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== Comorbidities, overlapping conditions, and common symptoms == [[File:Fibromyalgia and comorbid conditions.JPG|700px|thumb|center|The most common comorbid conditions in fibromyalgia are [[ME/CFS]], which is the most common comorbidity,<ref name="Jason2001" /> [[irritable bowel syndrome]] (IBS), [[tension-type headache]]s, [[migraine]], [[temporomandibular joint disorder]], [[chronic pelvic pain]], vulvodynia in women, [[interstitial cystitis]], painful bladder syndrome, and in men chronic prostatitis, and prostadynia.<ref name="ScienceOfFibro" /> Also common are [[autoimmune disease|autoimmune disease]]s, [[migraine]]s, [[Multiple chemical sensitivity|multiple chemical sensitivity]] (MCS), and [[orthostatic intolerance]] (OI) / [[postural orthostatic tachycardia syndrome]] (POTS).<ref name="Firdous2012" /><ref name="Yun2013" /><ref name="Comorbid2020">{{Cite journal | last = Sleurs | first = David | authorlink = | last2 = Tebeka | first2 = Sarah | authorlink2 = | last3 = Scognamiglio | first3 = Claire | authorlink3 = | last4 = Dubertret | first4 = Caroline | authorlink4 = | last5 = Le Strat | first5 = Yann | authorlink5 = | date = 2020 | title=Comorbidities of self-reported fibromyalgia in United States adults: A cross-sectional study from The National Epidemiological Survey on Alcohol and Related Conditions (NESARC-III)| url = https://onlinelibrary.wiley.com/doi/abs/10.1002/ejp.1585|journal=European Journal of Pain|language=en|volume=24|issue=8 | pages = 1471–1483|doi=10.1002/ejp.1585|issn=1532-2149|pmc=|pmid=|access-date=|quote=|via=}}</ref> Overlapping conditions are [[ME/CFS]], [[IBS]], [[Temporomandibular joint disorder]] (TMD), [[interstitial cystitis]], [[multiple chemical sensitivity]], chronic [[tension-type headache]], and chronic low back pain.<ref name="Firdous2012" /><ref name="mayo" /><ref name="Yunus2008" />]] ====Overlapping conditions ==== The most common overlapping medical conditions in people with fibromyalgia are [[ME/CFS]], [[IBS]], [[Temporomandibular joint disorder]] (TMD), [[interstitial cystitis]], [[multiple chemical sensitivity]], chronic [[tension-type headache]], and chronic low back pain<ref name="Yunus2008">{{Cite journal | last = Yunus | first = Muhammad B. | author-link = Muhammad Yunus | date = 2007-06-01 | title = Fibromyalgia and Overlapping Disorders: The Unifying Concept of Central Sensitivity Syndromes |url =https://www.sciencedirect.com/science/article/pii/S0049017207000066|journal=Seminars in Arthritis and Rheumatism|language=en|volume=36|issue=6 | pages = 339–356|doi=10.1016/j.semarthrit.2006.12.009|issn=0049-0172|pmc=|pmid=|access-date=|quote=|via=}}</ref> ===[[Allodynia]]=== Allodynia is when ordinary sensations cause pain, and is common in people with fibromyalgia.<ref name="Coster2008">{{Cite journal | last = Cöster | first = Lars | last2 = Kendall | first2 = Sally | last3 = Gerdle | first3 = Björn | last4 = Henriksson | first4 = Chris | last5 = Henriksson | first5 = Karl G. | last6 = Bengtsson | first6 = Ann | date = 2008 | title = Chronic widespread musculoskeletal pain – A comparison of those who meet criteria for fibromyalgia and those who do not| url = https://onlinelibrary.wiley.com/doi/abs/10.1016/j.ejpain.2007.10.001|journal=European Journal of Pain|language=en|volume=12|issue=5 | pages = 600–610|doi=10.1016/j.ejpain.2007.10.001|issn=1532-2149}}</ref><ref name="Baron2010">{{Cite journal | last = Baron | first = Ralf | author-link = | last2 = Tölle | first2 = Thomas R. | authorlink2 = | last3 = Freynhagen | first3 = Rainer | authorlink3 = | last4 = Brosz | first4 = Mathias | authorlink4 = | last5 = Gockel | first5 = Ulrich | authorlink5 = | last6 = Koroschetz | first6 = Jana | authorlink6 = | last7 = Rehm | first7 = Stefanie E. | author-link8 = | date = Jun 1, 2010 | title = A cross-sectional survey of 3035 patients with fibromyalgia: subgroups of patients with typical comorbidities and sensory symptom profiles |url =https://academic.oup.com/rheumatology/article/49/6/1146/1790415|journal=Rheumatology|language=en|volume=49|issue=6 | pages = 1146–1152|doi=10.1093/rheumatology/keq066|issn=1462-0324|quote=|via=|pmc=|pmid=|access-date=}}</ref> The main types of [[allodynia]] are: * '''Mechanical / Tactile''' Caused by movement across the skin such as a cotton bud, or brushing a painter's brush against the skin; or by light pressure or touch, e.g. clothing or bedsheets touching the skin. * '''Thermal / Temperature''' Caused by heat or cold that is not extreme enough to cause damage to skin tissues.<ref name="Jensen2014">{{Cite journal | last = Jensen | first = Troels S | last2 = Finnerup | first2 = Nanna B | date = 2014-09-01 | title = Allodynia and hyperalgesia in neuropathic pain: clinical manifestations and mechanisms |url =https://www.sciencedirect.com/science/article/pii/S1474442214701024|journal=The Lancet Neurology|language=en|volume=13|issue=9 | pages = 924–935|doi=10.1016/S1474-4422(14)70102-4|issn=1474-4422}}</ref> {{See also|Allodynia}} ===Anxiety=== Anxiety is more common in people with fibromyalgia than in healthy people.<ref name="PatientInfo" /><ref name="Jensen2010" /> {{See also|Anxiety}} ===[[Body temperature]]=== Hypersensitivity to cold or heat is common in fibromyalgia, especially in people with [[allodynia]].<ref name="Baron2010" /><br> [[Small fiber peripheral neuropathy]] occurs in some people with fibromyalgia, causing a combination of [[temperature sensitivity]], burning, tingling, and prickling due to [[paresthesia]], [[numbness]], [[dry eye syndrome|dry eyes]] and [[dry mouth]].<ref name="ACR2010" /><ref name="PN-webmd">{{Cite web | url = https://www.webmd.com/brain/understanding-peripheral-neuropathy-basics#3 | title = Peripheral Neuropathy -- Symptoms, Types, and Causes of Peripheral Neuropathy | date = |website=WebMD|access-date=2018-10-04|archive-url=|archive-date=| page=3|language=en-US}}</ref> {{See also|Temperature sensitivity}} ===[[Chest pain]]=== Chest pain has been reported in many people with fibromyalgia. A study of over 2,000 FM patients prescribed the popular pain drugs [[Lyrica]] or [[Cymbalta]] found that approximately 23% had chest pain.<ref name="Gore2012">{{Cite journal | last = Gore | first = Mugdha | last2 = Tai | first2 = Kei-Sing | last3 = Chandran | first3 = Arthi | last4 = Zlateva | first4 = Gergana | last5 = Leslie | first5 = Douglas| date = 2011-10-20 | title = Clinical comorbidities, treatment patterns, and healthcare costs among patients with fibromyalgia newly prescribed pregabalin or duloxetine in usual care | url =https://www.tandfonline.com/doi/pdf/10.3111/13696998.2011.629262|journal=Journal of Medical Economics|volume=15|issue=1 | pages = 19–31|doi=10.3111/13696998.2011.629262|issn=1369-6998}}</ref> ===[[Cognitive dysfunction]] and [[Fibro fog]]=== The cognitive problems or "fibro fog" in fibromyalgia are part of the diagnostic criteria, although [[cognitive dysfunction|brain fog]] in general occurs in a number of different health conditions.<ref name="ACR2010" /> Cognitive dysfunction in fibromyalgia includes problems with thinking and memory.<ref name="Park2001" /> Fibromyalgia is known to cause multiple types of cognitive impairment.<ref name="Wu2018">{{Cite journal| url = https://journals.lww.com/psychosomaticmedicine/Fulltext/2018/06000/Cognitive_Impairment_in_Fibromyalgia__A.5.aspx | title = Cognitive Impairment in Fibromyalgia: A Meta-Analysis of Case-Control Studies | last = Wu | first = Yu-Lin | last2 = Huang | first2 = Chun-Jen | date = 2018|journal=Psychosomatic medicine|volume = 80|issue =5 | pages =432-438|pmid=29528888 | last3 = Fang | first3 = Su-Chen | last4 = Ko | first4 = Ling-Hsin | last5 = Tsai | first5 = Pei-Shan}}</ref> ====Fibro fog ==== The "Fibro fog" or brain fog in fibromyalgia is a highly disabling symptom that includes memory problems, problems managing activities/schedule, difficulty with verbal expression, focus/concentration, and generally experiencing "life in a haze".<ref name="Kratz2015" /> Fibro fog has been found to linked to the degree of pain and was found to be unrelated to any depression or anxiety that some people with fibromyalgia also have.<ref name="Park2001" /> The term '''dyscognition''' is sometimes used to refer to signs of cognitive problems, including diminished performance on tests of memory tests, verbal fluency, attention and concentration problems, reduced executive functioning.The Multiple Ability Self-Report Questionnaire (MASQ) is often used to assess cognitive dysfunction in fibromyalgia research, including "fibro fog".<ref name="Kratz2015">{{Cite journal | last = Kratz | first = Anna L. | author-link = | last2 = Schilling | first2 = Stephen | authorlink2 = | last3 = Goesling | first3 = Jenna | authorlink3 = | last4 = Williams | first4 = David A. | authorlink4 = | date = Jun 2015 | title = Development and Initial Validation of a Brief Self-Report Measure of Cognitive Dysfunction in Fibromyalgia| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456217/|journal=The journal of pain : official journal of the American Pain Society|volume=16|issue=6 | pages = 527–536|doi=10.1016/j.jpain.2015.02.008|issn=1526-5900|pmc=4456217|pmid=25746197|access-date=|quote=|via=}}</ref> Improving pain and sleep may reduce cognitive impairment. Treatment for cognitive dysfunction in FM including "fibro fog" include [[transcranial direct current stimulation]], [[exercise|physical activity]], and CBT for sleep although studies are limited.<ref name="Bell2019">{{Cite journal | last = Bell | first = Tyler Reed | authorlink = | last2 = Trost | first2 = Zina | authorlink2 = | last3 = Buelow | first3 = Melissa T. | authorlink3 = | last4 = Clay | first4 = Olivio | authorlink4 = | last5 = Younger | first5 = Jarred | authorlink5 = | last6 = Moore | first6 = David | authorlink6 = | last7 = Crowe | first7 = Michael | date = Sep 2018 | title = Meta-analysis of cognitive performance in fibromyalgia| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6151134/|journal=Journal of clinical and experimental neuropsychology|volume=40|issue=7 | pages = 698–714|doi=10.1080/13803395.2017.1422699|issn=1380-3395|pmc=6151134|pmid=29388512|access-date=|quote=|via=}}</ref> One randomized controlled trial found CBT for sleep difficulties in FM improved executive functions and alertness but [[sleep hygiene]] did not.<ref name="Bell2019" /> {{See also|Cognitive dysfunction}} ===[[Depression]] and [[anxiety]]=== {{See also|Depression|Depression|Anxiety|Anxiety}} Fibromyalgia sufferers are "up to three times more likely to have depression at the time of their diagnosis than someone without fibromyalgia."<ref name="webmd-depress">{{Cite news |url =https://www.webmd.com/fibromyalgia/fibromyalgia-and-depression#1 | title = Fibromyalgia and Depression|work=WebMD|access-date=2018-08-19|language=en-US}}</ref> [[Anxiety]] is also more common.<ref name="PatientInfo" /> {{See also|Depression}}{{See also|Mental health}} ====<span id="depression">Differences between depression and fibromyalgia==== * Depression and anxiety are common in fibromyalgia but are not core diagnostic symptoms, so they are not required for a diagnosis of fibromyalgia in the ACR criteria<ref name="ACR1990" /><ref name="ACR2010" /> * A study of over 3,000 patients by Koroschetz et al. (2011) found that a significant number of people with fibromyalgia have never had depression.<ref name="Koroschetz2011-symptoms">{{Cite journal | last = Koroschetz | first = Jana | last2 = Rehm | first2 = Stefanie E. | last3 = Gockel | first3 = Ulrich | last4 = Brosz | first4 = Mathias | last5 = Freynhagen | first5 = Rainer | last6 = Tölle | first6 = Thomas R. | last7 = Baron | first7 = Ralf | date = 2011-05-25 | title = Fibromyalgia and neuropathic pain - differences and similarities. A comparison of 3057 patients with diabetic painful neuropathy and fibromyalgia| url = https://doi.org/10.1186/1471-2377-11-55|journal=BMC Neurology|volume=11|issue=1 | pages = 55|doi=10.1186/1471-2377-11-55|issn=1471-2377|pmc=3125308|pmid=21612589}}</ref> * Fibromyalgia is a diagnosis of '''chronic widespread pain''', but pain is part of the diagnostic criteria for depression.<ref name="Muller2007">{{Cite journal | last = Müller | first = W. | last2 = Schneider | first2 = E.M. | last3 = Stratz | first3 = T. | date = 2007-09-01 | title = The classification of fibromyalgia syndrome | url =https://doi.org/10.1007/s00296-007-0403-9|journal=Rheumatology International|language=en|volume=27|issue=11 | pages = 1005–1010|doi=10.1007/s00296-007-0403-9|issn=1437-160X}}</ref><ref name="webmd-notdepress">{{Cite web | url = https://www.webmd.com/depression/news/20031024/fibromyalgia-isnt-depression | title = Fibromyalgia Isn't Depression | last = DeNoon | first = Daniel J.|website=WebMD|language=en|access-date=2021-03-27}}</ref> * Jensen et al. (2010) found that [[anxiety]] and [[depression]] are not linked to increased pain sensitivity or alertered pain processing, which are key mechanisms in fibromyalgia.<ref name="Jensen2010" /> ===[[Sjögren's syndrome|Dry eye syndrome]]=== [[Sjögren's syndrome]], also known as Sicca or dry eye syndrome causes dry eyes and a dry mouth; it is a less common comorbidity in people with fibromyalgia.<ref name="Firdous2012" /><ref name="sjogrens">{{Cite web | url = https://www.mayoclinic.org/diseases-conditions/sjogrens-syndrome/symptoms-causes/syc-20353216 | title = Sjogren's syndrome - Symptoms and causes|website=Mayo Clinic|language=en|access-date=2021-11-29}}</ref> {{See also|Sjögren's syndrome}} ===[[Fatigue]]=== Most people with fibromyalgia experience fatigue, and it is a recognized diagnostic symptom. Some people with fibromyalgia also met the full diagnostic criteria for [[myalgic encephalomyelitis]] or [[chronic fatigue syndrome]].<ref name="PatientInfo" /><ref name="ACR2010" /> {{See also|Chronic fatigue}} ===Fibro fog=== See [[#Cognitive_dysfunction_and_Fibro_fog|cognitive dysfunction and Fibro fog]]. ===[[Digestive problems|Gastrointestinal problems]]=== [[Irritable bowel syndrome|IBS]] often occurs in people with fibromyalgia.<ref name="ScienceOfFibro" /> {{See also|Irritable bowel syndrome}} ===[[Gulf War Illness]]=== GWI increases risk of developing fibromyalgia.<ref name="VA">{{Cite web | url = https://www.publichealth.va.gov/exposures/gulfwar/fibromyalgia.asp | title = Fibromyalgia in Gulf War Veterans - Public Health | last = US Department of Veterans Affairs|language=en|access-date=2018-08-19}}</ref> {{See also|Gulf War Illness}} ===[[Hyperalgesia]]=== Fibromyalgia involves an increased sensitivity to painful stimuli, known as [[hyperalgesia]]. Hyperalgesia has been described as a lowered pain threshold, and can be thought of as "increasing the volume" of pain.<ref name="ScienceOfFibro" /> {{See also|Hyperalgesia}} ===[[Interstitial cystitis]]=== Interstitial cystitis is a common comorbidity in people with fibromyalgia, and causes a painful bladder.<ref name="ScienceOfFibro" /><ref name="Nickel2010">{{Cite journal | last = Nickel | first = J. Curtis | last2 = Tripp | first2 = Dean A. | last3 = Pontari | first3 = Michel | last4 = Moldwin | first4 = Robert | last5 = Mayer | first5 = Robert | last6 = Carr | first6 = Lesley K. | last7 = Doggweiler | first7 = Ragi | last8 = Yang | first8 = Claire C. | last9 = Mishra | first9 = Nagendra | date = 2010 | title=Interstitial cystitis/painful bladder syndrome and associated medical conditions with an emphasis on irritable bowel syndrome, fibromyalgia and chronic fatigue syndrome | url =https://www.ncbi.nlm.nih.gov/pubmed/20719340|journal=The Journal of Urology|volume=184|issue=4 | pages = 1358–1363|doi=10.1016/j.juro.2010.06.005|issn=1527-3792|pmid=20719340|via=}}</ref> {{See also|Interstitial cystitis}} ===[[Irritable bowel syndrome]] === IBS is a particularly common comorbidity in people with fibromyalgia. Other [[:Category:Digestive signs and symptoms|digestive system problems]] may also occur.<ref name="ScienceOfFibro" /> {{See also|Irritable bowel syndrome}} ===Language impairment and [[word-finding problems]]=== The [[cognitive dysfunction|"fibro fog"]] or brain fog that is a well recognized symptom of FM typically causes problems with words and language.<ref name="ACR2010" /> Cognitive impairment in fibromyalgia includes: *[[Word-finding problems]]<ref name="Park2001">{{Cite journal | last = Park | first = Denise C. | last2 = Glass | first2 = Jennifer M. | last3 = Minear | first3 = Meredith | last4 = Crofford | first4 = Leslie J.| date = 2001 | title = Cognitive function in fibromyalgia patients | url = https://onlinelibrary.wiley.com/doi/abs/10.1002/1529-0131%28200109%2944%3A9%3C2125%3A%3AAID-ART365%3E3.0.CO%3B2-1 | journal = Arthritis & Rheumatism |language=en|volume=44|issue=9 | pages = 2125–2133|doi=10.1002/1529-0131(200109)44:9<2125::AID-ART365>3.0.CO;2-1|issn=1529-0131}}</ref><ref name="Natelson2019" /> * [[Memory problems|short-term memory problems]] * vulnerability to distraction by irrelevant stimuli (known as "selective attention") *[[Slowed thought|mental slowing]] *[[information overload]], and *[[multi-tasking problems]] *[[attention deficit|attention]] and [[concentration problems|concentration problems]]<ref name="Bell2019" /><ref name="Kratz2015" /><ref name="Teodoro2018">{{Cite journal | last = Teodoro | first = Tiago | author-link = | last2 = Edwards | first2 = Mark J. | authorlink2 = | last3 = Isaacs | first3 = Jeremy D. | authorlink3 = | date = 2018-12-01 | title = A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review | url =https://jnnp.bmj.com/content/jnnp/89/12/1308.full.pdf | journal=Journal of Neurology, Neurosurgery & Psychiatry|language=en|volume=89|issue=12 | pages = 1308–1319|doi=10.1136/jnnp-2017-317823|issn=0022-3050|pmc=|pmid=29735513|access-date=|quote=|via=}}</ref> {{See also|Cognitive dysfunction}} ===[[Lower back pain]]=== Mechanical [[lower back pain]] is more common in patients with FM.<ref name="PMC5741304" /> A study of over 2,000 FM patients prescribed the popular pain drugs [[Lyrica]] or [[Cymbalta]] found that over 60% had some form of lower back pain.<ref name="Gore2012" /> ===[[Mast cell activation syndrome|Mast Cell Activation Syndrome]]=== Migratory bone pain, [[arthralgia|joint pain]] or [[myalgia|muscle pain]] and fibromyalgia are common in people with [[mast cell activation syndrome]] (MCAS). MCAS is far less common than fibromyalgia and it is unclear how many fibromyalgia patients also have MCAS.<ref name="Afrin2020">{{Cite journal | title = Diagnosis of mast cell activation syndrome: a global “consensus-2” | date = 2021-05-01| url = https://www.degruyter.com/document/doi/10.1515/dx-2020-0005/html?lang=en|journal=Diagnosis|volume=8|issue=2 | pages = 137–152 | last = Afrin | first = Lawrence B. | author-link = Lawrence Afrin | last2 = Ackerley | first2 = Mary B. | authorlink2 = | last3 = Bluestein | first3 = Linda S. | authorlink3 = | last4 = Brewer | first4 = Joseph H. | authorlink4 = Joseph Brewer | last5 = Brook | first5 = Jill B. | authorlink5 = | last6 = Buchanan | first6 = Ariana D. | authorlink6 = | last7 = Cuni | first7 = Jill R. | last8 = Davey | first8 = William P. | last9 = Dempsey | first9 = Tania T. | last10 = Dorff | first10 = Shanda R. | last11 = Dubravec | first11 = Martin S.|language=en|doi=10.1515/dx-2020-0005|pmc=|pmid=|access-date=|issn=2194-802X|quote=|via=}}</ref><ref name="Valent2019">{{Cite journal | title = Doctor, I Think I Am Suffering from MCAS: Differential Diagnosis and Separating Facts from Fiction | date = 2019-04-01| url = https://www.jaci-inpractice.org/article/S2213-2198(18)30819-5/abstract|journal=The Journal of Allergy and Clinical Immunology: In Practice|volume=7|issue=4 | pages = 1109–1114 | last = Valent | first = Peter | last2 = Akin | first2 = Cem|language=English|doi=10.1016/j.jaip.2018.11.045|pmid=30961836|issn=2213-2198}}</ref> The MCAS consensus criteria (2020) states that it is unclear how many people with fibromyalgia may have MCAS ''associated with'' their fibromyalgia, or as a cause of their fibromyalgia.<ref name="Afrin2020" /> {{See also|Mast cell activation syndrome}} === Menstrual cycle effects === Schertzinger et al. (2017) found that levels of the sex hormones [[progesterone]] and [[testosterone]] were linked to pain severity in fibromyalgia.<ref name="Schertzinger2017">{{Cite journal | title = Daily Fluctuations of Progesterone and Testosterone Are Associated With Fibromyalgia Pain Severity | date = 2018-04-01| url = https://www.jpain.org/article/S1526-5900(17)30804-0/abstract|journal=The Journal of Pain|volume=19|issue=4 | pages = 410–417 | last = Schertzinger | first = Meredith | last2 = Wesson-Sides | first2 = Kate | last3 = Parkitny | first3 = Luke | last4 = Younger | first4 = Jarred|language=English|doi=10.1016/j.jpain.2017.11.013|pmid=29248511|issn=1526-5900}}</ref> ===[[Migraine]] and [[headache]]s=== Both [[tension-type headache]]s and [[migraine]]s are commonly in patients with fibromyalgia.<ref name="ScienceOfFibro" /><ref name="PatientInfo" /> <blockquote>Both fibromyalgia and migraine may reflect problems in the brain’s pain processing center. It is believed that both conditions are caused by excitation of the nervous system or an over-response to stimuli. Stress is usually cited as a trigger for both migraine and fibromyalgia attacks.<ref name="migrainecenters">{{Cite news |url =https://migrainecenters.com/blog/migraines-and-fibromyalgia/ | title = Migraines and Fibromyalgia - Migraine Centers | date = 2016-05-06|work=Migraine Centers|access-date=2018-08-19|language=en-US}}</ref></blockquote> {{See also|Tension-type headache|Tension-type headache|Migraine|Migraine}} ===Mood disorder symptoms=== While [[depression]] and depressive symptoms are common in FB, bipolar disorder symptoms are also much more common than in the general population. Alciati et al 2012 reports on this.<ref name="Alciati2012">{{Cite journal | last = Alciati | first = A. | last2 = Sgiarovello | first2 = P. | last3 = Atzeni | first3 = F. | last4 = Sarzi-Puttini | first4 = P. | date = 2012-09-28 | title = Psychiatric problems in fibromyalgia: clinical and neurobiological links between mood disorders and fibromyalgia| url = https://air.unimi.it/retrieve/handle/2434/667633/1304487/document.pdf | journal=Reumatismo|volume=64|issue=4 | pages = 268–274|doi=10.4081/reumatismo.2012.268|issn=0048-7449|pmid=23024971}}</ref> {{See also|Mental health}} ===[[Multiple chemical sensitivity|Multiple Chemical Sensitivity]]=== [[Multiple chemical sensitivity]] (MCS) has been found in approximately 50% of fibromyalgia patients, although this is based on a very small number of studies using the 1990 ACR criteria for fibromyalgia.<ref name="MCS1">{{Cite journal | last = Slotkoff | first = A.T. | last2 = Radulovic | first2 = D.A. | last3 = Clauw | first3 = D.J. | date = 1997-01-01 | title = The Relationship between Fibromyalgia and the Multiple Chemical Sensitivity Syndrome | url =https://doi.org/10.3109/03009749709065700|journal=Scandinavian Journal of Rheumatology|volume=26|issue=5 | pages = 364–367|doi=10.3109/03009749709065700|issn=0300-9742|pmid=9385348}}</ref><ref name="MCS2">{{Cite journal | last = Hudson | first = J.I. | last2 = Goldenberg | first2 = D.L. | last3 = Pope | first3 = H.G. | last4 = Keck | first4 = P.E. | last5 = Schlesinger | first5 = L. | date = Apr 1992 | title = Comorbidity of fibromyalgia with medical and psychiatric disorders |url =https://pubmed.ncbi.nlm.nih.gov/1558082/|journal=The American Journal of Medicine|volume=92|issue=4 | pages = 363–367|doi=10.1016/0002-9343(92)90265-d|issn=0002-9343|pmid=1558082}}</ref><ref name="Slotkoff1997">{{Cite journal | last = Slotkoff | first = A.T. | last2 = Radulovic | first2 = D.A. | last3 = Clauw | first3 = D.J. | date = 1997-01-01 | title = The Relationship between Fibromyalgia and the Multiple Chemical Sensitivity Syndrome | url =https://doi.org/10.3109/03009749709065700|journal=Scandinavian Journal of Rheumatology|volume=26|issue=5 | pages = 364–367|doi=10.3109/03009749709065700|issn=0300-9742|pmid=9385348}}</ref> MCS has been referred to as a partially overlapping condition, with [[fatigue]] and [[headache]]s occurring in both FM and MCS, and muscle or joint pain being reported in some people with MCS.<ref name="Yunus2008" /><ref name="J092v05n03_06">{{Cite journal | last = Donnay | first = Albert | last2 = Ziem | first2 = Grace | date = 1999-01-01 | title = Prevalence and Overlap of Chronic Fatigue Syndrome and Fibromyalgia Syndrome Among 100 New Patients with Multiple Chemical Sensitivity Syndrome | url =https://doi.org/10.1300/J092v05n03_06|journal=Journal of Chronic Fatigue Syndrome|volume=5|issue=3-4 | pages = 71–80|doi=10.1300/J092v05n03_06|issn=1057-3321}}</ref> {{See also|Multiple chemical sensitivity}} ===Obesity=== Obesity is commonly found in patients with fibromyalgia, and increased [[body mass index]] been linked to increased pain severity and increases in other fibromyalgia symptoms, however the effects of [[weight loss]] on fibromyalgia symptoms is not clear.<ref name="DOnghia2020">{{Cite journal | last = D'Onghia | first = Martina | last2 = Ciaffi | first2 = Jacopo | last3 = Lisi | first3 = Lucia | last4 = Mancarella | first4 = Luana | last5 = Ricci | first5 = Susanna | last6 = Stefanelli | first6 = Nicola | last7 = Meliconi | first7 = Riccardo | last8 = Ursini | first8 = Francesco | date = 2021-04-01 | title = Fibromyalgia and obesity: A comprehensive systematic review and meta-analysis |url =https://www.sciencedirect.com/science/article/pii/S0049017221000275|journal=Seminars in Arthritis and Rheumatism|language=en|volume=51|issue=2 | pages = 409–424|doi=10.1016/j.semarthrit.2021.02.007|issn=0049-0172}}</ref><ref name="Gore2012" /> A few studies have reported positive effects from weight loss in FM, either by [[bariatric surgery]], a combination of [[:Category:Diets|diet]] and [[exercise]] combination or behavioral weight loss.<ref name="DOnghia2020" /> ===Obstetrics and gynaecology=== [[Chronic pelvic pain]] and [[vulvodynia]], which is chronic pain around the opening of the vagina, are particularly common in women with FM.<ref name="ScienceOfFibro" /><ref name="PMC5741304" /><ref name="vulvodynia">{{Cite web | url = https://www.mayoclinic.org/diseases-conditions/vulvodynia/symptoms-causes/syc-20353423 | title = Vulvodynia - Symptoms and causes|website=Mayo Clinic|language=en|access-date=2021-11-28}}</ref> [[Early menopause]] and [[hysterectomy]] are linked to increased risk of fibromyalgia.<ref name="Pamuk2009">{{Cite journal | title = Increased frequencies of hysterectomy and early menopause in fibromyalgia patients: a comparative study | date = 2009-05-01| url = https://doi.org/10.1007/s10067-009-1087-1|journal=Clinical Rheumatology|volume=28|issue=5 | pages = 561–564 | last = Pamuk | first = Ömer Nuri | last2 = Dönmez | first2 = Salim | last3 = Çakir | first3 = Necati|language=en|doi=10.1007/s10067-009-1087-1|issn=1434-9949}}</ref> A number of studies have found that women with fibromyalgia were more likely to have had a hysterectomy than the general population, and they were more likely to have poorer health and higher health costs than women with fibromyalgia who had not had a hysterectomy.<ref name="Santoro2012">{{Cite journal | title = Fibromyalgia and hysterectomy: the impact on health status and health care costs | date = Nov 2012| url = https://pubmed.ncbi.nlm.nih.gov/22875702/|journal=Clinical Rheumatology|volume=31|issue=11 | pages = 1585–1589 | last = Santoro | first = Maya S. | author-link = | last2 = Cronan | first2 = Terry A. | authorlink2 = | last3 = Adams | first3 = Rebecca N. | authorlink3 = | last4 = Kothari | first4 = Dhwani J. | authorlink4 = |doi=10.1007/s10067-012-2051-z|pmc=|pmid=22875702|access-date=|issn=1434-9949|quote=|via=}}</ref> Fibromyalgia patients were more likely to have had a gynaecological surgery compared to other chronic pain patients, with rates of fibromyalgia being higher in patients who had hysterectomy, oophorectomy (ovary removal) and cystectomy (bladder or cyst removal) than only hysterectomy.<ref name="Brooks2015">{{Cite journal | title = Assessing the prevalence of autoimmune, endocrine, gynecologic, and psychiatric comorbidities in an ethnically diverse cohort of female fibromyalgia patients: does the time from hysterectomy provide a clue? | date = 2015-08-20| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4548754/|journal=Journal of Pain Research|volume=8 | pages = 561–569 | last = Brooks | first = Larry | last2 = Hadi | first2 = Joseph | last3 = Amber | first3 = Kyle T | last4 = Weiner | first4 = Michelle | last5 = La Riche | first5 = Christopher L | last6 = Ference | first6 = Tamar|doi=10.2147/JPR.S86573|pmc=4548754|pmid=26316807|issn=1178-7090}}</ref> [[#Pregnancy complications|Pregnancy complications]] have been found to be more common in women with fibromyalgia,<ref name="Magtanong2019">{{Cite journal | title = Maternal and neonatal outcomes among pregnant women with fibromyalgia: a population-based study of 12 million births | date = 2019-02-01| url = https://doi.org/10.1080/14767058.2017.1381684|journal=The Journal of Maternal-Fetal & Neonatal Medicine|volume=32|issue=3 | pages = 404–410 | last = Magtanong | first = Glenda Gatan | last2 = Spence | first2 = Andrea R. | last3 = Czuzoj-Shulman | first3 = Nicholas | last4 = Abenhaim | first4 = Haim Arie|doi=10.1080/14767058.2017.1381684|pmid=28954564|issn=1476-7058}}</ref> and the menstrual cycle has been found to be related to pain fluctuations in fibromyalgia.<ref name="Schertzinger2017" /> {{See also|Menopause}} ===[[Orthostatic intolerance]] (OI) === [[Postural orthostatic tachycardia syndrome]] (POTS) and other forms of orthostatic intolerance often occur in people with fibromyalgia.<ref name="Yun2013">{{Cite journal | last = Yun | first = Dong Joo | last2 = Choi | first2 = Han Na | last3 = Oh | first3 = Gun-Sei | date = 2013 | title = A Case of Postural Orthostatic Tachycardia Syndrome Associated with Migraine and Fibromyalgia| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710947/|journal=The Korean Journal of Pain|volume=26|issue=3 | pages = 303–306|doi=10.3344/kjp.2013.26.3.303|issn=2005-9159|pmid=23862007|via=}}</ref> Symptoms can include [[Orthostatic hypotension|low blood pressure on standing]] and/or sudden high blood pressure, [[dizziness]], [[syncope|fainting]]. Dr Charles Lapp found that fibromyalgia symptoms and ME/CFS symptoms predicted the outcome of [[tilt table test]]ing for [[orthostatic intolerance]].<ref>{{Cite web | url = http://drlapp.com/wp-content/uploads/TTT_symptoms.pdf | title=Symptoms Predict the Outcome of Tilt Table Testing in CFS/ME/FM | last = Lapp | first = Charles W. | last2 = Black | first2 = Laura | date = |website=drlapp.com|archive-url=|archive-date=|access-date= | last3 = Smith | first3 = Rebekah S.}}</ref> Orthostatic intolerance may often be l overlooked in fibromyalgia patients.<ref name="Zumuner2017">{{Cite journal | title = The degree of cardiac baroreflex involvement during active standing is associated with the quality of life in fibromyalgia patients | date = 2017-06-14| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5470709/|journal=PLoS ONE|volume=12|issue=6| pages = e0179500 | last = Zamunér | first = Antonio Roberto | last2 = Porta | first2 = Alberto | last3 = Andrade | first3 = Carolina Pieroni | last4 = Forti | first4 = Meire | last5 = Marchi | first5 = Andrea | last6 = Furlan | first6 = Raffaello | last7 = Barbic | first7 = Franca | last8 = Catai | first8 = Aparecida Maria | last9 = Silva | first9 = Ester|doi=10.1371/journal.pone.0179500|pmc=5470709|pmid=28614420|issn=1932-6203}}</ref> {{See also|Orthostatic intolerance}} ===[[Painful bladder syndrome]] and [[chronic pelvic pain]]=== [[Painful bladder syndrome]] and [[chronic pelvic pain]] are common comorbidities in people with fibromyalgia.<ref name="ScienceOfFibro" /> === Pregnancy complications === A study of 12 million live births found that fibromyalgia was a "high risk" condition in pregnancy, associated with higher rates of gestational diabetes, venous thromboembolism, delivery by cesarean, and intrauterine growth restriction in the babies.<ref name="Magtanong2019" /> ===Prostrate symptoms === Men with fibromyalgia commonly experience inflammation of the prostate, known as chronic prostatitis, and prostadynia, which is a chronic nonbacterial and painful inflammation of the prostate. These cause [[chronic pelvic pain]].<ref name="ScienceOfFibro" /><ref name="prostratepain">{{Cite book | title = Understanding Pain: What You Need to Know to Take Control | pages = 149|isbn=978-0-313-39604-5|edition=|language=en| title-link = |chapter-url=https://books.google.com/books?id=bAha4v18oTMC&lpg=PA149&dq=prostadynia&pg=PA149#v=onepage&q&f=true|access-date=| date = 2011-10-10 | publisher = ABC-CLIO |editor-last = Kaye|editor-first = Alan D. |editor-last2 = Urman|editor-first2 = Richard D. |veditors=|others=|doi=|oclc=|quote=|archive-url=|archive-date=|location=|chapter=Gynecological, Pelvic, and Urological Pain | first = Rinoo V. | last = Shah | first2 = Alan D. | last2 = Kaye}}</ref> Frequent and urgent urination are common.<ref name="prostratepain" /> ===[[Raynaud's syndrome]]=== In Raynaud's syndrome or Raynaud's phenomenon, the blood vessels narrow more than they should, which means less blood to get through, making your extremities cold, and making them extremely difficult to warm up. Reynauld's causes fingers, toes, lips, nose, and other parts of you go cold and numb. Fingers and toes change color to white, then blue. As you warm up, skin turns red and they feel tingle, throb or swell up. Reynauld's attacks are caused by cold or emotional [[stress]].<ref name="reynaulds">{{Cite news |url =https://www.mayoclinic.org/diseases-conditions/raynauds-disease/symptoms-causes/syc-20363571 | title = Reynauld's disease - Symptoms and causes|work=Mayo Clinic|access-date=2021-11-28|language=en}}</ref> Raynaud's symptoms have been commonly reported in people with fibromyalgia.<ref name="Firdous2012" /><ref name="ACR2010" /><ref name="Pauling2019">{{Cite journal | last = Pauling | first = John D. | last2 = Hughes | first2 = Michael | last3 = Pope | first3 = Janet E. | date = 2019-12-01 | title = Raynaud’s phenomenon—an update on diagnosis, classification and management| url = https://doi.org/10.1007/s10067-019-04745-5|journal=Clinical Rheumatology|language=en|volume=38|issue=12 | pages = 3317–3330|doi=10.1007/s10067-019-04745-5|issn=1434-9949}}</ref> {{See also|Raynaud's syndrome}} ===Rheumatic conditions - other rheumatic conditions=== [[Osteoarthritis]], [[rheumatoid arthritis]], [[systemic lupus erythematosus|lupus]], and [[ankylosing spondylitis]] are more common in people with fibromyalgia.<ref name="CDC-complications" /> ===[[Sleep dysfunction]]=== Sleep problems occur in most people with FM.<ref name="PatientInfo" /> Waking unrefreshed is a diagnostic symptom, and the sleep disorders [[sleep apnea]], [[restless legs syndrome]] and [[nocturnal myclonus]] are common in people with fibromyalgia.<ref name="ACR2010" /><ref name="NBK279092" /> Vatthauer et al. (2015) found that sleep was associated with task-negative [[brain]] activity in fibromyalgia participants with comorbid chronic [[insomnia]].<ref name="Vatthauer2015">{{Cite journal | last = Vatthauer | first = Karlyn E | last2 = Craggs | first2 = Jason G | last3 = Robinson | first3 = Michael E | last4 = Staud | first4 = Roland | last5 = Berry | first5 = Richard B | last6 = Perlstein | first6 = William M | last7 = McCrae | first7 = Christina S | date = 2015-11-12 | title = Sleep is associated with task-negative brain activity in fibromyalgia participants with comorbid chronic insomnia| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4648619/|journal=Journal of Pain Research|volume=8 | pages = 819–827|doi=10.2147/JPR.S87501|issn=1178-7090|pmc=|pmid=26648751|issue=|via=|quote= | authorlink3 = | authorlink4 = Roland Staud | authorlink5 = }}</ref> <blockquote>The present results of this study suggest that long-term, comorbid pain and sleep disturbance may be associated with increased activation in core default mode brain areas that is above and beyond long-term pain disturbance alone.<ref name="Vatthauer2015" /></blockquote> {{See also|Sleep dysfunction}} ===[[Stress]] and [[Post-traumatic stress disorder]]=== PTSD, which is a mental illness that results from traumatic events, is a risk factor for fibromyalgia.<ref name="PatientInfo" /><ref name="NIAMScauses" /> {{See also|Stress}}{{See also|Post-traumatic stress disorder}} ===[[Temporomandibular joint disorder|Temporomandibular disorder or temporomandibular joint disorder]] (TMD/TMJ) === [[File:Skull_diagram.png|350px|thumb|right|The temporomandibular joint is the joint between the mandible (light blue) and the temporal bone (orange) of the skull.<br>Source: [https://commons.wikimedia.org/wiki/User:LadyofHats LadyofHats on Wikimedia Commons], public domain image.]] TMD, previously known as TMJ, is common in people with fibromyalgia.<ref name="ScienceOfFibro" /> TMD symptoms other than [[headache]]s include: *Jaw pain *Discomfort or difficulty chewing *Painful clicking in the jaw *Difficulty opening or closing the mouth *Locking jaw *Ringing in the ears<ref name="tmh">{{Cite web | website =John Hopkins Medicine|access-date=2021-11-28 | title = Temporomandibular disorder |url =https://www.hopkinsmedicine.org/health/conditions-and-diseases/temporomandibular-disorder-tmd}}</ref> A review by Soares et al (2015) found fibromyalgia has "characteristics that constitute predisposing and triggering factors for TMD".<ref name="Soares2015">{{Cite journal | last = Soares Gui | first = Maisa | last2 = Pimentel | first2 = Marcele Jardim | last3 = Rizzatti-Barbosa | first3 = C'elia Marisa | date = 2015-03-01 | title = Temporomandibular disorders in fibromyalgia syndrome: a short-communication | url =https://www.sciencedirect.com/science/article/pii/S2255502114001758|journal=Revista Brasileira de Reumatologia (English Edition)|language=en|volume=55|issue=2 | pages = 189–194|doi=10.1016/j.rbre.2014.07.004|issn=2255-5021|via=ScienceDirect}}</ref> {{See also|Temporomandibular joint disorder}} ===[[Thyroid disease]]=== People with [[Hashimoto's thyroiditis (hypothyroidism)|Hashimoto's autoimmune thyroid disease]] often experience significant fatigue and body aches. While these symptoms are common in Hashimoto's, they can also be markers of other diseases, like chronic fatigue syndrome or fibromyalgia.<ref name="NBK540974" /><ref name="amthyass">{{Cite web | url = https://www.thyroid.org/hashimotos-thyroiditis/ | title = Hashimoto’s Thyroiditis|website=American Thyroid Association|language=en-US|access-date=2020-08-26}}</ref> {{See also|Hashimoto's thyroiditis (hypothyroidism)}} ===Other symptoms=== *Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/ Conditions associated with fibromyalgia. (Table 1)] *[http://www.ncbi.nlm.nih.gov/books/NBK540974/ Fibromyalgia] - StatPearls
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