Learn about Fibromyalgia, current treatments available and helpful tips to help form part of a co-management treatment plan

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 Fibromyalgia. Fibromyalgia affects two to eight percent of people1. The reasons why people get Fibromyalgia are unclear with a number of theories proposed including genetic susceptibility, environmental triggers that may interact with genes, and changes in how the body responds to inflammation, physical or emotional stress, or an illness. FM represents a constellation of symptoms, with body pain present as the key symptom. There is a clinical spectrum of severity that is associated with functional outcome, and symptoms may fluctuate over time2.

In Fibromyalgia, 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) in people with Fibromyalgia also appears to be changed. This means that normal non-painful sensations like touch and movement can be interpreted as painful and pain sensations are amplified, hurting even more than usual (increased pain sensitivity).

What are the symptoms of Fibromyalgia?

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

  • 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 doctor can help make a diagnosis and if needed, may refer you to a specialist, usually a rheumatologist. At present, there is no confirmatory laboratory test and repeated laboratory testing is strongly discouraged. The most widely used clinical criteria for diagnosing Fibromyalgia come from the American College of Rheumatology (2010). These include:

  1. Pain and symptoms over the past week, based on the total number of painful areas out of 18 parts of the body, plus the level of severity of fatigue, waking unrefreshed and cognitive (memory or thought) problems. Plus the number of other general physical symptoms
  2. Symptoms lasting at least three months at a similar pain intensity level
  3. No other health condition that would explain the pain and symptoms you are experiencing.

What treatments are available for Fibromyalgia?

Current evidence recommends that treatments should be multimodal, and include both non-pharmacologic (e.g. exercise, activity, diet, sleep hygiene) and pharmacologic (medicines) strategies with a strong orientation towards active self-management directed at improving function2,3. Your treatment needs to be directed at your needs, as one size does not fit all. Discuss this with your doctor or health professional. Like many other pain conditions, currently there is no cure for Fibromyalgia, but there are many things that, taken together, can help! These treatments 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.

If you think that you may have a nutritional problem, ask your doctor for further guidance. So far, there has been no one dietary change that helps everybody with Fibromyalgia4; 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, a dietician may be of help.

Medications may also have a role to play. The key is to try and work out the parts of your Fibromyalgia pain condition you can address and what are the main triggers for your pain. You may like to draw a pie chart and allocate the “pieces of the pie” that are part of your Fibromyalgia pain condition that need management.

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 setting your focus 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.

What is the role of medications in managing Fibromyalgia?

Like many other pain disorders, medications can play a role in the management of Fibromyalgia, but are not recommended as a standalone treatment2. The use of medications is designed to help keep you moving and stay engaged 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 Fibromyalgia are designed to reduce or calm down nerve activity, reducing pain hypersensitivity. Evidence to support these medications in treating Fibromyalgia are lacking on the whole5, so it is important to discuss with your doctor what options they recommend.

Medications for Fibromyyalgia3,5 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 Fibromyalgia is also being explored with preliminary data suggesting some positive effects but there is not yet sufficient evidence for a recommendation about Melatonin6.

There is always research being done to try to find new medications which might be useful for people with Fibromyalgia. Ask your doctor about any medicines or natural agents to ensure you get accurate information about risks and 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, the use of paracetamol or anti-inflammatory medications may also be recommended. While these are not recommended specifically for Fibromyalgia, they may help to reduce pain in other body areas, thereby lessening the pain load on you. You can read more in our medicines and procedures pain management post 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 pain management 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 management 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 management 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 of benefit
  • 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, Arthritis Victoria 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. 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]
  4. 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]
  5. 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]
  6. 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]
  7. 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.