While fibromyalgia symptoms aren’t well understood, they’re very real. You may have fairly consistent levels of fibromyalgia symptoms or you may experience periods of low activity (remission) or suddenly intensified symptoms (flares).
This article details the full range of possible fibromyalgia symptoms and what they feel like, so you and your healthcare provider can identify fibromyalgia and find the right treatments for you.
Fibromyalgia Pain Symptoms
The hallmark symptom of fibromyalgia is widespread pain that can range or fluctuate from mild to incapacitating. To be considered widespread, the pain must be on both sides of your body plus above and below the waist.
In fibromyalgia, the brain processes pain signals in abnormal ways. That leads to unusual pain types:
Hyperalgesia, which is a heightened response to painful stimuli (“turning up the volume” of pain) Allodynia, which is pain from stimuli that usually aren’t painful, such as light touch or moderate heat or cold Paresthesia, which is abnormal nerve sensations including tingling, burning, or itching
Some people also have pain that moves in waves through the body. It’s common in fibromyalgia to have multiple types of pain symptoms.
Fibromyalgia pain may change from day to day or even over the course of the day. It may be:
SharpDiffuseThrobbingStabbing
A measurement of widespread pain is called a tender point exam. Healthcare providers check for pain in 18 places (9 paired points) throughout the body. This used to be part of the primary method of diagnosing fibromyalgia and can be used to gauge the success of treatments.
You may not be aware of pain in the tender point locations, but they’re painful when the provider applies pressure.
Muscle and Joint Symptoms
Fibromyalgia isn’t a joint disease like arthritis, but it can cause joint-related symptoms. Most, and possibly all, fibromyalgia cases involve symptoms of the soft tissues, including the muscles and connective tissues (tendons, ligaments, and fascia).
Muscle and joint symptoms may include:
Morning stiffness Muscle spasms or twitches (fasciculations) Muscle weakness, especially in the legs Diffuse, non-inflammatory swelling of the limbs, hands, and feet Joint pain around where tendons attach to bones and muscles Temporomandibular joint disorder (TMJ)
Research suggests these fibromyalgia symptoms are tied to increased rates of functional disability. They can lead to a slower walking speed, shorter stride, and balance problems on a level similar to that of rheumatoid arthritis or osteoarthritis.
Cognitive Symptoms
“Fibro fog,” also known as “brain fog,” is one of the more pervasive symptoms of fibromyalgia. Symptoms of cognitive dysfunction include:
ForgetfulnessConfusionTrouble concentratingTemporary loss of familiarity with your surroundingsImpaired comprehensionDifficulty speaking known words (dysphasia)Difficulty orienting direction or space (topographagnosia)Difficulty processing information you hear (central auditory processing disorder)Difficulty processing numbers or math (dyscalculia)
Many people living with the illness find cognitive dysfunction as debilitating as the pain itself—or even more so.
Energy and Sleep Symptoms
In fibromyalgia, fatigue is about more than just being tired—it’s persistent exhaustion that isn’t improved by rest. This chronic fatigue compounds feelings of fogginess and disorientation and contributes to high rates of depression.
Fibromyalgia is closely tied to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). They have similar symptoms and some common underlying physiology, and many people have both of them.
Fibromyalgia-related fatigue often goes hand-in-hand with sleep problems. This pair of symptoms all but guarantees to leave you exhausted and drained.
Symptoms and overlapping sleep disorders include:
Light or regularly broken sleepSleep starts (hypnic jerks)Obstructive sleep apneaRestless leg syndrome (RLS)Insomnia
Treating sleep disorders can help you feel not only better rested, but can lessen other fibromyalgia symptoms, as well.
Neurosensory Symptoms
As with pain, the neurosensory symptoms of fibromyalgia come from your brain’s abnormal reaction to normal stimuli.
Symptoms can include:
HeadachesChronic migrainesDizziness and vertigoFainting (syncope)Sensitivity to temperature, humidity, and an atmospheric pressureSensitivity to light (photophobia)Sensitivity to noise (hyperacusis)Sensitivity to smells (hyperosmia)
While the cause isn’t well understood, the symptoms are believed to be largely related to hyperactive neurotransmitters (chemical messengers in the brain) and overstimulation of certain nerve pathways.
Digestive and Elimination Symptoms
Digestive problems are common in people with fibromyalgia, with as many as 50% diagnosed with symptoms of irritable bowel syndrome (IBS). Like fibromyalgia, IBS is believed to be caused by abnormal central nervous system activity.
Symptoms may include:
BloatingNauseaAbdominal crampsDiarrheaConstipationIndigestionFrequent passing of gasDifficulty swallowing (dysphagia)Frequent urinationFrequent need to urinate (urinary urgency)Pain during urination (dysuria)Bladder spasmsPain during sexual intercourse (dyspareunia)
People with fibromyalgia frequently have interstitial cystitis (IC), a condition that causes chronic bladder pain.
Psychological Symptoms
Fibromyalgia and depression are closely linked. Some of that may be due to the long-term emotional impact of the condition.
However, some scientists believe it’s due to something shared by the two conditions: neurotransmitter dysregulation. Both fibromyalgia and major depression involve problems with:
SerotoninNorepinephrineDopamine
This is why you may be prescribed antidepressants for fibromyalgia even if you don’t have depression.
In addition to depression, other psychological fibromyalgia symptoms may include:
Anxiety or panic attacksGeneralized anxiety disorderMood swingsUnaccountable irritability
Reproductive Symptoms
Hormones are believed to play a cause-and-effect role in fibromyalgia. On one hand, hormones are believed to trigger symptoms. For example, you may have flares related to your menstrual cycle.
On the other hand, fibromyalgia may cause hormonal imbalances that trigger symptoms of the reproductive system, predominately in biological females.
Symptoms may include:
Extremely painful periodsPelvic painChronic pain of the vulva (vulvodynia)Premature menopause (premature ovarian failure)
When to See a Healthcare Provider
Fibromyalgia symptoms might seem strange, especially when they come and go and can even change considerably from hour to hour. Rest assured that you’re not the first person to feel this way about them, and healthcare providers who treat fibromyalgia are used to all of that.
You should talk to your provider if you have any of the following symptoms:
Chronic, severe, or recurrent pain that interferes with your daily lifePain that causes you emotional stress, anxiety, or depressionChronic fatigue and/or unrefreshing sleepInability to concentrate or think clearlyPain plus other potential fibromyalgia symptoms that worry you
At your appointment, try not to focus on just the “big” symptoms, as that may lead them in the wrong direction. Give a complete picture, including all of the symptoms you’ve been experiencing.
If your provider doesn’t understand fibromyalgia well, ask for a referral to a rheumatologist. That’s a doctor who specializes in musculoskeletal and autoimmune conditions.
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You can find a board-certified specialist in your area through the American College of Rheumatology’s online locator.
PainFatigueCognitive dysfunctionInsomniaHeadaches (especially changes in headache type, frequency, or severity)DepressionDigestive issues
More localized pain is common but varies from person to person, and even day to day in the same person. The most consistent area of pain is probably the spine.
Also, COVID-19 infection has been found to trigger flares in people who already have fibromyalgia.
Being more sedentary due to fibromyalgia symptoms and depressionPossible changes in the metabolism due to the illnessMedications that are tied to weight gain, especially Lyrica (pregabalin)
Carrying extra weight also appears to make fibromyalgia symptoms worse.`
