OVERVIEW

What is fibromyalgia syndrome?

Fibromyalgia syndrome, as the name suggests, refers to pain in muscle fibers, tendons, ligaments, and other tissues. Since muscle tissues are distributed throughout the body, the pain caused by fibromyalgia syndrome is characterized by widespread, diffuse discomfort that may occur in the neck, chest, lower back, thighs, calves, hands, and other areas. Additionally, this condition is often accompanied by fatigue, poor sleep, cognitive impairment (such as memory problems), and other issues. However, fibromyalgia syndrome does not cause damage to internal organs, and with appropriate treatment, the majority of patients can recover.

Is fibromyalgia syndrome common?

According to statistics, the prevalence of fibromyalgia syndrome in the United States is approximately 2%, with 3.4% in women and 0.5% in men. In rheumatology clinics in the U.S., one out of every six patients seeks treatment for fibromyalgia syndrome. There are no precise statistics in China yet, and the diagnosis rate of this condition remains relatively low.

What are the types of fibromyalgia syndrome?

Fibromyalgia syndrome can be divided into primary and secondary types.

• Primary (idiopathic) fibromyalgia syndrome: This type is not associated with any organic disease, meaning there is no damage to internal organs—only symptoms like pain are present.
• Secondary fibromyalgia syndrome: This type is believed to develop secondary to other conditions, such as osteoarthritis, rheumatoid arthritis, or systemic lupus erythematosus. However, the relationship between secondary fibromyalgia syndrome and its underlying causes is not yet fully understood. Diagnosing secondary fibromyalgia syndrome requires ruling out other possible diseases first, making its diagnosis relatively more challenging.

SYMPTOMS

What are the manifestations of fibromyalgia syndrome?

• Pain: Widespread pain throughout the body is the main characteristic of fibromyalgia syndrome.
• Tenderness: You may be abnormally sensitive to pressure on certain areas of your body, experiencing intense pain upon touch, leading to defensive reactions like withdrawal or refusal to continue pressure. These sensitive areas show no visible skin abnormalities. Studies of numerous fibromyalgia patients have found that tender points (trigger points) are consistent across different patients and align with diagnostic criteria.
• Pronounced fatigue and poor sleep quality.
• Joint symptoms: You may also experience joint pain, often with morning stiffness that improves with movement, typically lasting >1 hour. However, joint-related tests show no significant abnormalities.
• Other manifestations: You may also experience low mood, excessive focus on your condition, or even severe anxiety, depression, and other emotional disorders. Many people also report difficulty concentrating, memory loss, and impaired executive function. Over half of fibromyalgia patients experience headaches, dizziness, episodic vertigo, numbness, tingling, or a sensation of ants crawling on the skin.

What is unique about the pain and fatigue in fibromyalgia syndrome?

The pain in fibromyalgia syndrome is often intense. Previously, due to a lack of objective diagnostic methods, some patients were misled into believing the pain was imaginary. However, the medical community now universally acknowledges fibromyalgia pain as real.

This pain is diffuse and hard to pinpoint precisely. Most patients describe it as a "dull ache," with fluctuating intensity that often does not improve with rest.

Beyond pain, fatigue is one of the most common and distressing symptoms. This fatigue is not the normal tiredness after a busy day but a persistent exhaustion, where the first sensation upon waking may still be weariness.

Where are the tender points located in fibromyalgia syndrome?

There are 9 pairs (18 total) of identified tender points: around the neck (6), upper chest (4), around the hips (4), 2 cm below and slightly outside the elbow creases (2), and the inner knees (2). The exact locations, pressure methods, force, and interpretation of results follow strict standards and should be assessed by a specialist.

A diagnosis of fibromyalgia syndrome requires 11 or more tender points. Typically, women have more tender points, with over 90% of patients meeting this criterion being female.

What is the relationship between fibromyalgia syndrome and sleep?

Many fibromyalgia patients experience sleep issues, including difficulty falling asleep or frequent nighttime awakenings.

A U.S. study found that some fibromyalgia patients remain in light sleep and fail to enter deep sleep, which is essential for brain restoration. Deep sleep allows the body to repair daily wear and tear, and its absence creates a vicious cycle. Poor sleep may worsen pain, which in turn further disrupts sleep quality.

What is the relationship between fibromyalgia syndrome and depression?

About one-third of diagnosed fibromyalgia patients also exhibit depressive symptoms. The relationship between the two remains unclear.

Some researchers suggest depression may result from chronic pain and fatigue, while others propose that depression and heightened pain sensitivity may share common causes. Depressive symptoms may include difficulty concentrating, hopelessness, or loss of interest in previously enjoyed activities. Antidepressants are often used in fibromyalgia treatment.

What conditions can fibromyalgia syndrome lead to?

Some fibromyalgia patients may develop irritable bowel syndrome, dry mouth, dry eyes, or, less commonly, bladder irritation (frequency, urgency, pain) or Raynaud’s phenomenon (skin color changes triggered by cold or stress). However, the relationship between these symptoms and fibromyalgia is unclear, and whether fibromyalgia has definitive complications remains unknown.

Does fibromyalgia syndrome carry a risk of death?

A U.S. study found that fibromyalgia patients do not have a higher mortality rate than osteoarthritis patients, but their suicide rate exceeds that of the general population. Danish research supports this, noting an elevated suicide risk, particularly among female patients.

CAUSES

What are the causes of fibromyalgia syndrome?

Unfortunately, the exact cause and pathogenesis of fibromyalgia syndrome remain unclear. Current research suggests associations with sleep disorders, neuroendocrine changes, immune dysfunction, and psychological factors. No definitive theory fully explains the condition, highlighting its complexity.

Who is most commonly affected by fibromyalgia syndrome?

Women aged 20–70 face the highest risk of developing fibromyalgia. The likelihood increases with age, peaking after 60.

Is fibromyalgia syndrome related to climate?

No substantial evidence indicates that climate affects daily pain or fatigue levels in fibromyalgia patients.

Is fibromyalgia syndrome hereditary?

Recent studies suggest genetic factors may influence pain sensitivity, fibromyalgia risk, and treatment response. However, epidemiological data show a very low probability of passing the condition to offspring.

Why does pain sometimes worsen in fibromyalgia patients?

Common triggers include overwork, excessive physical labor, improper exercise, stress, and anxiety. Trauma, humidity, cold weather, and viral infections may also exacerbate symptoms.

DIAGNOSIS

Which department should I visit for fibromyalgia syndrome?

Fibromyalgia syndrome falls under the category of rheumatic diseases, so it is recommended to visit the rheumatology and immunology department. In foreign countries, after a clear diagnosis, a multidisciplinary team will provide collaborative assistance, including participation from rheumatology, neuropsychiatry, physiotherapy, rehabilitation medicine, medical psychology, and pain management departments.

How should patients with fibromyalgia syndrome describe their condition when seeing a doctor?

When visiting a doctor, patients should describe their discomfort as accurately and in as much detail as possible. For pain, they should describe:

• The time of onset, location, and severity of the pain, and whether there was any specific cause for its occurrence;
• Whether the pain has ever lessened or worsened and under what circumstances;
• Whether the pain is accompanied by other discomforts such as fever, cough, diarrhea, or vomiting;
• Whether they have taken any medication or received treatment at other medical institutions.
• They should also describe recent sleep conditions, dietary changes, mood, energy levels, and whether they have been diagnosed with other diseases (including cardiovascular diseases, diabetes, rheumatic-related diseases, bone and joint diseases, or whether they have undergone surgery or blood transfusion therapy).

The attending doctor will ask these questions in a certain order, and patients only need to cooperate and answer them clearly.

What tests should be done for fibromyalgia syndrome?

The cause of fibromyalgia syndrome is unclear, and primary fibromyalgia syndrome is not accompanied by organ damage. Therefore, there are currently no specific auxiliary tests to confirm the diagnosis.

However, to differentiate it from other diseases and assess the condition, doctors may conduct routine tests, including blood tests, electrolyte levels, liver and kidney function, serum calcium and phosphorus levels, ESR, CRP, etc. However, these tests often show no significant abnormalities.

Sometimes, doctors may also use functional magnetic resonance imaging (fMRI) or assessment scales (such as the Fibromyalgia Impact Questionnaire or Visual Analog Scale for pain) for evaluation. Therefore, if test results are normal, it does not mean you do not have fibromyalgia syndrome.

How is fibromyalgia syndrome diagnosed?

When unexplained chronic pain in multiple areas is accompanied by fatigue, poor sleep quality, anxiety, joint stiffness, and multiple tender points, a diagnosis can be made after ruling out other diseases.

Currently, the diagnosis is mostly based on the 1990 classification criteria for fibromyalgia syndrome proposed by the American College of Rheumatology. The criteria are as follows:

• Widespread pain lasting for more than 3 months: pain distributed on both sides of the body, above and below the waist, and in the axial skeleton (cervical spine, anterior chest, thoracic spine, or lower back).
• Pain in at least 11 of the 18 standard tender points.

A diagnosis is confirmed if both conditions are met. Fatigue, poor sleep quality, anxiety, and joint stiffness should also be considered to improve diagnostic accuracy.

The 2010 revised diagnostic criteria no longer require specific tender points. Instead, the body is divided into 19 regions, and pain in at least 7 regions is counted to form a Widespread Pain Index (WPI). Concurrent symptoms (such as fatigue, sleep disturbances, and cognitive dysfunction) are also included to form a Symptom Severity Score (SSS). The two scores are combined for diagnosis.

Which diseases can fibromyalgia syndrome be easily confused with?

Chronic pain and fatigue are common clinical symptoms. Fibromyalgia syndrome should be differentiated from chronic fatigue syndrome, myofascial pain syndrome, polymyalgia rheumatica, and other diseases. When you visit a doctor, they will differentiate based on your medical history and relevant tests.

What is the difference between fibromyalgia syndrome and muscle soreness after exercise?

After prolonged exercise, most people experience muscle soreness due to lactic acid buildup, which can be relieved with rest. Some soreness may also occur one or two days after exercise but can be alleviated with rest. Patients with fibromyalgia syndrome describe similar "soreness," but this pain occurs without any cause and usually does not improve with rest.

What is the difference between fibromyalgia syndrome and cancer pain?

Cancer pain usually occurs in the middle or late stages of cancer. Depending on the location and extent of tumor invasion, the nature and severity of cancer pain may vary, but it is often intense and difficult to control, requiring strong medications. Additionally, cancer patients often experience poor emotional states and significant psychological distress.

Fibromyalgia syndrome is much more manageable. First, it does not involve organ damage and does not affect lifespan. Second, there are multiple methods to control or even eliminate the pain, leading to recovery. Patients with fibromyalgia syndrome should have confidence in overcoming the condition.

TREATMENT

How Should Patients with Fibromyalgia Syndrome Participate in Their Treatment?

Patients should first alleviate their concerns—this condition is not life-threatening—and accept reality, as resistance can easily worsen symptoms. Rely on self-psychological adjustment, relax, and engage in regular physical exercise to improve negative mental states and alleviate symptoms. Cultivate diverse interests and communicate more with others, especially discussing the condition with doctors.

What Are the Medication Treatments for Fibromyalgia Syndrome?

Common medications for fibromyalgia syndrome include antidepressants (e.g., amitriptyline), anticonvulsants (e.g., pregabalin), analgesics (e.g., tramadol), and sedative-hypnotics.

In 2009, the U.S. FDA approved new drugs for fibromyalgia syndrome, such as duloxetine and pramipexole, which have shown satisfactory clinical results. Doctors will prescribe suitable medications based on your specific condition, starting with low doses.

If secondary fibromyalgia syndrome is caused by a clear underlying condition, the primary disease should also be treated.

Do Medications for Fibromyalgia Syndrome Have Severe Side Effects?

Here are the side effects of three common medications: Amitriptyline may cause dry mouth, drowsiness, constipation, and blurred vision; pregabalin may lead to dizziness, drowsiness, fatigue, dry mouth, and blurred vision; duloxetine generally causes dizziness, nausea, and headaches.

Note that these side effects are general cases. For complete information, refer to the drug instructions.

It’s best to choose cost-effective medications suitable for your condition under a doctor’s guidance, strictly follow dosage instructions, and reduce or discontinue use when symptoms improve.

Side effects occur at certain rates. Seek medical attention if severe side effects appear.

What Non-Drug Therapies Are Available for Fibromyalgia Syndrome?

These include exercise therapy and cognitive behavioral therapy (CBT).

• Moderate exercise and physical activity can reduce pain and enhance comfort. Exercising about three times a week alleviates fatigue and depressive symptoms, but avoid overexertion. Start with walking, stretching, or swimming, and find a suitable exercise routine and intensity.
• If cognitive or executive dysfunction is present, a psychologist or psychiatrist can help design an appropriate CBT plan.

Can Physical Therapy Be Used for Fibromyalgia Syndrome?

Physical therapies include electrotherapy (low-, medium-, and high-frequency currents, iontophoresis, etc.), phototherapy, and natural therapies (air baths, sunbathing, thalassotherapy, etc.). Some physical therapies have proven analgesic effects with minimal side effects. While no literature confirms their definitive efficacy for fibromyalgia syndrome, research is ongoing. Consult pain or rehabilitation specialists for experimental treatment.

With So Many Treatment Options, How Should I Choose?

Multiple options mean flexibility but also indicate that no single method may be entirely effective.

Medication decisions weigh efficacy against side effects. Though you may prefer non-drug treatments due to side effect concerns, follow your doctor’s advice if medication is necessary and evaluate its effects before continuing. For non-drug therapies, choose methods you enjoy to sustain long-term adherence.

What Is the Prognosis for Fibromyalgia Syndrome Patients?

Since fibromyalgia does not damage muscles, joints, or organs, it is non-disabling and non-life-threatening. Most patients achieve good outcomes with comprehensive treatment, experiencing significant pain relief and improved quality of life. However, a minority with severe psychiatric conditions, drug dependence, or long-term treatment resistance may have poorer outcomes.

Can Fibromyalgia Syndrome Be Cured?

Fortunately, though the cause remains unclear, doctors can help most patients manage pain, significantly improve their quality of life, and even achieve complete recovery.

DIET & LIFESTYLE

What is the level of public awareness of fibromyalgia syndrome?

Currently, the medical community also lacks a clear understanding of the nature of fibromyalgia syndrome. There are no definitive diagnostic tests, and treatment methods remain controversial. As a result, some healthcare professionals may not prioritize or fully understand the diagnosis and treatment of fibromyalgia syndrome. Diagnosis becomes even more challenging when the condition coexists with other diseases. Consequently, the number of confirmed cases in China is relatively low, and insufficient public education further contributes to the low awareness of fibromyalgia syndrome among the general population.

How does fibromyalgia syndrome affect daily life?

• Chronic pain and fatigue can lead to irritability, anxiety, and depression;
• It may impair one's ability to focus on work, care for children, or manage household chores;
• Fatigue and irritability can also cause difficulties in social activities.

What should patients with fibromyalgia syndrome pay attention to in daily life?

After being diagnosed with fibromyalgia syndrome, understanding the condition correctly, reducing mental stress and anxiety, preventing injuries, and avoiding damp or cold environments can help alleviate or control symptoms. Overexertion, excessive exercise, and irregular sleep patterns should also be avoided. Some patients report feeling worse after consuming certain foods, but there is no consistent pattern among these reports, so no specific food component has been conclusively linked to symptom aggravation. If you notice that certain foods, activities, or environments worsen your discomfort or pain, you should try to avoid them.

Can yoga, meditation, etc., help with fibromyalgia syndrome?

Reducing stress in daily life can significantly aid in managing the condition. You may choose yoga, meditation, or other stress-relieving activities.

How can family members of fibromyalgia syndrome patients support them?

Family support can help patients build confidence and determination to overcome the disease, encourage them to participate in social activities, and monitor emotional changes. If necessary, family members should urge the patient to seek medical attention promptly.

PREVENTION

Can Fibromyalgia Syndrome Be Prevented?

Since the cause of the disease remains unclear, there are no specific preventive measures. Maintaining a healthy lifestyle and actively adjusting physical and mental states are essential for preventing any disease.