Fibromyalgia (also called fibromyalgia syndrome or FMS) is a long‑term condition that causes pain and tenderness in many parts of the body and is often accompanied by tiredness and sleep problems. It is a chronic pain syndrome rather than a disease of the joints or muscles – the joints, muscles and bones are usually normal on examination. The condition can affect anyone but it is more common in women than men and usually starts between ages 25 and 55. Studies suggest up to 2 % of adults may have fibromyalgia and as many as one person in 25 may develop the condition at some stage.

Fibromyalgia is not life‑threatening and does not damage the joints or organs. However it can have a major impact on everyday life. A combination of self‑management strategies, exercise, psychological therapies and sometimes medicines can help to control symptoms and improve quality of life.

 

Causes and risk factors

 

The exact cause is unknown. Research shows that people with fibromyalgia have changes in the way their brain and spinal cord process pain; sensations that would not normally hurt are perceived as painful (a phenomenon called central sensitisation). This may involve abnormal levels of neurotransmitters such as substance P. Genetics may play a role – fibromyalgia can run in families. The condition often starts after physical or emotional triggers such as an injury, surgery, childbirth, infection or significant stress. Factors associated with a higher risk include being female, aged 25–55, a family history of fibromyalgia, trauma and certain infections.

 

Symptoms

 

The main symptom is widespread pain, often described as aching, burning or stabbing, which can affect the whole body but is frequently worse in the back or neck. Many people have tender points on both sides of the body and in multiple regions. Symptoms can vary from day to day and flare‑ups may be triggered by stress, weather changes or activity.

Other common symptoms include:

·         Extreme sensitivity – even light touch, noise, temperature or bright light can cause pain or discomfort (hyperalgesia or allodynia).

·         Stiffness – particularly after periods of inactivity such as on waking.

·         Fatigue – persistent tiredness that can range from mild to severe and may feel like having the flu.

·         Poor sleep – often waking unrefreshed even after adequate hours of sleep (non‑restorative sleep). Restless legs syndrome and sleep apnoea may also occur.

·         “Fibro‑fog” – problems with memory, concentration and thinking clearly.

·         Headaches or migraines.

·         Digestive problems – such as irritable bowel syndrome causing stomach pain, bloating, diarrhoea or constipation.

·         Tingling or numbness in the hands and feet.

·         Feeling too hot or too cold, dizziness or clumsiness.

·         Anxiety or depression – persistent low mood occurs in some people and should be discussed with a GP.

Because symptoms overlap with many other conditions, fibromyalgia can be difficult to diagnose and often takes years before being recognised.

 

Diagnosis

 

Fibromyalgia is diagnosed clinically – there is no specific blood test or imaging test for the condition. Doctors make the diagnosis by listening to your symptoms and medical history and ruling out other conditions such as arthritis, hypothyroidism or anaemia with blood tests or scans. Guidance from the American College of Rheumatology (ACR) 2016 criteria suggests that fibromyalgia may be diagnosed when all of the following apply:

1.    Widespread pain index (WPI) ≥ 7 and symptom severity scale ≥ 5; or WPI 4–6 and symptom severity scale ≥ 9.

2.    Generalised pain in at least four of five body regions (left/right upper, left/right lower and axial).

3.    Symptoms have persisted at a similar level for at least three months and cannot be explained by another disorder.

Your GP may also use a symptom checklist or tender point examination and consider associated symptoms such as unrefreshing sleep, cognitive difficulties and fatigue. Sometimes referral to a rheumatologist or pain specialist is needed if the diagnosis is uncertain or there are “red flags” suggesting another condition.

 

Treatment – general principles

 

Fibromyalgia cannot be cured, but symptoms can be managed. Evidence‑based guidelines emphasise a multidisciplinary approach with self‑management, exercise and psychological therapy as first‑line interventions, and medicines considered only when necessary. People usually need a combination of strategies; what works for one person may not work for another.

 

Non‑drug treatments

Evidence‑based approach	Key points	Evidence
Graded exercise programmes	Regular aerobic and strengthening exercises reduce pain and improve quality of life. Swimming, walking and cycling are commonly recommended; a physiotherapist can help design a programme and teach pacing so activity is increased gradually without flare‑ups. Short‑term increases in pain are common when starting exercise.	NHS and EULAR guidelines emphasise exercise as a core treatment for fibromyalgia. A Cochrane review found exercise improves fatigue and pain control.
Psychological therapies	Acceptance and commitment therapy (ACT) and cognitive behavioural therapy (CBT) can help you cope with pain, improve sleep and mood, and change unhelpful thinking patterns. These therapies address the emotional impact of chronic pain and encourage behaviour change.	NHS guidance recommends ACT and CBT for long‑term pain. Studies show CBT may reduce pain and improve quality of life.
Education and self‑management	Learning about fibromyalgia and understanding how pain is processed can reduce fear and improve control. Setting realistic goals, pacing activities, relaxation and stress‑management strategies all help. Support groups offer shared experiences.	Evidence indicates that patient education and self‑management empower individuals to manage symptoms.
Sleep hygiene	Good sleep habits (consistent wake times, relaxing routines before bed, avoiding caffeine/alcohol in the evening and making the bedroom comfortable) can improve non‑restorative sleep. Cognitive therapies and regular exercise also aid sleep.	NHS and Versus Arthritis recommend improving sleep hygiene and avoiding sedatives because long‑term use of sleeping tablets can cause dependence and are generally ineffective.
Occupational therapy and pain management programmes	Occupational therapists can advise on ergonomic adjustments and energy‑conserving techniques to manage daily activities. Multidisciplinary pain clinics teach coping skills and may offer group programmes.	Evidence supports multidisciplinary pain management for persistent pain.
Complementary therapies	Acupuncture may provide short‑term pain relief for up to three months. Warm‑water therapy and gentle massage can improve comfort or reduce stress. These treatments should be used alongside, not instead of, core treatments.	NICE and Versus Arthritis caution that evidence for these therapies is limited, and benefits are usually short‑term.
Diet and lifestyle	No specific diet cures fibromyalgia, but maintaining a healthy weight, limiting saturated fats, sugar and salt, and eating plenty of fruit and vegetables can improve general health. Some people identify food sensitivities and may benefit from keeping a food diary and doing elimination trials under guidance. Regular hydration and avoiding smoking are also advised.	Versus Arthritis notes that a balanced diet supports overall health and may help manage symptoms.
Relaxation and stress management	Techniques such as deep breathing, meditation, mindfulness and gentle yoga reduce tension and may ease pain. Taking time each day to relax and engaging in enjoyable activities can help prevent flare‑ups.	Stress can worsen symptoms; relaxation techniques are recommended by NHS and Versus Arthritis.
Support groups and education programmes	Contacting charities like Fibromyalgia Action UK (helpline: 0300 999 3333) and UK Fibromyalgia can provide information, peer support and coping tips. Many local health services offer pain management courses or fibromyalgia self‑management programmes.	Support groups improve social connection and wellbeing.

 

Medicines

 

Medication is not a cure and is usually reserved for cases where non‑drug measures have been optimised. Drugs should be reviewed regularly with a healthcare professional.

• Antidepressants – Low‑dose antidepressants may relieve pain, improve sleep and boost mood. Commonly used medicines include amitriptyline, duloxetine, fluoxetine, paroxetine, citalopram and sertraline. NICE recommends antidepressants as first‑line drug treatment for chronic primary pain such as fibromyalgia. Benefits may take several weeks; potential side effects (e.g., drowsiness, dry mouth, nausea) should be discussed with your doctor.
• Gabapentin – These medicines target nerve pain. Some people benefit, but evidence is limited and they are not routinely recommended by NICE. They can cause dizziness and drowsiness and may lead to dependence.
• Painkillers – Conventional painkillers (paracetamol, ibuprofen or stronger opioids) often provide little benefit for fibromyalgia because they act on the peripheral tissues rather than the central nervous system. Strong opioids (e.g., morphine) and tramadol are generally avoided because of addiction risks and lack of long‑term benefit. See our page on long term opioid use - https://www.kensingtonmedicalcentre.co.uk/information-for-people-on-longer-term-painkillers
• Sleeping tablets and muscle relaxants – Sedative medicines and sleeping tablets are not recommended as they do not improve fibromyalgia and can cause dependence. Muscle relaxants such as cyclobenzaprine may improve sleep slightly but not pain and cause adverse effects.

 

Living with Fibromyalgia

 

Living with fibromyalgia involves learning to manage symptoms and pace activities. Symptoms tend to fluctuate; many people experience good days and bad days. The condition does not shorten life expectancy. Some people’s symptoms improve significantly over time, while others have ongoing symptoms that wax and wane. Key strategies include:

1.    Understand your condition – Recognise that the pain is real and related to how your nervous system processes pain signals. Learning about fibromyalgia can reduce fear and anxiety.

2.    Pace yourself – Balance activity and rest. Break tasks into smaller steps and take breaks before reaching exhaustion.

3.    Stay active – Gentle, regular exercise and stretching improve fitness and mood and help prevent muscle deconditioning.

4.    Look after your mental health – Talk to your GP if you feel low or anxious. Counselling, CBT or other therapies can help.

5.    Adopt healthy sleep habits – Keep to a regular sleep schedule and create a relaxing bedtime routine.

6.    Eat a balanced diet – Maintain a healthy weight and stay hydrated.

7.    Ask for support – Share how you feel with family and friends. Join support groups and online communities.

 

When to seek medical advice

 

·         If you think you may have fibromyalgia or have persistent unexplained pain and tiredness.

·         If you develop new symptoms such as joint swelling, fever, weight loss or neurological problems – these may suggest another condition.

·         If your current treatment is not helping or causes troublesome side effects.

·         If you feel low, anxious or overwhelmed; mental health support is available.

 

Key points

 

·         Fibromyalgia is a chronic pain syndrome characterised by widespread pain, fatigue and sleep problems; it does not damage the body but can affect quality of life.

·         The cause is unknown, but changes in pain processing, genetics and triggers such as stress or injury are involved.

·         Diagnosis is clinical; there is no specific test. Doctors use criteria based on widespread pain, symptom severity and duration.

·         Management focuses on non‑drug approaches: graded exercise, psychological therapies, education, pacing, sleep hygiene and lifestyle changes.

·         Medicines, usually antidepressants, may help some people but opioids and many other drugs are not recommended.

·         Support from healthcare professionals, family, friends and support groups is important for coping with the condition.

 

 

Charity Summaries

 

Fibromyalgia Action UK - https://www.fmauk.org/

·         A registered charity predominantly run by volunteers—many of whom live with fibromyalgia themselves—and provides a wealth of support options fibromyalgiafund.org+13Pain UK+13fmauk.org+13.

·         Services include:

o    National helpline covering benefits and condition-specific advice

o    A UK-wide network of support groups

o    Online support forums and email-based responses by regional coordinators

o    Support with awareness raising, medical information, and legal or benefits guidance Pain UK.

 

The Brain Charity

·         Provides practical and emotional support for fibromyalgia through its classification as a neurological condition The Brain Charity.

·         Offers counselling, phone befriending, group therapy, social activities, and access to informational resources from its Liverpool centre, for both patients and carers The Brain Charity.

·         Also offers additional resources, including publications and a library system for related conditions .

 

UK Fibromyalgia - https://ukfibromyalgia.com/

·         An organization offering community and informational support to those affected by fibromyalgia .

·         Provides:

o    A monthly magazine in print and digital formats

o    Advice on therapies, navigating healthcare, lifestyle support, and complementary approaches

o    A support groups map and online community-building tools .

 

This leaflet is for general information and is not a substitute for medical advice. Consult your GP or specialist for individual assessment and treatment.