Pain can be a symptom for many conditions and diseases, but what happens when it doesn’t have a definable cause? Fibromyalgia is a disorder that causes fatigue and a pattern of unexplained mild-to-intense pain throughout the body. The condition is six times more common in women than in men, though this female predominance seems to be much lower when newer diagnostic criteria are used.

The cause of the disorder is as yet unknown, and there is no cure. However, your doctor can help you manage your symptoms with lifestyle changes and medication.

“One way to think about fibromyalgia is that a person’s “pain thermostat” is set too low. For patients, this pain is real. It’s not just in their heads. But it can be much harder to treat that many other types of pain, says Joshua Bilsborrow, MD, a Yale Medicine rheumatologist. 

The most common symptoms of fibromyalgia are chronic widespread pain, fatigue, and generalized muscle aching. The pain is most commonly found in the soft tissue areas of the body, including the neck, upper shoulders, chest, rib cage, lower back, thighs, arms, and areas around certain joints (like the knees). Symptoms can flare up or worsen in response to infections, physical trauma, and emotional stress.

Patients also tend to have difficulty sleeping well, describe cognitive and memory difficulties (known as “brain fog”), and other co-occurring conditions like depression and anxiety. Other conditions commonly present in patients with fibromyalgia are irritable bowel syndrome (IBS) and rheumatologic conditions such as rheumatoid arthritis and lupus.

It’s unclear. Fibromyalgia is considered a “functional disorder,” which means that it’s characterized by specific symptoms that don’t appear to be caused by any physical or structural issue. Examples of other functional disorders include IBS, interstitial cystitis, and chronic pelvic pain.

Some studies suggest that fibromyalgia may be caused by an abnormality in the central nervous system leading to abnormal pain processing. Patients are more sensitive to pain signals, and sensations that would not normally be considered bothersome can be experienced as irritating or painful.

There may also be a genetic component. Studies show that fibromyalgia tends to run in families, and researchers have found genes related to the pain response that may play a role in a person’s risk for developing the condition.

Fibromyalgia is a diagnosis of exclusion, which means it’s diagnosed only after you undergo a thorough physical examination, medical history, and tests to rule out other potential conditions. 

During the physical exam, your doctor can look for a pattern of tender spots throughout your body. These tender spots, coupled with other common symptoms including fatigue, low-quality sleep, and brain fog, can point the doctor in the direction of a fibromyalgia diagnosis. Newer diagnostic criteria move beyond tender spots to identify widespread pain in different body regions, such as the arms, legs, chest, back, and hips.

Your doctor may also order lab tests to rule out other conditions that might be causing the pain.

Unfortunately, there is currently no cure for fibromyalgia, but lifestyle changes and medications can help to reduce your symptoms.

The following lifestyle changes to manage stress can reduce fibromyalgia symptoms:

• Improving sleep quality: Although it’s unclear whether low quality of sleep causes symptoms or if symptoms cause low-quality of sleep, there is a correlation between the two. Improving your quality of sleep by reducing stressors, adhering to a strict bedtime schedule and routine, as well as other techniques could reduce your symptoms.
• Exercising: Some evidence suggests that exercise may reduce pain.
• Mindfulness-based activities: Limited evidence shows that mindfulness-based activities including yoga and meditation may reduce pain symptoms. 

Medications your doctor might prescribe to treat symptoms of fibromyalgia include:

• Serotonin Norepinephrine Reuptake Inhibitors (SNRIs): Certain antidepressants prescribed at lower doses than those used to treat depression can decrease pain. They can also help improve sleep. 
• Gabapentinoids: these medications can improve pain in patients with fibromyalgia.

Complementary therapies, including massage, movement therapies, acupuncture, and chiropractic treatments may also help.

The Yale Medicine rheumatology department provides state-of-the-art clinical care for patients with arthritis and complicated, multisystem autoimmune diseases. We also utilize a full array of imaging and laboratory services to diagnose and treat conditions.

Yale Medicine’s approach to treating fibromyalgia incorporates medications, regular low-to-moderate intensity physical exercise, optimizing sleep quality, and treating concurrent mood issues (if present) such as depression and anxiety. Our doctors may also recommend complementary therapies such as physical therapy, massage, and mindfulness programs.