"Symptoms have been present at a similar level for at least 3 months."''
# ''"Widespread pain index (WPI) ≥ 7 and symptom severity scale (SSS) score ≥ 5 OR WPI of 4–6 and SSS score ≥ 9."''
# ''"A diagnosis of fibromyalgia is valid irrespective of other diagnoses. A diagnosis of fibromyalgia does not exclude the presence of other clinically important illnesses."''<ref name="Wolfe2016" />

[[File:Widespread Pain Index Areas.svg|thumbnail|Widespread pain index (WPI) areas]]

*The 5 body regions are right upper, left upper, right lower, left lower, and axial.<ref name="Wolfe2016" /><ref name="RCP Worksheet">{{Cite web |url=https://www.rcp.ac.uk/media/yuhdz53b/fibromyalgia-syndrome-diagnostic-worksheet_1_0_0.pdf |title=Fibromyalgia diagnostic worksheet |publisher=[[Royal College of Physicians]] |year=2022 |access-date=22 August 2025}}</ref><ref>'axial' here seems to refer to the 'central axis area of the body' (https://dictionary.cambridge.org/us/dictionary/english/axial). This includes axial body components (e.g. gut) in addition to the [[axial skeleton]].</ref>
*The Widespread Pain Index (WPI) was 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.<ref name=Wolfe2010 />
*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), [[non-restorative sleep|waking up tired (unrefreshed)]] (0-3), pain or cramps in lower abdomen (0-1), depression (0-1) and headache (0-1).<ref name=Wolfe2010 />{{rp|607}}<ref name="RCP Worksheet"/>
As of 2022, among diagnosis methods in the US, the ACR 2016 criteria have been judged as the best FM diagnosis criteria available.<ref>{{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}}</ref><ref>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 }}</ref> The UK [[Royal College of Physicians|RCP]] also recommends these criteria for FM diagnosis.<ref name="RCP Diagnosis">{{Cite web |url=https://www.rcp.ac.uk/improving-care/resources/the-diagnosis-of-fibromyalgia-syndrome/ |title=The diagnosis of fibromyalgia syndrome |publisher=Royal College of Physicians |date=13 September 2023 |access-date=22 August 2025}}</ref> A similar diagnostic approach is taken in Germany.<ref>{{Cite web|url=https://gesund.bund.de/en/fibromyalgia|title=Fibromyalgia: causes and treatment|date=21 October 2022|website=gesund.bund.de}}</ref>[[File:Fibromyalgia pain sites APS 2019.svg|thumb|The nine possible pain sites used in the 2019 APS FM diagnostic criteria.]]In 2019, the [[American Pain Society]] in collaboration with the U.S. [[Food and Drug Administration]] developed a new diagnostic system using two dimensions.<ref name="Arnold-2019">{{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 }}</ref> The first dimension included core diagnostic criteria, and the second included common features.

The core diagnostic criteria are:

# Multisite pain is 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
# Moderate to severe [[Sleep disorder|sleep problems]] or [[fatigue]], for at least three months
A 2025 review found that challenges and limitations continue, due to patients over- or under-estimating their symptoms, or describing them differently.<ref>{{cite journal | doi=10.3390/jcm14030955 | doi-access=free | title=Fibromyalgia: Understanding, Diagnosis and Modern Approaches to Treatment | date=2025 | last1=Filipovic | first1=Tamara | last2=Filipović | first2=Aleksandar | last3=Nikolic | first3=Dejan | last4=Gimigliano | first4=Francesca | last5=Stevanov | first5=Jelena | last6=Hrkovic | first6=Marija | last7=Bosanac | first7=Ivana | journal=Journal of Clinical Medicine | volume=14 | issue=3 | page=955 | pmid=39941626 | pmc=11818761 }}</ref> Some people can move into and out of an FM diagnostic level over time as their symptoms vary.<ref name="RCP Diagnosis" />

=== Scales for fibromyalgia severity===
The Fibromyalgia Impact Questionnaire (FIQ)<ref>{{Cite web|url=https://www.physio-pedia.com/Fibromyalgia_Impact_Questionnaire_(FIQ)|title=Fibromyalgia Impact Questionnaire (FIQ)|website=Physiopedia}}</ref> was introduced in 1991<ref>{{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 }}</ref> and the Revised Fibromyalgia Impact Questionnaire (FIQR)<ref>{{Cite web|url=https://www.physio-pedia.com/Revised_Fibromyalgia_Impact_Questionnaire_(FIQR)|title=Revised Fibromyalgia Impact Questionnaire (FIQR)|website=Physiopedia}}</ref> in 2009.<ref name="Bennett-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 | article-number = R120 | date = 2009-01-01 | pmid = 19664287 | pmc = 2745803 | doi = 10.1186/ar2783 | doi-access = free }}</ref> It is used as a way of measuring the impact of fibromyalgia on living, although there is some debate on ratings scales.<ref>{{cite journal |last1=Duhn |first1=P.H. |last2=Amris |first2=K. |last3=Bliddal |first3=H. |last4=Wæhrens |first4=E.E. |title=POS1492-HPR PSYCHOMETRIC PROPERTIES OF THE FIBROMYALGIA IMPACT QUESTIONNAIRE – REVISED IN FIBROMYALGIA AND CHRONIC WIDESPREAD PAIN: A RASCH ANALYSIS |journal=Annals of the Rheumatic Diseases |date=June 2022 |volume=81 |page=1091 |doi=10.1136/annrheumdis-2022-eular.5187 }}</ref><ref>{{cite journal |last1=Pinto |first1=A.M. |last2=Costa |first2=C. |last3=Pereira |first3=A.T. |last4=Marques |first4=M. |last5=Pereira da Silva |first5=J.A. |last6=Macedo |first6=A. |title=Exploring the factorial structure of the revised Fibromyalgia Impact Questionnaire (FIQR) in a Portuguese sample of fibromyalgia patients |journal=European Psychiatry |date=March 2016 |volume=33 |issue=S1 |pages= S206–S207 |doi=10.1016/j.eurpsy.2016.01.495 }}</ref>

The polysymptomatic distress scale (PSD) was derived from the 2010 ACR diagnosis criteria and aimed to measure FM severity.<ref>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}}</ref><ref>{{cite journal |last1=Wolfe |first1=Frederick |last2=Michaud |first2=Kaleb |last3=Klooster |first3=Peter M ten |last4=Rasker |first4=Johannes J. |title=Looking at fibromyalgia differently – An observational study of the meaning and consequences of fibromyalgia as a dimensional disorder |journal=Seminars in Arthritis and Rheumatism |date=February 2023 |volume=58 |article-number=152145 |doi=10.1016/j.semarthrit.2022.152145 |pmid=36476499 }}</ref>

===Differential diagnosis===
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 or psychosocial [[Stress (biology)|stress]], a general hypersensitivity to [[Somatosensory system|touch]], [[Sense of smell|smell]], [[noise]], [[taste]], [[hypervigilance]], and various [[Somatic anxiety|somatic symptoms]] ([[Gastrointestinal disease|gastrointestinal]], [[urology]], [[Gynaecology|gynecology]], [[neurology]]) may signal FM.<ref name=Hauser2019/> 
*A physical examination and laboratory investigations may be used to eliminate alternative causes.<ref name="RossiDiLollo" /><ref name="Goldenberg2009">{{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 }}</ref><ref name="MarchesoniDeMarco2018">{{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 }}</ref><ref name="PalazziDAmico2016">{{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 }}</ref> Common tests that are conducted include [[complete blood count]], [[comprehensive metabolic panel]], [[erythrocyte sedimentation rate]], [[C-reactive protein]], and [[Thyroid function tests|thyroid function test]].<ref name="Arnold-2019" />

Possible misdiagnoses are
* Early undiagnosed [[Rheumatism|rheumatic diseases]] such as preclinical [[rheumatoid arthritis]], early stages of inflammatory [[Spondyloarthropathy|spondyloarthritis]], [[polymyalgia rheumatica]], [[myofascial pain syndrome]]s and [[Hypermobility spectrum disorder|hypermobility syndrome]].<ref name="Hauser2019">{{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 }}</ref><ref name="Hauser2017">{{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 | article-number = e598 | date = May 2017 | pmid = 29392213 | pmc = 5741304 | doi = 10.1097/PR9.0000000000000598 }}</ref> 
*[[Neurological disorder|Neurological diseases]] that can have important pain and fatigue components include [[multiple sclerosis]], [[Parkinson's disease]] and [[peripheral neuropathy]].<ref name="Hauser2019" /><ref name="Hauser2017" /> 
*Other medical illnesses that should be ruled out are [[endocrine disease]] or [[metabolic disorder]] ([[hypothyroidism]], [[hyperparathyroidism]], [[acromegaly]], [[vitamin D deficiency]]), [[Gastrointestinal disease|gastro-intestinal disease]] ([[Coeliac disease|celiac]] and [[non-celiac gluten sensitivity]]), [[Infection|infectious diseases]] ([[Lyme disease]], [[hepatitis C]] and [[Immunodeficiency|immunodeficiency disease]]) and the early stages of a [[malignancy]] such as [[multiple myeloma]], [[Metastasis|metastatic cancer]] and [[leukemia]]/[[lymphoma]].<ref name="Hauser2019" /><ref name="Hauser2017" /> 
*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]].<ref name="RossiDiLollo">{{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 }}</ref><ref name="Goldenberg2009" /><ref name="MarchesoniDeMarco2018" /><ref name="PalazziDAmico2016" /> 
*Several medications can evoke pain ([[statin]]s, [[aromatase inhibitor]]s, [[bisphosphonate]]s, and [[opioid]]s).<ref name="Arnold-2019" />

==Epidemiology==
Fibromyalgia is estimated to affect 1.8% of the population.<ref>{{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 }}</ref> German Federal Ministry of Health guidance is that about 2% of adults in Germany suffer from fibromyalgia.<ref name="auto14"/> Information about FM prevalence in many parts of the world is limited by lack of information and by differing diagnosis standards.<ref>{{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 |article-number=e15428 |doi=10.1111/1756-185X.15428 |pmid=39618110 }}</ref> A 2024 study found more patients met fibromyalgia proxy criteria than were clinically diagnosed with fibromyalgia, implying that fibromyalgia is underdiagnosed.<ref name="Alter Moses DeSensi Hierarchical Clustering">{{cite journal |last1=Alter |first1=Benedict J. |last2=Moses |first2=Mark |last3=DeSensi |first3=Rebecca |last4=O'Connell |first4=Brian |last5=Bernstein |first5=Cheryl |last6=McDermott |first6=Sean |last7=Jeong |first7=Jong-Hyeon |last8=Wasan |first8=Ajay D. |title=Hierarchical Clustering Applied to Chronic Pain Drawings Identifies Undiagnosed Fibromyalgia: Implications for Busy Clinical Practice |journal=The Journal of Pain |date=July 2024 |volume=25 |issue=7 |page=104489 |doi=10.1016/j.jpain.2024.02.003 |pmid=38354967 |pmc=11180596 }}</ref>

Historically, diagnosed FM cases have been between 4%-20% male.<ref name="auto10">{{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 }}</ref> As a result historically most FM research has focused on women.<ref name="auto5"/> However men may be relatively underdiagnosed.<ref>https://theconversation.com/fibromyalgia-why-is-this-common-debilitating-condition-being-ignored-in-male-patients-244000</ref>

==Prognosis==
Symptoms of fibromyalgia are regarded as persistent in nearly all patients.<ref>{{cite journal |last1=Wolfe |first1=Frederick |last2=Anderson |first2=Janice |last3=Harkness |first3=Deborah |last4=Bennett |first4=Robert M. |last5=Caro |first5=Xavier J. |last6=Goldenberg |first6=Don L. |last7=Russell |first7=I. Jon |last8=Yunus |first8=Muhammad B. |title=Health status and disease severity in fibromyalgia. Results of a six-center longitudinal study |journal=Arthritis & Rheumatism |date=September 1997 |volume=40 |issue=9 |pages=1571–1579 |doi=10.1002/art.1780400905 |pmid=9324010 }}</ref><ref>{{cite journal |last1=Walitt |first1=Brian |last2=Fitzcharles |first2=Mary-Ann |last3=Hassett |first3=Afton L. |last4=Katz |first4=Robert S. |last5=HäUser |first5=Winfried |last6=Wolfe |first6=Frederick |title=The Longitudinal Outcome of Fibromyalgia: A Study of 1555 Patients |journal=The Journal of Rheumatology |date=October 2011 |volume=38 |issue=10 |pages=2238–2246 |doi=10.3899/jrheum.110026 |pmid=21765102 }}</ref><ref name=Hauser2018/> 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.<ref name="auto19">{{Cite web|url=https://gesund.bund.de/en/fibromyalgia#outlook|title=Fibromyalgia: causes and treatment|date=21 October 2022|website=gesund.bund.de}}</ref><ref name="Walitt2011">{{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 }}</ref><ref>{{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 }}</ref>

Fibromyalgia can cause substantial disability, with impacts on the ability to work, engage in [[recreational activities]], and do household duties. Amongst people with fibromyalgia, the proportion that are able to maintain their jobs has been estimated at between 34% and 77%, and some research suggest the typical reduction in work hours is between 50-70%. There is variation in the level of impact, with 71.4% of those who are mild remaining in employment, compared to 61.2% of those who are moderate and 28.5% of those who are severe.<ref name=":11">{{Cite journal |last=Skaer |first=Tracy L. |date=May 2014 |title=Fibromyalgia: Disease Synopsis, Medication Cost Effectiveness and Economic Burden |journal=PharmacoEconomics |language=en |volume=32 |issue=5 |pages=457–466 |doi=10.1007/s40273-014-0137-y |pmid=24504852 }}</ref>  Levels of pain can vary significantly over time, from severe pain to almost symptom-free phases.<ref name="auto19"/><ref name="Walitt2011"/>

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]].<ref name="auto18">{{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 | article-number = e003005 | date = July 2023 | pmid = 37429737 | pmc = 10335452 | doi = 10.1136/rmdopen-2023-003005 }}</ref> A 2021 review found that people with FM had suicide ideation [[odds ratio|OR]] 9.12, suicide attempt OR 3.12, suicide risk OR 36.77 and suicide events [[hazard ratio|HR]] 1.38, but commented that FM impact could not be separated from the effects of comorbidities and sleep deprivation.<ref>{{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|article-number=629417|doi=10.3389/fpsyt.2021.629417|doi-access=free |pmid=34867495|pmc=8640182}}</ref> 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.<ref name="The Prevalence of Suicidal Behaviou"/>

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 [[accident]]s, and 1.66 (95% CI 1.15 to 2.38) due to [[infection]]s. 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.<ref name="auto18"/>

A 2020 review found that many of the core clinical symptoms of FM were more strongly associated with suicidal ideation than with suicidal behaviours.<ref>https://pmc.ncbi.nlm.nih.gov/articles/PMC7538832/</ref>

==Management==
Management of FM symptoms, to improve quality of life,<ref>{{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 }}</ref> often uses integrated pharmacological and non-pharmacological approaches.<ref name="JAMA2014" /> There is no single intervention shown to be effective for all patients.<ref name="Management of fibromyalgia syndrome">{{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 }}</ref><ref name=Prab2019>{{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 | article-number = 14 | date = March 2019 | pmid = 30830504 | doi = 10.1007/s11926-019-0814-0 }}</ref> A personalized, multidisciplinary approach to treatment that includes pharmacologic considerations and begins with effective patient education is most beneficial.<ref name=Prab2019/> Self-help can play a role.<ref name="auto16"/>

Several associations have published guidelines for the diagnosis and management of fibromyalgia, including the German  [[Federal Ministry of Health (Germany)|Federal Ministry of Health]] in 2022,<ref name="auto15">{{Cite web|url=https://gesund.bund.de/en/fibromyalgia#treatment|title=Fibromyalgia: causes and treatment|date=21 October 2022|website=gesund.bund.de}}</ref> Italian guidelines in 2021,<ref>{{cite journal |last1=Ariani |first1=A. |last2=Bazzichi |first2=L. |last3=Sarzi-Puttini |first3=P. |last4=Salaffi |first4=F. |last5=Manara |first5=M. |last6=Prevete |first6=I. |last7=Bortoluzzi |first7=A. |last8=Carrara |first8=G. |last9=Scirè |first9=C.A. |last10=Ughi |first10=N. |last11=Parisi |first11=S. |title=The Italian Society for Rheumatology clinical practice guidelines for the diagnosis and management of fibromyalgia. Best practices based on current scientific evidence |journal=Reumatismo |date=3 August 2021 |volume=73 |issue=2 |pages=89–105 |doi=10.4081/reumatismo.2021.1362 |pmid=34342210 |hdl=10281/367284 |hdl-access=free }}</ref> the [[European League Against Rheumatism]] in 2017,<ref name="Macfarlane-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/ }}</ref>{{efn|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 exercise|aerobic]] and [[Exercise|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 disorder]]s or unhelpful [[Coping|coping strategies]].
**[[Chiropractic]] was strongly recommended against, due to [[safety]] concerns.
**Medications weakly recommended for severe pain were ([[duloxetine]], [[pregabalin]], [[tramadol]]) or [[Sleep disorder|sleep disturbance]] ([[amitriptyline]], [[cyclobenzaprine]], [[pregabalin]]).
**Medications not recommended due to a lack of efficacy were ([[nonsteroidal anti-inflammatory drug]]s, [[monoamine oxidase inhibitor]]s and [[selective serotonin reuptake inhibitor]]s).
**Medications strongly recommended against, due to lack of efficacy and [[side effect]]s, were [[growth hormone]], [[sodium oxybate]], [[opioid]]s, and [[steroid]]s.}} and the [[Canadian Pain Society]] in 2012.<ref name="Canadian">{{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 &#124; Canadian Guidelines for the Diagnosis and Management of Fibromyalgia|archive-date=11 June 2013}}</ref><ref>{{Cite web|url=https://fmguidelines.ca/?page_id=25|title=Conclusion &#124; Canadian Guidelines for the Diagnosis and Management of Fibromyalgia}}</ref>

===Mental tools===
FM can cause negative mental effects.<ref>{{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}}</ref> German guidance<ref name="auto15"/> 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 limits.<ref name="auto15"/>

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.<ref>{{cite journal |last1=Williams |first1=Amanda C de C |last2=Fisher |first2=Emma |last3=Hearn |first3=Leslie |last4=Eccleston |first4=Christopher |title=Psychological therapies for the management of chronic pain (excluding headache) in adults |journal=Cochrane Database of Systematic Reviews |date=14 August 2020 |volume=2021 |issue=11 |article-number=CD007407 |doi=10.1002/14651858.CD007407.pub4 |pmid=32794606 |pmc=7437545 }}</ref> CBT and related psychological and behavioral therapies have a small to moderate effect in reducing symptoms of fibromyalgia.<ref>{{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 | article-number = CD009796 | date = September 2013 | pmid = 24018611 | pmc = 6481397 | doi = 10.1002/14651858.CD009796.pub2 }}</ref><ref name="Glo2010">{{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 }}</ref> Effect sizes tend to be small when psychological therapies are used as treatment for patients with fibromyalgia, and are comparable to the effect sizes seen with other drug and pain treatments. Multicomponent treatment appears to have greater efficacy than any individual treatment.<ref name="Glo2010" /> Several reviews have found that CBT has no significant effect in pain reduction,<ref name=":8">{{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 |volume=64 |issue=8 |article-number=keaf147 |doi=10.1093/rheumatology/keaf147 |pmid=40084994 |pmc=12316380 }}</ref><ref>{{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}}</ref> although it does improve sleep quality.<ref name=":8" /><ref name="Whale-2022">{{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 | article-number = 440 | date = May 2022 | pmid = 35546397 | pmc = 9092772 | doi = 10.1186/s12891-022-05318-5 | doi-access = free }}</ref> There is also limited evidence that [[acceptance and commitment therapy]] improves outcomes such as [[health-related quality of life]] and pain acceptance.<ref>{{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 }}</ref>

Patient education is recommended by the [[European League Against Rheumatism]] (EULAR) as an important treatment component.<ref name="Macfarlane-2017" /> As of 2022, there is only low-quality evidence showing that patient education can decrease pain and fibromyalgia impact.<ref>{{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 }}</ref><ref>{{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 }}</ref>

[[Sleep hygiene]] interventions show low effectiveness in improving insomnia in people with chronic pain.<ref name="Whale-2022" />

=== Exercise ===
In 2017, exercise was the only fibromyalgia treatment given a strong recommendation by the European Alliance of Associations for Rheumatology ([[EULAR]]).<ref>{{Cite web |title=Managing fibromyalgia |url=https://www.eular.org/document/download/251/cfc1fc15-1cab-4262-b7f8-4d50cb60be84/267 |website=www.eular.org}}</ref> There is strong evidence indicating that exercise improves fitness, sleep and quality of life and may reduce pain and fatigue for people with fibromyalgia.<ref name="Busch2007">{{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 | article-number = CD003786 | date = October 2007 | pmid = 17943797 | doi = 10.1002/14651858.CD003786.pub2 }}</ref><ref name="Ibáñez-Vera-2018" /><ref name="Andrade-2020">{{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 }}</ref> The rate of [[adverse event]]s reported in studies of exercise is low, with the most common being muscle pain, and no [[serious adverse event]]s reported.<ref name="Andrade-2020" />

There are several hypothesized biological mechanisms for exercise benefits in FM.<ref name="Masquelier-2021">{{cite journal |vauthors=Masquelier E, D'haeyere J |date=October 2021 |title=Physical activity in the treatment of fibromyalgia |journal=Joint Bone Spine |volume=88 |issue=5 |article-number=105202 |doi=10.1016/j.jbspin.2021.105202 |pmid=33962033 |hdl=2078.1/246291|hdl-access=free }}</ref><ref>{{cite journal |last1=Kan |first1=Shigeyuki |last2=Fujita |first2=Nobuko |last3=Shibata |first3=Masahiko |last4=Miki |first4=Kenji |last5=Yukioka |first5=Masao |last6=Senba |first6=Emiko |title=Three weeks of exercise therapy altered brain functional connectivity in fibromyalgia inpatients |journal=Neurobiology of Pain |date=August 2023 |volume=14 |article-number=100132 |doi=10.1016/j.ynpai.2023.100132 |pmid=38099286 |pmc=10719530 }}</ref> Exercise may improve pain modulation through serotonergic pathways.<ref name="Masquelier-2021" /> It may reduce pain by altering the hypothalamic-pituitary-adrenal axis and reducing cortisol levels.<ref name="Masquelier-2021" /><ref>{{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 }}</ref> It also has anti-inflammatory effects that may improve fibromyalgia symptoms.<ref name="El-Shewy-2019" /><ref>{{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 }}</ref> Aerobic exercise can improve muscle metabolism and pain through mitochondrial pathways.<ref name="El-Shewy-2019" />

Despite its benefits, exercise is a challenge for patients with fibromyalgia, due to the chronic fatigue and pain they experience.<ref name="Masquelier-2021" /> They may have negative experiences with being given non-personalized exercise programs by healthcare providers who they feel do not understand the impact of the condition.<ref name="Masquelier-2021" /> Adherence is higher when the exercise program is recommended by doctors or supervised by nurses.<ref>{{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 }}</ref> Sufferers perceive exercise as more effortful than healthy adults.<ref>{{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 }}</ref> Depression and higher pain intensity serve as barriers to physical activity.<ref>{{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 }}</ref>

A recommended approach to a graded exercise program begins with small, frequent exercise periods and builds up from there.<ref name="Albuquerque-2022" /><ref name="Ryan2013">{{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 }}</ref> To reduce pain the use of an exercise program of 13 to 24 weeks is recommended, with each session lasting 30 to 60 minutes.<ref name="Albuquerque-2022">{{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 }}</ref>

When different exercise programs are compared, aerobic exercise is capable of modulating the [[Autonomic nervous system|autonomic nervous]] function of fibromyalgia patients, whereas resistance exercise does not show such effects.<ref name="Andrade-2019" /> A 2022 meta-analysis found that aerobic training showed a high effect size while strength interventions showed moderate effects.<ref name="Albuquerque-2022" /> Meditative exercise seems preferable for improving sleep,<ref name="Estevez2021">{{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}}</ref><ref>{{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 |article-number=152216 |doi=10.1016/j.semarthrit.2023.152216 |pmid=37229847 |doi-access=free}}</ref> with no differences between resistance, flexibility, and aquatic exercise in their favorable effects on fatigue.<ref name="Estevez2021" />

==== Aerobic ====
Aerobic exercise for fibromyalgia patients is the most investigated type of exercise.<ref name="Andrade-2020" /> It includes activities such as walking, jogging, spinning, cycling, dancing and exercising in water,<ref name="El-Shewy-2019" /><ref name="Andrade-2019" /> with walking being named as one of the best methods.<ref>{{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 }}</ref> 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.<ref name="Bid2017">{{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 | article-number = CD012700 | date = June 2017 | pmid = 28636204 | pmc = 6481524 | doi = 10.1002/14651858.cd012700 }}</ref> A 2019 meta-analysis showed that exercising aerobically can reduce autonomic dysfunction and increase heart rate variability.<ref name="Andrade-2019">{{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 }}</ref> This happens when patients exercise at least twice a week, for 45–60 minutes at about 60%–80% of the maximum heart rate.<ref name="Andrade-2019" /> Aerobic exercise also decreases anxiety and depression, and improves the quality of life.<ref name="Andrade-2019" /> Exercising aerobically 2–3 times a week has been shown to alleviate pain.<ref>{{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 |article-number=e4783 |doi=10.1002/ejp.4783 |pmc=11730678 |pmid=39805734}}</ref>

==== Resistance ====
In [[Strength training|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,<ref name="Andrade-2019" /><ref>{{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 }}</ref> one found that it decreases pain and disease severity<ref>{{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 }}</ref> and one found that it improves quality of life.<ref name="Andrade-2019" /> Resistance training may also improve sleep, with a greater effect than that of flexibility training and a similar effect to that of aerobic exercise.<ref>{{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 }}</ref>

The dosage of [[Strength training|resistance exercise]] for women with fibromyalgia was studied in a 2022 [[meta-analysis]].<ref name="daSilva2022">{{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 }}</ref> 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.<ref name="daSilva2022" /> Most studies use moderate [[exercise intensity]] of 40% to 85% [[one-repetition maximum]]. This intensity was effective in reducing pain.<ref name="daSilva2022" /> Some treatment regimes increase the intensity over time (from 40% to 80%), whereas others increase it when the participant can perform 12 repetitions.<ref name="daSilva2022" /> High-intensity exercises may cause lower [[Adherence (medicine)|treatment adherence]].

==== Other exercise types ====
A 2021 [[meta-analysis]] found that [[Meditation|meditative]] exercise programs ([[tai chi]], [[yoga]], [[qigong]]) were superior to other forms of exercise ([[Aerobic exercise|aerobic]], [[Exercise|flexibility]], [[Strength training|resistance]]) in improving [[sleep]] quality.<ref name=Estevez2021/> Other meta-analyses also found positive effects of tai chi for sleep,<ref>{{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 }}</ref> fibromyalgia symptoms,<ref>{{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 }}</ref> and pain, fatigue, depression and quality of life.<ref>{{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 }}</ref> 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 [[Antioxidant|antioxidation]], [[Anti-inflammatory|anti-inflammation]], reduction in [[Sympathetic nervous system|sympathetic]] activity, and modulation of [[glucocorticoid receptor]] sensitivity.<ref name="El-Shewy-2019" />

Several reviews and meta-analyses suggest that aquatic training can improve symptoms and wellness in people with fibromyalgia.<ref>{{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 | article-number = CD011336 | date = October 2014 | volume = 2014 | pmid = 25350761 | doi = 10.1002/14651858.cd011336 | pmc = 10638613 }}</ref><ref>{{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 }}</ref><ref>{{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 }}</ref><ref>{{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 }}</ref><ref name="Calles Plata-2023">{{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 }}</ref><ref>{{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 }}</ref> It is recommended to practice aquatic therapy at least twice a week using a low to moderate intensity.<ref name="Calles Plata-2023" /> However, [[aquatic therapy]] does not appear to be superior to other types of exercise.<ref>{{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 }}</ref>

Combinations of different exercises, such as flexibility and aerobic training, may improve stiffness.<ref name="Bidonde2019">{{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 | article-number = CD013340 | date = May 2019 | pmid = 31124142 | pmc = 6931522 | doi = 10.1002/14651858.cd013340 }}</ref> However, the evidence is of low-quality.<ref name="Bidonde2019" /> It is not clear if flexibility training alone, compared to aerobic training, is effective at reducing symptoms or has any adverse effects.<ref>{{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 | article-number = CD013419 | date = September 2019 | pmid = 31476271 | pmc = 6718217 | doi = 10.1002/14651858.CD013419 }}</ref> According to a 2017 systematic review it is uncertain whether [[vibration training]] in combination with exercise may improve pain, fatigue, and stiffness.<ref>{{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 |article-number=CD011755 |doi=10.1002/14651858.cd011755.pub2 |pmc=6483692 |pmid=28950401}}</ref>

=== Medications ===
{{See also|List of investigational fibromyalgia drugs}}

A 2024 review found that currently available pharmacological options appeared to be limited in efficacy for FM.<ref>{{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}}</ref> As of 2018, all country published guidelines for the management and treatment of fibromyalgia emphasized that medications are not required. The [[Germany|German]] guidelines outlined parameters for drug therapy termination and recommended considering [[drug holiday]]s after six months.<ref name="Hauser2018" />

[[Health Canada]] and the US [[Food and Drug Administration]] (FDA) have approved [[pregabalin]]<ref name="FDAFibro">{{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 |archive-url=https://web.archive.org/web/20080221172848/https://www.fda.gov/bbs/topics/NEWS/2007/NEW01656.html |archive-date=21 February 2008}}</ref><ref name="pmid38355316">{{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 |article-number=101933 |doi=10.1016/j.berh.2024.101933 |pmid=38355316}}</ref> (an [[anticonvulsant]]) and [[duloxetine]]<ref name="pmid38355316" /> (a [[serotonin–norepinephrine reuptake inhibitor]]) for the management of fibromyalgia. The FDA also approved [[milnacipran]]<ref name="pmid38355316" /> (another [[serotonin–norepinephrine reuptake inhibitor]]), but the [[European Medicines Agency]] refused marketing authority.<ref name="Doc. Ref.: EMA/814249/2009">{{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}}</ref>

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.<ref name=":9">{{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 }}</ref>

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.<ref>{{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 |article-number=CD011824 |doi=10.1002/14651858.CD011824 |pmc=6485478 |pmid=35658166}}</ref> Some medications have the potential to cause withdrawal symptoms when stopping, so gradual discontinuation may be warranted, particularly for antidepressants and pregabalin.<ref name="pmid19623319" /> 

A 2018 research review (16 studies included) found there was very little evidence to support or refute that combinations of medications were more effective than single medications for reducing fibromyalgia pain.<ref name="Thorpe Combination pharmacotherapy">{{cite journal |last1=Thorpe |first1=Joelle |last2=Shum |first2=Bonnie |last3=Moore |first3=R Andrew |last4=Wiffen |first4=Philip J. |last5=Gilron |first5=Ian |title=Combination pharmacotherapy for the treatment of fibromyalgia in adults |journal=Cochrane Database of Systematic Reviews |date=2018 |volume=2020 |issue=10 |article-number=CD010585 |doi=10.1002/14651858.CD010585.pub2 |pmid=29457627 |pmc=6491103 }}</ref>

====Antidepressants====
[[Antidepressant]]s are one of the common drugs for fibromyalgia. Antidepressants can improve the quality of life for fibromyalgia patients in the medium term.<ref name="Mascarenhas-2021" /> [[Duloxetine]] and [[milnacipran]] have good evidence of substantial pain relief, with no increased risk for serious adverse effects.<ref name=":9" /> However, there is no good evidence showing that amitriptyline, [[milnacipran]], or [[duloxetine]] improve sleep quality.<ref name=":8" />

A 2023 meta-analysis found that duloxetine improved fibromyalgia symptoms, regardless of the dosage.<ref>{{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 |article-number=504 |doi=10.1186/s13018-023-03995-z |pmc=10351165 |pmid=37461044 |doi-access=free}}</ref>  SSRIs may be also be used to treat depression in people diagnosed with fibromyalgia.<ref>{{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 |article-number=CD011735 |doi=10.1002/14651858.cd011735 |pmc=4755337 |pmid=26046493}}</ref>

While amitriptyline has been used as a first-line treatment, the quality of evidence to support this use is poor.<ref name="Moore2015">{{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}}</ref>

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.<ref>{{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 |article-number=CD012708 |doi=10.1002/14651858.CD012708.pub2 |pmc=6513659 |pmid=30080242}}</ref>

Tentative evidence suggests that [[monoamine oxidase inhibitor]]s (MAOIs) such as [[pirlindole]] and [[moclobemide]] are moderately effective for reducing pain.<ref name="Tort2012">{{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 |article-number=CD009807 |doi=10.1002/14651858.cd009807 |pmc=11729144 |pmid=22513976}}</ref> Very low-quality evidence suggests pirlindole as more effective at treating pain than moclobemide.<ref name="Tort2012" /> Side effects of MAOIs may include nausea and vomiting.<ref name="Tort2012" />

====Anti-seizure medication====
The anti-convulsant medications [[gabapentin]] and [[pregabalin]] may be used to reduce pain.<ref name="Coch2017Gab">{{cite journal |last1=Cooper |first1=Tess E |last2=Derry |first2=Sheena |last3=Wiffen |first3=Philip J |last4=Moore |first4=R Andrew |title=Gabapentin for fibromyalgia pain in adults |journal=Cochrane Database of Systematic Reviews |date=3 January 2017 |volume=2018 |issue=3 |article-number=CD012188 |doi=10.1002/14651858.CD012188.pub2 |pmid=28045473 |pmc=6465053 }}</ref> There is tentative evidence that gabapentin may be of benefit for pain in about 18% of people with fibromyalgia.<ref name="Coch2017Gab" /> 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.<ref>{{cite journal |last1=Wiffen |first1=Philip J |last2=Derry |first2=Sheena |last3=Bell |first3=Rae Frances |last4=Rice |first4=Andrew SC |last5=Tölle |first5=Thomas Rudolf |last6=Phillips |first6=Tudor |last7=Moore |first7=R Andrew |title=Gabapentin for chronic neuropathic pain in adults |journal=Cochrane Database of Systematic Reviews |date=9 June 2017 |volume=2020 |issue=2 |article-number=CD007938 |doi=10.1002/14651858.CD007938.pub4 |pmid=28597471 |pmc=6452908 }}</ref> Pregabalin demonstrates a benefit in about 9% of people,<ref>{{cite journal |last1=Derry |first1=Sheena |last2=Cording |first2=Malene |last3=Wiffen |first3=Philip J |last4=Law |first4=Simon |last5=Phillips |first5=Tudor |last6=Moore |first6=R Andrew |title=Pregabalin for pain in fibromyalgia in adults |journal=Cochrane Database of Systematic Reviews |date=29 September 2016 |volume=2019 |issue=5 |article-number=CD011790 |doi=10.1002/14651858.CD011790.pub2 |pmid=27684492 |pmc=6457745 }}</ref> it may also enhance sleep quality.<ref name=":8" /> Pregabalin reduced time off work by 0.2 days per week.<ref name="Straube2011">{{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 |article-number=125 |doi=10.1186/1471-2474-12-125 |pmc=3118156 |pmid=21639874 |doi-access=free}}</ref> A 2025 review found that, for enhancing sleep quality in FM, [[pregabalin]] might be beneficial but had potential risks.<ref>{{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 |volume=64 |issue=8 |article-number=keaf147 |doi=10.1093/rheumatology/keaf147 |pmid=40084994 |pmc=12316380 }}</ref>

====Opioids====
The use of opioids is controversial. As of 2015, no opioid is approved for use in this condition by the FDA.<ref name="Mac2015">{{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}}</ref> A 2016 [[Cochrane (organisation)|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.<ref>{{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 |article-number=CD012329 |doi=10.1002/14651858.CD012329 |pmc=6457853 |pmid=27582266 |collaboration=Cochrane Pain, Palliative and Supportive Care Group}}</ref> 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.<ref name="NIH2014Tx">{{cite web |date=July 2014 |title=Questions and Answers about Fibromyalgia |url=https://www.niams.nih.gov/health-topics/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 |url-status=live |website=NIAMS}}</ref> The [[Association of the Scientific Medical Societies in Germany]] in 2012 made no recommendation either for or against the use of weak [[opioid]]s because of the limited amount of scientific research addressing their use in the treatment of fibromyalgia. They strongly advise against using strong opioids.<ref name="German">{{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}}</ref> 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.<ref name="Canadian" />

A 2015 review found fair evidence to support tramadol use if other medications do not work.<ref name="Mac2015" /> A 2018 review found little evidence to support the combination of [[paracetamol]] (acetaminophen) and tramadol over a single medication.<ref name="Thorpe Combination pharmacotherapy"/> 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.<ref name="Don2016">{{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}}</ref>

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,<ref name="pmid21303476">{{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}}</ref> with around 10% of those prescribed short-acting opioids using tramadol;<ref name="Berger">{{cite conference |vauthors=Berger A |url=http://abstract.mci-group.com/cgi-bin/mc/printabs.pl?APP=EULAR2009SCIE-abstract&TEMPLATE=&keyf=2307&showHide=show&client= |title=Patterns of use of opioids in patients with fibromyalgia |conference=EULAR |date=2009 |article-number=SAT0461 | archive-url=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= | archive-date=6 June 2013 }}</ref> and a 2011 Canadian study of 457 people with fibromyalgia found 32% used opioids and two-thirds of those used strong opioids.<ref name="Canadian" />

====Muscle relaxants====
In August 2025 the [[FDA]] approved [[cyclobenzaprine]] [[hydrochloride]] (produced under the brand name 'Tonmya') for use in fibromyalgia.<ref>https://www.accessdata.fda.gov/drugsatfda_docs/appletter/2025/219428Orig1s000ltr.pdf</ref><ref>{{Cite web|url=https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=BasicSearch.process|title=Drugs@FDA: FDA-Approved Drugs|website=www.accessdata.fda.gov}}</ref> Some trials had shown significant pain reduction<ref>{{cite journal |last1=Lederman |first1=Seth |last2=Arnold |first2=Lesley M |last3=Vaughn |first3=Ben |last4=Engels |first4=Jean M |last5=Kelley |first5=Mary |last6=Sullivan |first6=Gregory M |title=Pain relief by targeting nonrestorative sleep in fibromyalgia: a phase 3 randomized trial of bedtime sublingual cyclobenzaprine |journal=Pain Medicine |date=8 July 2025 |article-number=pnaf089 |doi=10.1093/pm/pnaf089 |pmid=40627411 |doi-access=free }}</ref><ref>{{cite web | title=FDA Greenlights Tonmya for Fibromyalgia Treatment | date=22 August 2025 | url=https://www.neurologyadvisor.com/news/fda-greenlights-tonmya-for-fibromyalgia-treatment/ }}</ref> although uncertainty remained on real world efficacy and scale of impact.<ref>{{cite web | title=Tonmya – Novel Fibromyalgia Treatment but Will it Deliver? | date=18 July 2025 | url=https://www.fibromyalgiafund.org/tonmya-novel-fibromyalgia-treatment-but-will-it-deliver/ }}</ref> 

The muscle relaxants [[cyclobenzaprine]], [[carisoprodol]] with acetaminophen and caffeine, and [[tizanidine]] are sometimes used to treat fibromyalgia; however, as of 2015 they were not approved for this use in the United States.<ref>{{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}}</ref><ref>{{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}}</ref>

====Other medications====
[[Melatonin as a medication and supplement|Melatonin]] has shown potential therapeutic value in managing fibromyalgia symptoms, including improvements in pain, sleep, anxiety levels, and quality of life.<ref name=":2">{{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|article-number=3736 |doi=10.1212/WNL.0000000000211204 }}</ref><ref name=":22">{{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 |article-number=101072 |doi=10.1016/j.ctcp.2019.101072 |pmid=31783341 }}</ref><ref>{{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 }}</ref> Melatonin is considered to be generally safe,<ref name=":22" /> hence it may be a promising supplementary treatment for fibromyalgia.<ref name=":2" />

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.<ref name="Mascarenhas-2021" />

Very low-quality evidence suggests [[quetiapine]] may be effective in fibromyalgia.<ref>{{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 |article-number=CD011804 |doi=10.1002/14651858.cd011804.pub2 |pmc=6457603 |pmid=27251337}}</ref>

[[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.<ref>{{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}}</ref>

[[Cannabinoid]]s may have some benefits for people with fibromyalgia. However, as of 2022, the data on the topic was still limited.<ref>{{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}}</ref><ref>{{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}}</ref><ref>{{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 |article-number=108216 |doi=10.1016/j.pharmthera.2022.108216 |pmid=35609718 |doi-access=free}}</ref> Cannabinoids may also have adverse effects and may negatively interact with common rheumatological drugs.<ref>{{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}}</ref> No high-quality evidence exists that suggests synthetic [[Tetrahydrocannabinol|THC]] ([[nabilone]]) helps with fibromyalgia.<ref>{{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 |article-number=CD011694 |doi=10.1002/14651858.cd011694.pub2 |pmc=6457965 |pmid=27428009}}</ref> 

[[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 [[Substance abuse|abuse]].<ref>{{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}}</ref>

[[Nonsteroidal anti-inflammatory drugs]] are not recommended for use as first-line therapy,<ref name="Heymann-">{{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}}</ref> and are not considered as useful in the management of fibromyalgia.<ref>{{cite journal |last1=Derry |first1=Sheena |last2=Wiffen |first2=Philip J |last3=Häuser |first3=Winfried |last4=Mücke |first4=Martin |last5=Tölle |first5=Thomas Rudolf |last6=Bell |first6=Rae Frances |last7=Moore |first7=R Andrew |title=Oral nonsteroidal anti-inflammatory drugs for fibromyalgia in adults |journal=Cochrane Database of Systematic Reviews |date=27 March 2017 |volume=2020 |issue=2 |article-number=CD012332 |doi=10.1002/14651858.CD012332.pub2 |pmid=28349517 |pmc=6464559 }}</ref>

===Nutrition and dietary supplements===
Reviews in 2023 and 2020 found only limited or no evidence existed to recommend any specific diet to people with FM.<ref>{{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 }}</ref><ref>{{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|page=2664|doi=10.3390/nu12092664|doi-access=free |pmid=32878326|pmc=7551150}}</ref>

Studies indicate that weight management is helpful for reducing FM impact.<ref name="Kadayifci-2022">{{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}}</ref><ref>{{cite journal |last1=Almirall |first1=Miriam |last2=Musté |first2=Marta |last3=Serrat |first3=Mayte |last4=Touriño |first4=Rafael |last5=Espartal |first5=Esther |last6=Marsal |first6=Sara |title=Restrictive Diets in Patients with Fibromyalgia: State of the Art |journal=Biomedicines |date=12 March 2024 |volume=12 |issue=3 |page=629 |doi=10.3390/biomedicines12030629 |pmid=38540241 |pmc=10968491 |doi-access=free }}</ref>

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.<ref name="Kadayifci-2022"/> The consumption of fruits and vegetables, low-processed foods, high-quality proteins, and healthy fats may have some benefits.<ref name="Kadayifci-2022" /> Low-quality evidence found some benefits of a vegetarian or [[Veganism|vegan]] diet.<ref>{{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 |page=4955 |doi=10.3390/ijerph18094955 |pmc=8125538 |pmid=34066603 |doi-access=free}}</ref>

Although [[dietary supplement]]s 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.<ref>{{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 }}</ref> It appears that [[Coenzyme Q10|Q10 coenzyme]] and [[vitamin D]] supplements can reduce pain and improve quality of life for fibromyalgia patients.<ref name="Ibáñez-Vera-2018">{{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}}</ref><ref name="The efficacy of vitamin D in treatm">{{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 }}</ref> Q10 coenzyme has beneficial effects on [[fatigue]] in fibromyalgia patients, with most studies using doses of 300&nbsp;mg per day for three months.<ref>{{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 }}</ref> Q10 coenzyme is hypothesized to improve mitochondrial activity and decrease inflammation.<ref>{{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 }}</ref> Vitamin D has been shown to improve some fibromyalgia measures, but not others.<ref name="The efficacy of vitamin D in treatm" /><ref>{{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 }}</ref>

=== Physical therapy ===
Patients with chronic pain, including those with fibromyalgia, can benefit from techniques such as [[manual therapy]], [[cryotherapy]], and [[balneotherapy]].<ref name=":5">{{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 | article-number = 101937 | date = August 2024 | pmid = 38669729 | doi = 10.1016/j.smrv.2024.101937 | hdl-access = free | doi-access = free | hdl = 10481/92720 }}</ref> These can lessen the experience of chronic pain and increase both the amount and quality of sleep. Patients' [[Quality of life (healthcare)|quality of life]] is also improved by decreasing pain mechanisms and increasing sleep quality, particularly during the [[Rapid eye movement sleep|REM]] phase, sleep efficiency, and alertness.<ref name=":5" />

A 2021 meta-analysis concluded that [[massage]] and [[myofascial release]] diminish pain in the medium term.<ref name="Mascarenhas-2021" /> As of 2015, there was no good evidence for the benefit of other mind-body therapies.<ref name="coch-mb">{{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 | article-number = CD001980 | date = April 2015 | pmid = 25856658 | pmc = 8409283 | doi = 10.1002/14651858.CD001980.pub3 }}</ref>

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.<ref>{{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 | article-number = CD007070 | date = May 2013 | pmid = 23728665 | pmc = 4105202 | doi = 10.1002/14651858.CD007070.pub2 }}</ref>

=== Electrical neuromodulation ===
Several forms of electrical neuromodulation, including [[transcutaneous electrical nerve stimulation]] (TENS) and [[Transcranial direct-current stimulation|transcranial direct current stimulation]] (tDCS), have been used to treat fibromyalgia. In general, they help reduce pain and depression and improve functioning.<ref>{{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 }}</ref><ref>{{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 }}</ref>

Transcutaneous electrical nerve stimulation (TENS) is the delivery of pulsed electrical currents to the [[skin]] to stimulate [[Peripheral nervous system|peripheral nerves]]. TENS is widely used to treat pain and is considered to be a low-cost, safe, and self-administered treatment.<ref>{{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 | article-number = CD012172 | date = October 2017 | pmid = 28990665 | pmc = 6485914 | doi = 10.1002/14651858.CD012172.pub2 | collaboration = Cochrane Pain, Palliative and Supportive Care Group }}</ref> As such, it is commonly recommended by clinicians to people suffering from pain.<ref name="Gibson-2019">{{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 | article-number = CD011890 | date = April 2019 | pmid = 30941745 | pmc = 6446021 | doi = 10.1002/14651858.CD011890.pub3 }}</ref> In 2019, an overview of eight [[Cochrane (organisation)|Cochrane reviews]] was conducted, covering 51 TENS-related [[randomized controlled trial]]s.<ref name="Gibson-2019" /> The review concluded that the quality of the available evidence was insufficient to make any recommendations.<ref name="Gibson-2019" /> A 2020 review concluded that transcutaneous electrical nerve stimulation may diminish pain in the short term, but there was uncertainty about the relevance of the results.<ref name="Mascarenhas-2021" />

Preliminary findings suggest that electrically stimulating the [[vagus nerve]] through an implanted device can potentially reduce fibromyalgia symptoms.<ref name="Martins-2021" /><ref name="Lange-2011">{{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 }}</ref> However, there may be adverse reactions to the procedure.<ref name="Lange-2011" />

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.<ref>{{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 }}</ref> A 2023 meta-analysis of 16 RCTs found that [[Transcranial direct-current stimulation|transcranial direct current stimulation]] (tDCS) of over 4 weeks can decrease pain in patients with fibromyalgia.<ref>{{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 }}</ref> 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.<ref name="Mascarenhas-2021" /> Several 2022 meta-analyses focusing on transcranial magnetic stimulation found positive effects on fibromyalgia.<ref>{{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 }}</ref><ref name="Choo-2022" /><ref name="Sun-2022" /> Repetitive transcranial magnetic stimulation improved pain in the short-term<ref name="Choo-2022" /><ref name="Sun-2022">{{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 }}</ref> and quality of life after 5–12 weeks.<ref name="Choo-2022" /><ref name="Sun-2022" /> Repetitive transcranial magnetic stimulation did not improve anxiety, depression, and fatigue.<ref name="Sun-2022" /> Transcranial magnetic stimulation to the left dorsolateral prefrontal cortex was also ineffective.<ref name="Choo-2022">{{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 }}</ref>

A systematic review of [[Neurofeedback|EEG neurofeedback]] for the treatment of fibromyalgia found most treatments showed significant improvements of the main symptoms of the disease.<ref name="pmid37179502">{{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 }}</ref> However, the protocols were so different, and the lack of [[Case–control study|controls]] or randomization impede drawing conclusive results.<ref name="pmid37179502"/>

=== Other interventions ===
A 2024 review found that [[fecal microbiota transplantation]] may reduce pain intensity and improve fatigue and quality of life in patients with fibromyalgia, but evidence was insufficient at that stage to support use.<ref>{{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 |page=5 |doi=10.3390/gidisord7010005 |doi-access=free }}{{Creative Commons text attribution notice|cc=by4|from this source=yes}}</ref> Research on gut microbiome links with FM continues.<ref>{{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 |article-number=e1224 |doi=10.1097/PR9.0000000000001224 |pmid=39726854 |pmc=11671092 }}</ref><ref>{{cite journal |last1=Minerbi |first1=Amir |last2=Gonzalez |first2=Emmanuel |last3=Brereton |first3=Nicholas J.B. |last4=Anjarkouchian |first4=Abraham |last5=Dewar |first5=Ken |last6=Fitzcharles |first6=Mary-Ann |last7=Chevalier |first7=Stéphanie |last8=Shir |first8=Yoram |title=Altered microbiome composition in individuals with fibromyalgia |journal=Pain |date=November 2019 |volume=160 |issue=11 |pages=2589–2602 |doi=10.1097/j.pain.0000000000001640 |pmid=31219947 |doi-access=free }}</ref><ref>{{Cite journal|title=Causal association between gut microbiota and fibromyalgia: a Mendelian randomization study|first1=Zhaohua|last1=Wang|first2=Dan|last2=Jiang|first3=Min|last3=Zhang|first4=Yu|last4=Teng|first5=Yaojiang|last5=Huang|date=29 May 2023|journal=Frontiers in Microbiology|volume=14|article-number=1305361|doi=10.3389/fmicb.2023.1305361|doi-access=free |pmid=38260871|pmc=10800605}}</ref>

[[Hyperbaric medicine|Hyperbaric oxygen therapy]] (HBOT) has shown beneficial effects in treating chronic pain by reducing inflammation and oxidative stress.<ref name="pmid362464011"/>  However, treating fibromyalgia with hyperbaric oxygen therapy is still controversial, in light of the scarcity of large-scale [[clinical trials]].<ref name="El-Shewy-2019" /> In addition, hyperbaric oxygen therapy raises safety concerns due to the [[Oxidative stress|oxidative damage]] that may follow it.<ref name="El-Shewy-2019">{{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 }}</ref>

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.<ref>{{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 | article-number = e062322 | date = January 2023 | pmid = 36690401 | pmc = 9872467 | doi = 10.1136/bmjopen-2022-062322 }}</ref>

==Society and culture==
Fibromyalgia causes a substantial economic and societal burden due to disability, reduced work hours, [[informal care]], early retirement, and healthcare utilization. According to a 2014 review indirect costs, such as those due to disability and lost productivity, accounted for most of the costs, and the cost to society amounted to "tens of thousands of dollars each year" per patient.<ref name=":11" /> A 2022 review of 36 studies found that fibromyalgia causes a significant economic burden on healthcare systems.<ref name="D'Onghia-2022">{{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 |article-number=152060 |date=October 2022 |pmid=35849890 |doi=10.1016/j.semarthrit.2022.152060}}</ref> Annual costs per patient were estimated to be $1,750 to $35,920 in the US, and $1,250 to $8,504 in Europe.<ref name="D'Onghia-2022" />

People with fibromyalgia can be subjected to significant stigma in society generally, and within the [[medical system]]. They may face disbelief in the legitimacy of their pain, moralizing attitudes, and suspicions of [[malingering]], which relate to the invisible nature of the pain and prejudices relating to the historic predominance of women amongst people with the condition.<ref name=":12">{{Cite journal |last=Quintner |first=John |date=2020-05-01 |title=Why Are Women with Fibromyalgia so Stigmatized? |journal=Pain Medicine |volume=21 |issue=5 |pages=882–888 |doi=10.1093/pm/pnz350 |pmid=31986200 }}</ref> Health professionals may hold negative attitudes towards patients with fibromyalgia, considering them "demanding" or their symptoms to be exaggerated or fake, and they may lack knowledge about the condition, which can also contribute to delays in diagnosis.<ref name=":12" /><ref name=":13">{{Cite journal |last1=Vázquez-González |first1=Gloria |last2=Allande-Cussó |first2=Regina |last3=Gómez-Salgado |first3=Juan |last4=Yildirim |first4=Murat |last5=Fagundo-Rivera |first5=Javier |last6=Climent-Rodríguez |first6=José Antonio |last7=Navarro-Abal |first7=Yolanda |date=2025-09-01 |title=Prejuicios, actitudes y estereotipos de los profesionales de la salud hacia la fibromialgia: una revisión sistemática |journal=Atención Primaria |volume=57 |issue=9 |article-number=103251 |doi=10.1016/j.aprim.2025.103251 |issn=0212-6567 |pmc=11951184 |pmid=40086066}}</ref> Many people with fibromyalgia feel that healthcare providers believe they are faking or exaggerating.<ref name=":13" /> This stigma can have a considerable impact on the social interactions, trust in healthcare, and mental health of people with fibromyalgia.<ref>{{Cite journal |last1=Colombo |first1=Benedetta |last2=Zanella |first2=Eleonora |last3=Galazzi |first3=Alessandro |last4=Arcadi |first4=Paola |title=The Experience of Stigma in People Affected by Fibromyalgia: A Metasynthesis |journal=Journal of Advanced Nursing |date=2025 |article-number=jan.16773 |doi=10.1111/jan.16773 |pmid=39835578 |doi-access=free |pmc=12460976 }}</ref>

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.<ref>{{Cite web|url=https://www.fibromyalgiafund.org/fibromyalgia-in-men/|title=Fibromyalgia in Men|website=American Fibromyalgia Syndrome Association (AFSA)}}</ref><ref>{{Cite web|url=https://ukfibromyalgia.com/blog/fibromyalgia-and-men|title=Fibromyalgia and Men|website=UK Fibromyalgia Magazine}}</ref><ref name="auto">{{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 }}</ref> There has been debate about whether men experience differences in FM symptoms compared to women.<ref name="auto" /><ref name="auto20"/><ref name="auto5" />

Well-known people with FM include [[Lady Gaga]],<ref name="auto13">{{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 }}</ref> [[Sinead O'Connor]],<ref name="auto13" /> [[Mary McDonough]],<ref>{{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 }}</ref> [[Janeane Garofalo]],<ref name="auto13" /> [[Rosie Hamlin]],<ref>{{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}}</ref> [[Kirsty Young]],<ref>{{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}}</ref><ref>{{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}}</ref> [[Lena Dunham]],<ref>{{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}}</ref><ref>{{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}}</ref> and [[Morgan Freeman]].<ref>{{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 }}</ref> [[Cricket|Cricketer]] [[Don Bradman#Troubled war years|Don Bradman]] was diagnosed with fibrositis, an early term for fibromyalgia.<ref>https://www.britannica.com/biography/Don-Bradman</ref><ref>https://trove.nla.gov.au/newspaper/article/26173143</ref><ref>https://adb.anu.edu.au/biography/bradman-sir-donald-george-don-32376</ref>

==History==

===Origins===
Chronic widespread pain had been described in the literature in the 19th century. Fibromyalgia was first recognized in the 1950s.<ref name="auto14"/>

Many names, including muscular rheumatism, fibrositis, psychogenic rheumatism, and [[neurasthenia]] had been applied historically to symptoms resembling those of fibromyalgia.<ref>{{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}}</ref> The term ''fibromyalgia'' was first used in 1976, when Phillip Kahler Hench used it to describe widespread pain symptoms,<ref name="pmid19623319"/> and it was used by researcher Mohammed Yunus in a scientific publication in 1981.<ref>{{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}}</ref>

A 1977 paper on fibrositis by Smythe and Moldofsky was important in the development of the fibromyalgia concept.<ref name=FMWars/><ref>{{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 |hdl=2027/uc1.31158006328784 }}</ref> The first [[Clinical trial|clinical]], controlled study of the characteristics of fibromyalgia syndrome was published in 1981,<ref name="Winfield">{{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}}</ref> providing support for symptom associations. In 1984, an interconnection between fibromyalgia syndrome and other similar conditions was proposed,<ref name="Inanici">{{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 }}</ref> and in 1986, trials of the first proposed medications for fibromyalgia were published.<ref name=Inanici/>

A 1987 article in the ''[[Journal of the American Medical Association]]'' used the term 'fibromyalgia syndrome', while saying it was a "controversial condition".<ref name="Goldenberg1987">{{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}}</ref> The [[American College of Rheumatology]] (ACR) published its first classification criteria for fibromyalgia in 1990.<ref name="Wolfe">{{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}}</ref> Later revisions were made in 2010,<ref name="Wolfe2010" /> 2016,<ref name="Wolfe2016" /> and 2019.<ref name="Arnold-2019" />

===Controversies on the nature and reality of fibromyalgia ===
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" was not a disease but instead a physical response to depression and stress.<ref name=Berenson>{{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}}</ref> 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."<ref name="news-medical.net">{{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 }}</ref> 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.<ref name="FMWars">{{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 }}</ref><ref name="p7880118">{{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 }}</ref>

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.<ref>{{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 }}</ref>

As of 2022, [[neurologist]]s and pain specialists tended to view fibromyalgia as a real pathology.<ref>{{Cite web|url=https://www.health.harvard.edu/diseases-and-conditions/is-fibromyalgia-real|title=Is fibromyalgia real?|first1=Hope|last1=Ricciotti|first2=Hye-Chun|last2=Hur|date=12 February 2021|website=Harvard Health|access-date=22 August 2025}}</ref> It was mostly seen as due to dysfunction of muscles and connective tissue as well as functional abnormalities in the central nervous system. [[Rheumatologists]] defined the syndrome in the context of "[[Nociplastic pain|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 proposed that fibromyalgia and other analogous syndromes be classified together as central sensitivity syndromes.<ref>{{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 }}</ref><ref name="Central sensitivity and fibromyalgi" />

===History of fibromyalgia diagnosis===
[[File:Tender points fibromyalgia.svg|thumb|The 18 tender points used in the 1990 [[American College of Rheumatology|ACR]] 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 the usefulness of tender points in diagnosis.<ref>{{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 }}</ref> Use of control points has been used to cast doubt on whether a person has fibromyalgia, and to claim the person is malingering.<ref name="pmid19623319">{{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 }}</ref>

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.<ref name=Wolfe2010>{{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 | doi-access = free | hdl-access = free | hdl = 2027.42/75772 | publisher = [[American College of Rheumatology]] }}</ref> 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.<ref name=Wolfe2010 />{{rp|607}}}} in which the person has experienced pain in the preceding week.<ref name=Wolfe2016/> The SSS rates the severity of the person's fatigue, [[non-restorative sleep|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.<ref name=Wolfe2010 />{{rp|607}}}} each on a scale from 0 to 3, for a composite score ranging from 0 to 12.<ref name=Wolfe2016/> 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.<ref name=Wolfe2010 />{{rp|607}}

==Notes==
{{notelist}}

== References ==
{{Reflist}}

== External links ==
{{Commons}}
* [https://www.cdc.gov/arthritis/basics/fibromyalgia.htm Arthritis&nbsp;– Types&nbsp;– 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 [[National Health Service|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:Fibromyalgia| ]]
[[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]]