Learn about Fibromyalgia and how you can manage it in partnership with your healthcare team

painHEALTH - Fibromyalgia

Fibromyalgia (FM) is a common health condition that causes widespread body pain and sensitivity to touch. Women are most often affected, but men and children can also have FM. FM affects two to eight percent of people1. No one knows what causes FM, but theories include genetic susceptibility, environmental triggers that interact with genes, and changes in how the body responds to inflammation, an illness, physical stress or emotional stress. FM represents a group of symptoms, with body pain as the key symptom. FM can range from mild to severe and symptoms may fluctuate over time2.

In FM, it is like the pain ‘volume button’ is turned up. The way in which the nervous system processes normal sensations (such as touch and movement) changes. This means that normal non-painful sensations like touch and movement can be interpreted as painful, and painful sensations hurt even more than usual. This is known as increased pain sensitivity.

What are the symptoms of Fibromyalgia?

A variety of symptoms can occur when you have Fibromyalgia such as:

  • Widespread body pain
  • Sleep disturbances
  • Generalised muscle and joint stiffness in the mornings
  • Headaches
  • Jaw pain and clicking
  • Numbness and tingling of the hands and feet
  • Restless legs syndrome
  • Sensitivity to hot and cold temperatures
  • Sensitivity to loud noises or bright lights
  • Cognitive (thinking) and memory difficulties
  • Low mood (depression) or anxiety.

You may also experience conditions such as irritable bowel syndrome, painful menstrual periods, chronic fatigue and other visceral (gut and bowel) conditions. It is important to see your doctor to check your symptoms, as there can be other medical reasons to explain some of these symptoms.

How do you diagnose Fibromyalgia?

Your GP can make a diagnosis. They may also refer you to a specialist, usually a rheumatologist. At present, there is no laboratory test that can diagnose FM and repeated testing is strongly discouraged.

Fibromyalgia diagnostic criteria were updated in 20163. FM may now be diagnosed in adults when all of the following criteria are met:

  • Generalised 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.

What treatments are available for Fibromyalgia?

Like many other pain conditions there is currently no cure for FM, but there are many things that can help. Current evidence recommends that treatments should include both non-pharmacologic (e.g. exercise, activity, diet, sleep hygiene) and pharmacologic (medicines) strategies. It is very important that you are actively involved in managing your FM, in partnership with your healthcare team (this is known as self-management)2,4.

Your treatment needs to be directed at your needs, as one size does not fit all. The key is to try and work out the parts of your FM you can address and the main triggers for your symptoms. You may like to draw a pie chart and allocate the “pieces of the pie” that are part of your condition that need management. Treatments may include:

  • Improving your sleep routine
  • Having a balanced diet
  • Relaxation
  • Meditation strategies
  • Pacing your activity
  • Exercise
  • Goal setting
  • Controlling your mood and your physical and emotional “load” or stress
  • Medicines.

The list of treatments above may be helpful to address various parts of your “pie”. Rather than tackling all pieces of the pie in one go, try focusing on 1 or 2 small achievable goals. For example, improving your sleep routine is a great start to better managing your pain. Developing a regular sleep time and routine will help to reduce your pain. Using a low dose anti-depressant may help you to regulate your sleep: discuss this with your doctor. Improved sleep means less pain and allows you to undertake more carefully paced activity and exercise. So, rather than using a single approach (like medications), you have coupled up a few simple strategies (sleep, medications and paced activity). This multimodal approach can make a big difference to your pain over time.

So far, there has been no one dietary change that helps everybody with FM5; what helps one person may not be useful to another. Most importantly, if you intend to change your diet make sure that you are able to maintain adequate nutrition. If you need advice, discuss this with your doctor or a dietician.

What is the role of medications in managing Fibromyalgia?

Like many other pain disorders, medications can play a role in the management of FM, but are not recommended as a standalone treatment2. The aim of using of medications is to help keep you moving and stay involved in the things you love to do. Side effects from medications can vary and you should ask your doctor about the risks and benefits of your medicines.

The medications recommended for use in FM are designed to reduce or calm down nerve activity, reducing pain hypersensitivity. Evidence to support these medications in treating FM is lacking on the whole5, so it is important to discuss with your doctor what options they recommend.

Medications for FM4,6 may include:

  • Anti-depressants (Amitriptyline, Nortriptyline, Trimipramine)
  • Serotonin Noradrenaline Reuptake Inhibitors (SNRIs) such as Duloxetine (Cymbalta) and Venlafaxine (Effexor)
  • Anti-epilepsy drugs (Gabapentin and Pregabalin).

The use of melatonin (sleep hormone) in the treatment of FM is being explored, with preliminary data suggesting some positive effects. However, there is not yet sufficient evidence for a recommendation about melatonin7.

There is always research being done to try to find new medications which might be useful for people with FM. Ask your doctor about any medicines or natural agents to ensure you get accurate information about risks, benefits and evidence for its use.

Some medications have been shown to have little benefit and many side effects, such as the morphine (opioid) family.

If you have additional pain conditions, paracetamol or anti-inflammatory medications may also be recommended. While these are not recommended specifically for FM, they may help to reduce pain in other body areas and this may reduce the pain load on you.

You can read more in our medicines and procedures module, which outlines the different medicines, their pros and cons and how they fit into your overall management.

Helpful tips to manage Fibromyalgia

  • Set yourself little tasks you can achieve TODAY
  • Pace your activities: this means doing small bits often or taking the middle road, rather than overdoing or under doing. This also helps to conserve energy. See the pacing and goal setting module.
  • Exercise a little everyday7. Doing exercise you like, means that you are more likely to do it, even if this is only a short walk
  • Exercise is good for your general well-being, your mood, heart and lungs, joints and muscles, your balance and your bone health. Check out the movement with pain module
  • Gentle stretching and relaxation are often useful options. Try changing positions frequently rather than staying in the one position for extended periods
  • A regular sleep routine is very important - dark room, same time, quiet music may help. Check out our pain and sleep module
  • Planning your work and social activities ahead helps you think about ways you can better manage challenging situations or pain flares. Possibly only going for part of the function rather than all will help manage your energy levels and pain levels. You may find the Work and Pain module helpful
  • Asking your family or friends to help where possible, may not only help you, but also help them to understand your condition

Want further information?

For more information about Fibromyalgia, visit Arthritis Australia, Move or the Fibromyalgia Support Network of WA and Cochrane Summaries. Alternatively, if you want to talk to someone about Fibromyalgia, please seek further assistance.

Making sense of pain

Pacing and goal settings

Movement with pain

Approaching Pain

Chronic and Non-Cancer pain management plan

Fibromyalgia | Arthritis Australia

Exercise and Fibromyalgia | Arthritis Australia

  1. Clauw DJ. Fibromyalgia: a clinical review. JAMA 2014; 311(15): 1547-55. [PubMed]
  2. Fitzcharles MA, Ste-Marie PA, Goldenberg DL, et al. Canadian Pain Society and Canadian Rheumatology Association recommendations for rational care of persons with fibromyalgia: a summary report. The Journal of rheumatology 2013; 40(8): 1388-93. [PubMed]
  3. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Hauser W, Katz RL, et al. 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum. 2016 Dec;46(3):319-29. [PubMed]
  4. Ablin J, Fitzcharles MA, Buskila D, Shir Y, Sommer C, Hauser W. Treatment of fibromyalgia syndrome: recommendations of recent evidence-based interdisciplinary guidelines with special emphasis on complementary and alternative therapies. Evidence-based complementary and alternative medicine : eCAM 2013; 2013: 485272. [PubMed]
  5. Rossi A, Di Lollo AC, Guzzo MP, et al. Fibromyalgia and nutrition: what news? Clin Exp Rheumatol 2015; 33(1 Suppl 88): S117-25. [PubMed]
  6. Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ. Amitriptyline for fibromyalgia in adults. The Cochrane database of systematic reviews 2015; 7: CD011824. [PubMed]
  7. de Zanette SA, Vercelino R, Laste G, et al. Melatonin analgesia is associated with improvement of the descending endogenous pain-modulating system in fibromyalgia: a phase II, randomized, double-dummy, controlled trial. BMC Pharmacol Toxicol 2014; 15: 40. [PubMed]
  8. Macfarlane GJ, Kronisch C, Dean LE, Atzeni F, Hauser W, Fluss E, et al. EULAR revised recommendations for the management of fibromyalgia. Annals of the rheumatic diseases. 2016. [PubMed]

This module has been developed by Pavla Walsh, MBBS (UWA), FRACP (Rheumatology), FFPMANZCA, GCPRheum (UWA). Paediatric Rheumatologist and Pain Medicine Specialist, Princess Margaret Hospital and Helen Slater, PhD, FACP, Associate Professor, School of Physiotherapy and Exercise Science, Curtin University, Perth Australia. The information in this module is based on current best evidence research and clinical practice.