Overview
Fibromyalgia is a chronic condition characterised by widespread musculoskeletal pain, fatigue, sleep disturbance, and cognitive difficulties. It is thought to involve abnormal processing of pain signals in the brain, making the nervous system amplify normal sensations into significant pain.
How common is it?
Fibromyalgia affects approximately 2 to 4% of the UK population. It is more common in women and typically develops between ages 25 and 55.
Causes and risk factors
The exact cause is unknown, but fibromyalgia involves central sensitisation, where the nervous system becomes hypersensitive to pain signals. Stressful physical or emotional events often precede onset.
Common risk factors
- Viral infection as a trigger in some people
- Physical or emotional trauma
- Female sex
- Family history of fibromyalgia
- Anxiety, depression, or post-traumatic stress
- Other rheumatic conditions (rheumatoid arthritis, lupus)
- Sleep disorders
Symptoms
- Widespread musculoskeletal pain in multiple body areas
- Fatigue despite sleeping, unrefreshing sleep
- Cognitive difficulties ('fibro fog'): poor memory, difficulty concentrating
- Headaches
- Irritable bowel symptoms
- Sensitivity to heat, cold, light, and noise
- Anxiety and depression
When to see a doctor
See a doctor for persistent widespread pain lasting more than 3 months. Blood tests and clinical assessment are needed to rule out inflammatory arthritis, thyroid disease, and other treatable conditions.
Diagnosis
Diagnosis is clinical based on widespread pain lasting over 3 months and other associated symptoms, after ruling out other conditions. Blood tests (CRP, thyroid, ANA, full blood count) are normal in fibromyalgia.
Treatments
Aerobic exercise
The most evidence-based treatment for fibromyalgia. Gradual, paced increase in aerobic exercise (swimming, walking, cycling) reduces pain and fatigue over time. Start gently and build very slowly.
Medications
Low-dose amitriptyline or duloxetine can improve sleep, pain, and fatigue. Pregabalin (licensed for fibromyalgia) reduces nerve pain. NSAIDs and opioids are not effective.
Cognitive behavioural therapy
Helps people manage the impact of chronic pain on daily functioning, improve coping strategies, and address accompanying depression or anxiety.
Self-care and lifestyle
- Prioritise sleep hygiene: regular bed times, cool dark quiet room, avoid screens
- Use pacing strategies to avoid boom-bust cycles of overactivity followed by flare
- Warm baths or hydrotherapy can reduce pain temporarily
- Build a support network and connect with fibromyalgia peer support groups
Prevention
Fibromyalgia cannot be reliably prevented. Addressing sleep problems, managing stress, and treating anxiety and depression early may reduce the risk in vulnerable individuals.