Fibromyalgia: Difference between revisions

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'''Fibromyalgia''' (FM/FMS) is the second most common rheumatic disorder behind osteoarthritis and is "now considered to be a lifelong [[Central nervous system]] disorder."<ref>[https://naidw.org/blog/members-myblogs/fibromyalgia-now-considered-as-a-lifelong-central-nervous-system-disorder Fibromyalgia now considered as a lifelong central nervous system disorder NAIDW.org]</ref> Sufferers experience "amplified pain that shoots through the body."<ref>[http://www.news-medical.net/news/20150518/Fibromyalgia-now-considered-as-a-lifelong-central-nervous-system-disorder.aspx Fibromyalgia now considered as a lifelong central nervous system disorder - News Medical Source: American Pain Society]</ref>
[[Fibromyalgia]] or '''FM''' or '''fibromyalgia syndrome''' or '''FMS''' is a chronic, debilitating disorder characterized by widespread [[pain]] with additional symptoms such as [[cognitive dysfunction]] or "fibro fog", [[sleep dysfunction|waking unrefreshed]] and [[fatigue]].<ref name="ACR2010" /><ref name="FibroBasics" /> Fibromyalgia is relatively common, affecting between 2-5% of the population.<ref name="ScienceOfFibro" />


Pain is widespread, on both sides of the body and above and below the waist. Sufferers are fatigued and tired even when sleeping for long periods of time. Sleep is often disrupted by pain. Many FM sufferers have sleep disorders like [https://en.wikipedia.org/wiki/Sleep_apnea Sleep apnea] and [[Restless leg syndrome]]. [[Cognitive impairment]] where one cannot focus or pay attention and has difficulty concentrating on mental tasks. Some experience depression, headaches, and lower [[abdominal pain]] or cramping.<ref>[http://www.mayoclinic.org/diseases-conditions/fibromyalgia/basics/symptoms/con-20019243 Fibromyalgia - Mayo Clinic]</ref> Other symptoms include tingling or numbness in hands and feet, pain in jaw and disorders of the jaw such as [[Temporomandibular joint disorder]] (TMJ) and digestive problems like [[Irritable bowel syndrome]]. Although diagnosed in people of all ages you are more likely to develop FM as you age. [https://en.wikipedia.org/wiki/Systemic_lupus_erythematosus Lupus] and [[Rheumatoid arthritis]] (RA) are risk factors in developing FM. Car accidents, [[Post-traumatic stress disorder]] (PTSD), repetitive injuries, illness such as a viral infection, family history, and obesity have all been linked to FM.<ref>[https://www.cdc.gov/arthritis/basics/fibromyalgia.htm Fibromyalgia Fact Sheet - CDC]</ref> Fibromyalgia has a F/M 7:1 ratio.<ref>[http://emedicine.medscape.com/article/329838-overview#a5 Fibromyalgia:Epidemiology - Medscape]</ref>
Brain imaging and neuroimaging studies have shown fibromyalgia to be a '''pain processing disorder''' involving altered pain processing in the [[central nervous system]].<ref name="ScienceOfFibro" /> The pain and other symptoms of fibromyalgia appear to be caused by neurochemical imbalances in the central nervous system that lead to a '''"central amplification"''' of pain perception (Clauw et al., 2011).<ref name="ScienceOfFibro" />


Dr. [[Jarred Younger]] has said that many patients that meet the criteria for FM also meet criteria for [[Chronic Fatigue Syndrome]] but the reverse is not necessarily true as a lot of people with [[CFS]] do not have chronic pain.<ref>[https://www.youtube.com/watch?v=wJB95m4FLa0#t=57m27s Webinar with Jarred Younger, Ph.D.]</ref>  
In fibromyalgia [[pain]] is widespread, on both sides of the body, and above and below the waist.<ref name="ACR2010" /><ref name="excerpt" />


[[File:Fibro_Tender_Points.png|300px|thumb|right|1990 ACR Diagnostic Criteria: 18 Tender Points]]
Sufferers are fatigued (excessively tired) even after sleeping for long periods of time, and sleep is often disrupted by pain. Many FM sufferers have [[Sleep dysfunction|sleep disorders]] like [[sleep apnea]] and [[restless legs syndrome]] (RLS).<ref name="webmd-guide" /><ref name="mayo" /><ref name="FibroBasics" /> [[cognitive dysfunction|Cognitive impairment]], when one cannot focus or pay attention and the patient has difficulty concentrating on mental tasks, is known by FM sufferers as "[[fibro fog]]".<ref name="webmd-guide" /><ref name="mayo" /><ref name="FibroBasics" /> Some people with fibromyalgia experience digestive system problems like [[irritable bowel syndrome]] or gastric-oesophagael reflux disease, [[depression]], [[headache]]s or [[migraine]]s, a painful bladder, or muscle cramps. Other symptoms may include [[Paresthesia|tingling]] or [[numbness]] in hands and feet, pain in jaw and disorders of the jaw such as [[temporomandibular joint disorder]] (TMJ), and [[Menstrual cycle#Health effects in other conditions|menstrual cycle]] cramps.<ref name="ScienceOfFibro" /><ref name="webmd-guide">{{Cite web |  url = https://www.webmd.com/fibromyalgia/guide/fibromyalgia-symptoms#1 | title = Fibromyalgia Symptoms|work=WebMD|access-date=2018-08-09|language=en-US}}</ref><ref name="mayo">{{Cite web | url = https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780 | title = Fibromyalgia - Symptoms and causes|work=Mayo Clinic|access-date=2018-08-09|language=en}}</ref><ref name="FibroBasics" />
[[File:Fibro_Widespread_Pain.png|300px|thumb|right|2010 ACR Preliminatry Diagnostic Criteria: Wisedpread Pain Index]]


== Diagnostic criteria and code==
[[Pain#Pain in Fibromyalgia|Other pain conditions are associated with FM]], such as [[rheumatoid arthritis]] (RA), [[systemic lupus erythematosus]] (Lupus), ankylosing spondylitis, [[interstitial cystitis]], and more.<ref name="mayo" />
===World Health Organization===
 
The World Health Organization (WHO) International Classification of Diseases (ICD) lists Fibromyalgia as a "disease of the [[musculoskeletal system]] and connective tissue', under the code M79.7 (WHO ICD-10 2016).<ref>World Health Organisation, [http://apps.who.int/classifications/icd10/browse/2016/en#/M79.7 International Classification of Diseases - Fibromyalgia M79.7], ICD-10, 2016</ref>
In 2017, the [[United Kingdom|United Kingdom]]'s [[National Health Service]] listed fibromyalgia as one of 20 most painful conditions.<ref name="20mostpainful">{{Cite web | access-date=|archive-url=https://web.archive.org/web/20180530191907/https://www.nhs.uk/live-well/healthy-body/20-painful-health-conditions/|archive-date=2018-05-30 | title = 20 Painful Health Conditions|website=[[National Health Service]] | date = 2017-06-23| url = https://www.nhs.uk/live-well/healthy-body/20-painful-health-conditions/|url-status=dead}}</ref><ref name="newsweek">{{Cite web |  url = https://www.newsweek.com/20-most-painful-conditions-nhs-1191081 | title = Here are 20 of the most painful health conditions you can get | last = Osborne | first = Hannah | date = 2018-10-29 | website = Newsweek|language=en|access-date=2019-03-26}}</ref> Fibromyalgia pain may be described as diffuse aching or burning, head to toe, and can be worse at some times than at others. The pain can change location and fluctuate in intensity.<ref name="20mostpainful" /><ref name="FMA-uk">{{Cite web |  title = What is Fibromyalgia|website=Fibromyalgia Action UK| url = https://www.fmauk.org/2-uncategorised/52-what-is-fibromyalgia | date = |access-date=2021-11-28}}</ref><ref name="FibroBasics" /> The [[United States|United States]] (US) [[Centers for Disease Control and Prevention]] (CDC) states fibromyalgia is a serious disorder, and "can cause pain, [[Fibromyalgia disability process|disability, and lower quality of life]]."<ref name="FibroBasics" />
 
The [[American College of Rheumatology]] (ACR) created and updates the diagnostic criteria for fibromyalgia.<ref name="ACR2010">{{Cite journal| url = https://www.rheumatology.org/Portals/0/Files/2010_Preliminary_Diagnostic_Criteria.pdf | title=American College of Rheumatology (ACR) Preliminary Diagnostic Criteria for Fibromyalgia | last = Wolfe | first = Frederick | date = May 2010|volume =62 | issue = 5 | pages = 600–610| doi = 10.1002/acr.20140|type=PDF|archive-url=|archive-date=|access-date= | authorlink = | last2 = Clauw | first2 = Daniel | authorlink2 = |journal=Arthritis Care & Research | last3 = Fitzcharles | first3 = Mary-Ann | first4 = Don | last5 = Katz | last4 = Goldenberg | first5 = Robert | last6 = Mease | first6 = Philip | last7 = Russel | first7 = Anthony | last8 = Russel | first8 = I. Jon | first9 = John | last9 = Winfield | first10 = Muhammad | last10 = Yunus|quote=The reference list consisted of: [[myalgia|muscle pain]], [[irritable bowel syndrome]], [[fatigue]]/tiredness, [[cognitive dysfunction|thinking or remembering problem]], [[paresis|muscle weakness]], [[headache]], pain/cramps in the abdomen, [[paresthesia|numbness/tingling]], [[dizziness]], [[insomnia]], [[depression]], [[constipation]], pain in the upper abdomen, [[nausea]], nervousness, [[chest pain]], [[blurred vision]], [[fever]], [[diarrhea]], dry mouth, [[skin itch|itching]], wheezing, [[Raynaud's syndrome|Raynaud’s phenomenon]], [[hives|hives/welts]], [[tinnitus|ringing in ears]], [[vomiting]], [[heartburn]], oral ulcers, loss of/change in taste, [[seizure]]s, [[dry eye syndrome|dry eyes]], [[dyspnea|shortness of breath]], [[anorexia (appetite loss)|loss of appetite]], [[skin rash|rash]], [[photophobia|sun sensitivity]], hearing difficulties, easy [[bruising]], [[hair loss]], frequent urination, [[painful bladder syndrome|painful urination]], and bladder spasms.}}</ref><ref name="ACR1990" /><ref name="excerpt2" /><ref name="ACR2010" /><ref name="excerpt">{{Cite web |  url = https://www.rheumatology.org/Portals/0/Files/2010%20Fibromyalgia%20Diagnostic%20Criteria_Excerpt.pdf | title=2010 Fibromyalgia Diagnostic Criteria - Excerpt | date = 2010 | last = | first = | authorlink = |website=American College of Rheumatology|archive-url=|archive-date=|access-date=}}</ref> See:  [[Fibromyalgia#Diagnosis|Fibromyalgia (Diagnosis)]].
 
 
[[File:Fibro_Widespread_Pain.png|400px|thumb|right|<span id="ACR1990-image">2010 ACR Preliminatry Diagnostic Criteria:</span> '''Widespread Pain Index (WPI)''', 19 Tender Point Areas<ref name="ACR2010" /><ref name="excerpt" /><br>Image: [https://commons.wikimedia.org/wiki/Category:Fibromyalgia#/media/File:Widespread_Pain_Index_Areas.svg Wikimedia Commons] by author Jmarchn. License: CC-by-sa-3.0]]
 
==Prevalence==
An estimated 4 million people in the US<ref name="FibroBasics" /> and 2-5% of the world population have fibromyalgia (Clauw et al, 2011). Fibromyalgia is the second most common rheumatic disorder behind [[osteoarthritis]]<ref name="ScienceOfFibro">{{Cite journal | last = Clauw | first = Daniel J.  | author-link = Daniel Clauw | last2 = Arnold | first2 = Lesley M. | authorlink2 = | last3 = McCarberg | first3 = Bill H. | date = Sep 2011 | title = The Science of Fibromyalgia| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258006/|journal=Mayo Clinic Proceedings|volume=86|issue=9 | pages = 907–911|doi=10.4065/mcp.2011.0206|issn=0025-6196|pmc=3258006|pmid=21878603|access-date=|quote=|via=}}</ref> and is considered by many pain experts to be a [[central nervous system]] disorder which is most often lifelong<ref name="Clauw2018">{{Cite journal | last = Harte | first = Steven E.  | author-link = | last2 = Harris | first2 = Richard E. | authorlink2 = | last3 = Clauw | first3 = Daniel J. | authorlink3 = Daniel Clauw | date = 2018 | title = The neurobiology of central sensitization | url =https://onlinelibrary.wiley.com/doi/abs/10.1111/jabr.12137|journal=Journal of Applied Biobehavioral Research|language=en|volume=23|issue=2| pages = e12137|doi=10.1111/jabr.12137|issn=1751-9861|pmc=|pmid=|access-date=|quote=|via=}}</ref> that is not fatal.<ref name="wm">{{Cite web |  url = https://www.womenshealth.gov/a-z-topics/fibromyalgia | title = Fibromyalgia | last = | first = | authorlink = | date = | website = Office on Women's Health|archive-url=|archive-date=|url-status=|access-date=2021-12-06}}</ref> It is occurs in women, men, children, and all ethnic groups. Fibromyalgia is often seen in families and most commonly diagnosed in middle aged people, and prevalence increases with age.<ref name="CDC-complications" /><ref name="ScienceOfFibro" />
 
FM is a [[female predominant diseases|female predominant disease]], diagnosed with female:male of between 7:1 and 1.5:1, depending on the criteria used.<ref name="ACR1990" /><ref name="excerpt2" /><ref name="ACR2010" /><ref name="excerpt" /><ref name="medscape" /> See: [[Fibromyalgia#American College of Rheumatology (ACR) Criteria|Fibromyalgia (''American College of Rheumatology (ACR) Criteria'')]]. A September 2018 study by Wolfe et al. found fewer women and more men are diagnosed under the 2010/11 criteria<ref name="Wolfe2018" /> (this criterion further updated in 2016<ref name="2016revision">{{Cite journal | date = 2016-12-01 | title = 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria| url = https://www.sciencedirect.com/science/article/pii/S0049017216302086|journal=Seminars in Arthritis and Rheumatism|language=en|volume=46|issue=3 | pages = 319–329|doi=10.1016/j.semarthrit.2016.08.012|issn=0049-0172}}</ref>).<blockquote>What we did not find in our unbiased CritFM samples was 9:1 female to male fibromyalgia ratios that are widely described by expert sources [11–13]. We believe that such findings only occur in the presence of selection bias or biased ascertainment.<ref name="Wolfe2018" /></blockquote><blockquote>As unbiased epidemiological studies show only a small increase in the female to male sex ratio (~1.5:1) as opposed to the observed ratio in clinical studies of 9:1, we believe that the over-identification of fibromyalgia in women and the consequent under-identification of men is the result of bias.<ref name="Wolfe2018">{{Cite journal | last = Wolfe | first = Frederick | last2 = Walitt | first2 = Brian | last3 = Perrot | first3 = Serge | last4 = Rasker | first4 = Johannes J. | last5 = Häuser | first5 = Winfried | date = 2018-09-13 | title = Fibromyalgia diagnosis and biased assessment: Sex, prevalence and bias |url =https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0203755|journal=PLOS ONE|language=en|volume=13|issue=9| pages = e0203755|doi=10.1371/journal.pone.0203755|issn=1932-6203|pmc=|pmid=30212526|via=}}</ref></blockquote>
 
==Fibromyalgia in ME/CFS==
The most common overlapping condition with [[ME/CFS]] is fibromyalgia.<ref name="ICC2011primer">{{citation | last = Carruthers | first1 = BM | author-link1 = Bruce Carruthers | last2 = van de Sande | first2 = MI | authorlink2 = Marjorie van de Sande | last3 = De Meirleir | first3 = KL | authorlink3 = Kenny de Meirleir | last4 = Klimas | first4 = NG | authorlink4 = Nancy Klimas | last5 = Broderick | first5 = G | authorlink5 = Gordon Broderick | last6 = Mitchell | first6 = T | authorlink6 = Terry Mitchell | last7 = Staines | first7 = D | author-link8 = A C Peter Powles | last8 = Powles | first8 = ACP | last9 = Speight | first9 = N | author-link9 = Nigel Speight | last10 = Vallings | first10 = R | author-link10 = Rosamund Vallings | last11 = Bateman | first11 =  L | author-link11 = Lucinda Bateman | last12 = Bell | first12 = DS | author-link12 = David Bell | last13 = Carlo-Stella | first13 =  N | author-link13 = Nicoletta Carlo-Stella | last14 = Chia | first14 =  J | author-link14 = John Chia | last15 = Darragh | first15 =  A | author-link15 = Austin Darragh | last16 = Gerken | first16 =  A | author-link16 = Anne Gerken | last17 = Jo | first17 =  D | author-link17 = Daehyun Jo | last18 = Lewis | first18 =  DP | author-link18 = Donald Lewis | last19 = Light | first19 = AR | author-link19 = Alan Light | last20 = Light | first20 =  KC | authorlink20 = Kathleen Light | last21 = Marshall-Gradisnik | first21 =  S | authorlink21 = Sonya Marshall-Gradisnik | last22 = McLaren-Howard | first22 =  J | authorlink22 = John McLaren-Howard | last23 = Mena | first23 =  I | authorlink23 =  Ismael Mena | last24 = Miwa | first24 =  K | authorlink24 =  Kunihisa Miwa | last25 = Murovska | first25 =  M | authorlink25= Modra Murovska | last26 = Stevens | first26 =  SR | authorlink26 =  Staci Stevens | title = Myalgic encephalomyelitis: Adult & Paediatric: International Consensus Primer for Medical Practitioners | date = 2012| isbn = 978-0-9739335-3-6 | url = http://www.investinme.org/Documents/Guidelines/Myalgic%20Encephalomyelitis%20International%20Consensus%20Primer%20-2012-11-26.pdf }}</ref><ref name="Jason2001">{{Cite journal | last = Jason | first = Leonard | last2 = Taylor | first2 = R.R. | last3 = Kennedy | first3 = C.L. | last4 = Song | first4 = S | last5 = Johnson | first5 = D | last6 = Torres | first6 = S.R. | date = 2001-01-01 | title = Chronic fatigue syndrome: Comorbidity with fibromyalgia and psychiatric illness |url =https://www.researchgate.net/publication/285787383_Chronic_fatigue_syndrome_Comorbidity_with_fibromyalgia_and_psychiatric_illness|journal=Medicine and Psychiatry|volume=4 | pages = 29–34}}</ref> While some have posited ME/CFS and FM are variants of the same illness, [[Benjamin Natelson]], MD summoned considerable amounts of data that suggest the two illnesses differ with different pathophysiologic processes leading to different treatments.<ref name="Natelson2019">{{Cite journal | last = Natelson | first = Benjamin H. | date = 2019-02-19 | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Fibromyalgia: Definitions, Similarities, and Differences |url =https://www.clinicaltherapeutics.com/article/S0149-2918(19)30003-7/abstract|journal=Clinical Therapeutics|language=English|volume=41|issue=4 | pages = 612|doi=10.1016/j.clinthera.2018.12.016|issn=0149-2918|pmid=30795933}}</ref>
 
Dr. [[Jarred Younger]] has said that many patients that meet the criteria for FM also meet criteria for [[chronic fatigue syndrome]] (CFS) but the reverse is not necessarily true as a lot of people with [[Chronic fatigue syndrome|CFS]] do not have widespread pain.<ref>{{Cite web |  url = https://www.youtube.com/watch?v=wJB95m4FLa0#t=57m27s | title = Webinar with Jarred Younger, Ph.D. | last = Younger | first = Jarred | date = May 20, 2016 | website = YouTube | at=57:27|via=|archive-url=|archive-date=|access-date=| publisher = SolveCFS|type=Video}}</ref> However, the [[Canadian Consensus Criteria]] (CCC) requires the symptom of pain to diagnose ME/CFS.<ref name="Carruthers, 2003">{{Citation | last = Carruthers | first1 = Bruce M. | author-link1 = Bruce Carruthers | last2 = Jain | first2 = Anil Kumar | authorlink2 = Anil Kumar Jain | last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny De Meirleir | last4 = Peterson | first4 = Daniel L. | authorlink4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | authorlink5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin | authorlink6 = Martin Lerner | last7 = Bested | first7 = Alison C. | author-link8 = Pierre Flor-Henry | last8 = Flor-Henry | first8 = Pierre | last9 = Joshi | first9 = Pradip | author-link9 = Pradip Joshi | last10 = Powles | first10 = AC Peter | author-link10 = A C Peter Powles | last11 = Sherkey | first11 = Jeffrey A. | author-link11 = Jeffrey Sherkey | last12 = van de Sande | first12 = Marjorie I. | author-link12 = Marjorie van de Sande | title =  Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols | journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | pages = 7-115 | date = 2003 | pmid = | doi = 10.1300/J092v11n01_02 | url = http://phoenixrising.me/wp-content/uploads/Canadian-definition.pdf }}</ref> It is the pattern (on both sides of the body, and above and below the waist) of chronic widespread [[Musculoskeletal system|musculoskeletal]] pain (involving muscle, cartilage, ligaments, and connective tissue) in FM that sets it apart from other diseases that have pain; it also causes [[cognitive dysfunction|cognitive symptoms]] and [[unrefreshing sleep]].<ref name="webmd-guide" /><ref name="mayo" />
 
A Swedish study of 234 ME/CFS patients meeting the [[Canadian Consensus Criteria]] found that 96% had trigger point pain consistent with fibromyalgia and 67% met the diagnostic criteria for fibromyalgia.<ref>{{Cite web |  url = https://osf.io/qwn5h/|website=Center for Open Science|access-date=2019-12-03 | title = Bragee Bertilson et al. - ME CFS and Intracranial Hypertension | date = Nov 27, 2019 | last = | first = | authorlink = |archive-url=|archive-date=}}</ref>
 
==Health complications==
Fibromyalgia is not considered a progressive disease<ref name="Firdous2012" /> but according to Dr. [[Daniel Clauw|Dan Clauw]] the "slow gradual worsening of chronic pain patients over time is due to downstream consequences of poorly controlled pain and other symptoms, wherein individuals then progressively get less active, sleep worse, are under more stress and unknowingly develop bad habits which worsen pain and other symptoms."<ref>{{Cite news |url =http://nationalpainreport.com/ask-the-dctors-is-fibromyalgia-progressive-8831105.html | title = Ask the Doctors: Is Fibromyalgia Progressive? | date = 2016-08-09|work=National Pain Report|access-date=2018-08-09|language=en-US}}</ref>
 
The [[Centers for Disease Control and Prevention|CDC]] recognizes the following complications:
 
*'''Lower quality of life'''
:Especially for women with fibromyalgia
*'''More hospitalizations'''
:In the [[United States]] people with fibromyalgia are twice as likely to be hospitalized
*'''Higher rates of major [[depression]]'''
:Adults with fibromyalgia are more than 3 times more likely to have major depression than adults without fibromyalgia, and rates of depression and other [[#Mood_disorder_symptoms|mood disorder symptoms]] are higher than in most other illnesses.<ref name="CDC-complications" /><ref name="Alciati2012" />
*'''Death rates from suicide and injuries are higher in people with FM'''
:Overall life span remains similar to the general population.
*'''Higher rates of other rheumatic conditions'''
:Comorbidities include other types of arthritis such as [[osteoarthritis]], [[rheumatoid arthritis]], [[systemic lupus erythematosus|lupus]], and [[ankylosing spondylitis]].<ref name="CDC-complications">{{Cite web |  url = https://www.cdc.gov/arthritis/basics/fibromyalgia.htm#diagnosis | title = Fibromyalgia {{!}} Arthritis | date = 2020-01-06 | last = Centers for Disease Control and Prevention|website=[[Centers for Disease Control and Prevention]]|language=en-us|access-date=2021-11-27}}</ref>
 
The American College of Rheumatology states that:
*Other conditions often occur in fibromyalgia patients
**Depression or [[anxiety]]
**[[Migraine]] or [[tension-type headache|tension headaches]]s
**Digestive problems, e.g. [[irritable bowel syndrome]] (IBS), [[gastroesophageal reflux disease]] (GERD)
**Irritable or [[overactive bladder]]
**[[Chronic pelvic pain|Pelvic pain]]
**[[Temporomandibular joint disorder]] (TMD)<ref name="PatientInfo">{{Cite web | url =https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Fibromyalgia | title = Fibromyalgia | last = | first = |website=American College of Rheumatology|archive-url=|archive-date=|access-date=2021-11-27}}</ref>
 
==Risk factors==
Fibromyalgia is more likely to occur in middle-aged people but can affect any age group, including children. It is more common in women and girls, in obese people and in people with a family history.<ref name="NIAMScauses" />
 
Rheumatic illnesses are risk factors in developing FM, especially [[systemic lupus erythematosus|lupus]] and [[rheumatoid arthritis]] (RA).<ref name="CDC-complications" />
 
Events linked to causing fibromyalgia to develop include car accidents, [[post-traumatic stress disorder]] (PTSD), repetitive injuries, and illnessss such as a [[virus]].<ref name="FibroBasics">{{Cite web |  url = https://www.cdc.gov/arthritis/basics/fibromyalgia.htm | title = Fibromyalgia {{!}} Arthritis | date = 2020-01-06 | website = [[Centers for Disease Control and Prevention]]|language=en-us|access-date=2018-08-09}}</ref><ref name="NIAMScauses">{{Cite web |  url = https://www.niams.nih.gov/health_info/Fibromyalgia/ | title = Fibromyalgia What Causes it? | last = Garrick | first = Nancy| publisher = National Institute of Arthritis and Musculoskeletal and Skin Diseases|access-date=2021-11-27|archive-url=|archive-date=|language=en}}</ref>
 
==Diagnosis==
The American College of Rheumatology  publishes the most widely used diagnostic criteria for fibromyalgia.<ref name="ACR2010" /><ref name="FibroBasics" /> Tender points, not [[trigger point]]s, are used to diagnose fibromyalgia.<ref>{{Cite web |  url = http://www.healthcentral.com/chronic-pain/c/662034/176031/fibromyalgia-trigger/ | title = The Difference Between Fibromyalgia Tender Points and Myofascial Trigger Points - Chronic Pain {{!}} HealthCentral | last = Cooper | first = Celeste | date = May 8, 2015 | website = healthcentral.com|language=en-US|archive-url=|archive-date=|access-date=2018-08-09}}</ref> 
 
In fibromyalgia, painful areas of the body will be both above and below the waist, and on both sides of the body. (See: 1990 ACR and 2010 ACR images above right depicting tender points.) It is important for clinicians to check for other conditions that could be causing pain such as [[hypothyroidism]], rheumatoid arthritis, lupus, osteoarthritis, ankylosing spondylitis, and polymyalgia rheumatica.<ref>{{Cite news |url =https://www.webmd.com/fibromyalgia/guide/fibromyalgia-diagnosis-and-misdiagnosis#1 | title = How Is Fibromyalgia Diagnosed?|work=WebMD|access-date=2018-08-12|language=en-US}}</ref>


===United States===
===United States===
==== American College of Rheumatology (ACR) Criteria ====


*1990, [http://www.rheumatology.org/Portals/0/Files/1990_Criteria_for_Classification_Fibro.pdf The American College Of Rheumatology 1990 Criteria For The Classification Of Fibromyalgia] "American College of Rheumatology guidelines suggest that people with fibromyalgia have pain in at least 11 of these tender points when a doctor applies a certain amount of pressure."<ref>[http://www.health.com/health/gallery/0,,20345635,00.html 18 Points Used to Diagnose Fibromyalgia - Health.com]</ref> <ref>[https://www.masscfids.org/8-resource-library/diagnosis/266-tender-points-might-no-longer-be-used-for-diagnosis-of-fibromyalgia Tender Points might no longer be used for diagnosis of Fibromyalgia - Massachusettes CFIDS/ME FM Association]</ref>
==== 2010 American College of Rheumatology (ACR) Criteria ====
 
The new ACR criteria for fibromyalgia assesses:
* [[#WPI|Widespread Pain Index]] (WPI), which replaces the older tender points assessment, and
* [[#SS|Symptom Severity Score]] (SS), which assesses somatic symptoms other than pain<ref name="ACR2010" />
 
=====<span id="WPI">Widespread pain index=====
 
There are 19 areas in the widespread pain index (WPI) in the newer ACR criteria.<ref name="masscfids" /><ref name="ACR2010" />
 
[[File:Widespread Pain Index Areas with numbers.svg|200px|thumb|right|'''WPI''' 19 areas of pain. Count 1 point for each area of pain present at least once a week.<ref name="Firdous2012" /><ref name="ACR2010" /><ref name="excerpt" /><br>
Image source: [https://commons.wikimedia.org/wiki/File:Widespread_Pain_Index_Areas_with_numbers.svg#/media/File:Widespread_Pain_Index_Areas_with_numbers.svg Wikimedia Commons] by author Jmarchn. License: CC-by-sa-3.0.]]
 
This '''Widespread Pain Index (WPI)''' is scored out of 19, and is one of the two required scores needed for a doctor to make a diagnosis of fibromyalgia, and is considered in combination with the SS score.<ref name="Firdous2012" /><ref name="ACR2010" />
 
=====<span id="SS">Symptom severity</span>=====
The Symptom Severity score ranks each of the following groups of fibromyalgia symptoms on a scale of 0-3, giving a SS score out of 12:
*[[Fatigue]]
*[[Unrefreshing sleep|Waking unrefreshed]]
*[[Cognitive dysfunction|Cognitive symptoms]]
*Somatic (physical) symptoms in general (such as [[headache]], weakness, [[Gastrointestinal system|bowel problems]], [[nausea]], [[dizziness]], [[numbness]]/[[Paresthesia|tingling]], [[hair loss]], [[Dry eye syndrome|dry eyes]], [[Raynaud's syndrome|Raynaud's phenomenon]], painful urination, and more.<ref name="Firdous2012" /><ref name="ACR2010" />
[[File:WPI SS Fibro.JPG|600px|thumb|center|Table 2: '''SS''' scale score. Add a 4th column for Somatic (physical) symptoms in general (such as Headache, weakness, bowel problems, nausea, dizziness, numbness/tingling, hair loss, dry eyes, Raynaud's phenomenon, painful urination, and more)<ref name="Firdous2012" /><ref name="ACR2010" /> The patient ranks specific symptoms on a scale of 0-3. The numbers assigned to each column are added up, for a total of 0-12.<ref name="Firdous2012" /><br>
Source: Jahan F, Nanji K, Qidwai W, Qasim R. Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management. Oman Med J 2012 May; 27(3):192-195. doi: 10.5001/omj.2012.44 license: CC-BY-NC]]
 
A fibromyalgia diagnosis is based on both the '''WPI''' score and the '''SS''' score either:
*'''WPI''' of at least 7 and '''SS''' scale score of at least 5, ''or''
*'''WPI''' of at least 4 and '''SS''' scale score of at least 9
*with symptoms present for at least three months<ref name="Firdous2012" /><ref name="ACR-rev" />
 
The 2010 American College of Rheumatology (ACR) proposed diagnostic criteria for fibromyalgia<ref name="ACR2010" /><ref name="excerpt" /> was modified in 2011,<ref name="2016revision" /> with the modification being validated in 2013 and published in 2014.<ref name="prelim2010">{{Cite journal | last = Bennett | first = Robert M. | last2 = Friend | first2 = Ronald | last3 = Marcus | first3 = Dawn | last4 = Bernstein | first4 = Cheryl | last5 = Han | first5 = Bobby Kwanghoon | last6 = Yachoui | first6 = Ralph | last7 = Deodhar | first7 = Atul | last8 = Kaell | first8 = Alan | last9 = Bonafede | first9 = Peter| date = 2014  | title = Criteria for the diagnosis of fibromyalgia: validation of the modified 2010 preliminary American College of Rheumatology criteria and the development of alternative criteria| url = https://www.ncbi.nlm.nih.gov/pubmed/24497443|journal=Arthritis Care & Research|volume=66|issue=9 | pages = 1364–1373|doi=10.1002/acr.22301|issn=2151-4658|pmid=24497443|via=}}</ref> In September 2016, another revision was been made.<ref name="ACR-rev">{{Cite news |url =http://acrabstracts.org/abstract/2016-revisions-to-the-20102011-fibromyalgia-diagnostic-criteria/ | title = 2016 Revisions to the 2010/2011 Fibromyalgia Diagnostic Criteria - ACR Meeting Abstracts | last = | first = | date = Sep 28, 2016|work=ACR Meeting Abstracts|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>


*2010, The [http://fibroknowledge.com/site/acr-2010.htm 2010 American College of Rheumatology (ACR) Preliminary Diagnostic Criteria for Fibromyalgia: Overview] was proposed and modified in 2011<ref>[http://www.celestecooper.com/fibromyalgia.html 2011 Modification of 2010 ACR Fibromyalgia Criteria - CelesteCooper.com]</ref> with the modification being validated in 2013 and published in 2014.<ref>[https://www.ncbi.nlm.nih.gov/pubmed/24497443 Criteria for the diagnosis of fibromyalgia: validation of the modified 2010 preliminary American College of Rheumatology criteria and the development of alternative criteria. - PubMed]</ref> September of 2016, another revision has been made.<ref>[http://acrabstracts.org/abstract/2016-revisions-to-the-20102011-fibromyalgia-diagnostic-criteria/ 2016 Revisions to the 2010/2011 Fibromyalgia Diagnostic Criteria]</ref>
=====Take the online Fibromyalgia test =====
This [https://www.fibromyalgiaforums.org/get-help/online-fibromyalgia-test online test by fibromyalgiaforums.org] uses the ACR 2010 Criterion to help diagnose fibromyalgia.


:Tender points were used to diagnose with the 1990 criteria, however "considerable skill is needed to correctly check for a patient’s tender points (i.e., digital palpation that is done with certain amount of applied pressure), yet this technique is not typically taught at most medical schools."<ref>[https://www.masscfids.org/8-resource-library/diagnosis/266-tender-points-might-no-longer-be-used-for-diagnosis-of-fibromyalgia#2 Tender Points might no longer be used for diagnosis of Fibromyalgia - Tender Points might no longer be used for diagnosis of Fibromyalgia - Massachusettes CFIDS/ME FM Association]</ref>  
=====Tender point test phased out =====
The older 1990 criteria's tender point examination was replaced because men often do not seem to form the tender points needed for diagnosis.<ref name="men">{{Cite news |url =http://www.webmd.com/fibromyalgia/features/how-fibromyalgia-affects-men#2 | title = How Fibromyalgia Affects Men: Symptoms and Diagnosis|work=WebMD|access-date=2018-08-09|language=en-US}}</ref> The 2010 proposed criteria correctly diagnosed more men, with a female:male ratio of 2:1.<ref name="medscape">{{Cite web | last = Boomershine | first = Chad | date = Nov 4, 2017 | title = Fibromyalgia: Practice Essentials, Background, Pathophysiology| url = http://emedicine.medscape.com/article/329838-overview#a5 | website = Medscape | pages = |via=}}</ref>


Tender point examination was also problematic because "considerable skill is needed to correctly check for a patient's tender points (i.e., digital palpation that is done with certain amount of applied pressure)", but this technique was not taught at most medical schools.<ref name="NBK279092" /><ref name="masscfids">{{Cite web |  url = https://www.masscfids.org/8-resource-library/diagnosis/266-tender-points-might-no-longer-be-used-for-diagnosis-of-fibromyalgia#2 | title = Tender Points might no longer be used for diagnosis of Fibromyalgia | last = Proskauer | first = Charmian | date = Feb 5, 2011 | website = [[Massachusetts ME/CFS & FM Association]]|language=en-GB|archive-url=|archive-date=|access-date=2018-08-09}}</ref>
:The new standards were designed to:
:The new standards were designed to:
:*eliminate the use of a tender point examination
:*eliminate the use of a tender point examination
:*include a severity scale by which to identify and measure characteristic FM symptoms
:*include a severity scale by which to identify and measure characteristic FM symptoms
:*utilize an index by which to rate pain<ref>[https://www.masscfids.org/8-resource-library/diagnosis/266-tender-points-might-no-longer-be-used-for-diagnosis-of-fibromyalgia#3 Tender Points might no longer be used for diagnosis of Fibromyalgia - The new criteria for FM diagnosis - Massachusettes CFIDS/ME FM Association]</ref>
:*utilize an index by which to rate pain<ref name="masscfids" />  
 
====1990 ACR criteria====
[[File:Fibro_Tender_Points.png|400px|thumb|right|<span id="ACR1990-image">1990 ACR Diagnostic Criteria: 18 Tender Points</span><ref name="ACR1990">{{Cite journal | last = Wolfe | first = Frederick  | author-link = Frederick Wolfe | last2 = Smythe | first2 = Hugh | authorlink2 = | last3 = Yunus | first3 = Muhammad | authorlink3 = Muhammad Yunnus | last4 = Bennett | first4 = Robert | authorlink4 = | last5 = Bombardier | first5 = Claire | authorlink5 = | last6 = Goldenberg | first6 = Don | authorlink6 = | last7 = Tugwell | first7 = Peter | author-link7 = | last8 = Campbell | first8 = Stephen | last9 = Abeles | first9 = Micha | author-link9 = |others=P Clark; A Fam; S Farber; J Fiechtner; CM Franklin; R Gatter; D Hamaty; J Lessard; A Lichtbroun; A Masi; G McCain; WJ Reynolds; T Romano; IJ Russell;  R Sheon | date = 1990 | title = The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia| url = https://www.rheumatology.org/Portals/0/Files/1990_Criteria_for_Classification_Fibro.pdf | journal=Arthritis and Rheumatism| publisher = The American College of Rheumatology|volume=33|issue=2 | pages = 160-172|quote=|via=}}</ref><ref name="excerpt2">{{Cite web |  url = https://www.rheumatology.org/Portals/0/Files/1990%20Fibromyalgia_Excerpt.pdf | title=1990 Fibromyalgia Excerpt | last = Wolfe | first = Frederick | authorlink = Frederick Wolfe | date = 1990 | website = American College of Rheumatology|archive-url=|archive-date=|access-date=}}</ref><br>Image source: [https://commons.wikimedia.org/wiki/File:Tender_points_fibromyalgia_svg.svg WikiMedia Commons], authors Sav vas and Jmarchn, license: CC0 / public domain.]]
*1990, [http://www.rheumatology.org/Portals/0/Files/1990_Criteria_for_Classification_Fibro.pdf The American College Of Rheumatology 1990 Criteria For The Classification Of Fibromyalgia]<ref name="ACR1990" /><ref name="excerpt2" /> "American College of Rheumatology guidelines suggest that people with fibromyalgia have pain in at least 11 of these tender points when a doctor applies a certain amount of pressure."<ref name="NBK279092" /><ref name="masscfids" />
 
====US Social Security Administration ====
The United States [[Social Security Administration]] (SSA) accepts a diagnosis of FM with either the 2010 or 1990 ACR criteria.<ref name="ACR1990" /><ref name="excerpt2" /><ref name="ACR2010" /><ref name="excerpt" /><ref name="ssa">{{Cite web |  url = https://www.ssa.gov/OP_Home/rulings/di/01/SSR2012-02-di-01.html | title = Social Security Ruling: SSR 12-2p | last = ORDP | last2 = OPPS | first = | date = Jul 25, 2012 | website = ssa.gov|language=en|archive-url=|archive-date=|access-date=2018-08-09}}</ref>
{{See also|Fibromyalgia disability process}}
 
==== Sleep studies====
[[Sleep dysfunction]] is often involved in FM. Treating a sleep disorder or sleep problems may help with FM symptoms, for example [[fatigue]]. [[Sleep apnea]], [[restless legs syndrome]] and [[nocturnal myclonus]] are often found in fibromyalgia patients, and waking unrefreshed is a diagnostic symptom of fibromyalgia.<ref name="NBK279092">{{Cite book | last = Kaltsas | first = Gregory | last2 = Tsiveriotis | first2 = Konstantinos | date = 2000|editor-last = Feingold|editor-first = Kenneth R.|editor2-last = Anawalt|editor2-first = Bradley|editor3-last = Boyce|editor3-first = Alison|editor4-last = Chrousos|editor4-first = George|editor5-last = de Herder|editor5-first = Wouter W.|editor6-last = Dhatariya|editor6-first = Ketan|editor7-last = Dungan|editor7-first = Kathleen|editor8-last = Hershman|editor8-first = Jerome M.|editor9-last = Hofland|editor9-first = Johannes | title = Endotext [Internet]|chapter=Fibromyalgia|chapter-url=http://www.ncbi.nlm.nih.gov/books/NBK279092/|location=South Dartmouth (MA)| publisher = MDText.com, Inc.|pmid=25905317}}</ref><ref name="ACR2010" /> A diagnosed sleep disorder is also helpful if one needs to [[Fibromyalgia disability process|file for disability]].
 
====Brain scans====
Brain scans are a potential aid to help diagnose fibromyalgia.<ref name="Hackshaw2021">{{Cite journal | last = Hackshaw | first = Kevin V.  | author-link = | date = Feb 2021 | title = The Search for Biomarkers in Fibromyalgia| url = https://www.mdpi.com/2075-4418/11/2/156|journal=Diagnostics|language=en|volume=11|issue=2 | pages = 156|doi=10.3390/diagnostics11020156|pmc=PMC7911687|pmid=33494476|access-date=|quote=|via=}}</ref><ref name="HashmiTrial">{{Cite web | last = Hashmi | first = Javeria | date = 2020-03-11|others=Nova Scotia Health Authority | title = Brain Imaging Study on Biomarkers for Fibromyalgia| url = https://clinicaltrials.gov/ct2/show/NCT03910010}}</ref> A small study by López-Solà et al. (2017) using a combination of [[functional magnetic resonance imaging|fMRI]] brain scans and artificial intelligence (machine learning) correctly diagnosed 95% of fibromyalgia patients.<ref name="Lopez2017" />


The 2010 preliminary diagnostic criteria has never been officially implemented.
A number of brain imaging studies have found significant results in patients with fibromyalgia, including a [[Functional magnetic resonance imaging|fMRI]] study that found patients with FM "have measurable pain signals in their brains, from a gentle finger squeeze that barely feels unpleasant to people without the disease"<ref name="Gracely2002" /> and MR/PET imaging by Loggia et al 2015 found [[neuroinflammation]] due to [[Glial cell|glial]] activation.<ref name="Loggia2015" />
{{See also|Fibromyalgia notable studies}}


==== Medical coding ====
====Blood tests and biomarkers====
*2015, Fibromyalgia M79.7<ref>[http://www.icd10data.com/ICD10CM/Codes/M00-M99/M70-M79/M79-/M79.7 2015/16 ICD-10-CM Diagnosis Code M79.7]</ref> <ref>[http://nationalpainreport.com/the-health-care-industry-finally-recognizes-fibromyalgia-8827637.html The Health Care Industry Finally Recognizes Fibromyalgia]</ref>
EpicGenetics developed the '''FM/a test''' blood test to diagnose FM in 2017 - and announced a linked treatment trial involving the BCG vaccine soon after; the trial has since been suspended indefinitely.<ref name="controversy2021" /><ref name="fmtest">{{Cite web |  url = http://fmtest.com/ | title = Home | last = |website=EpicGenetics' FM/a® Test is FDA-compliant and has successfully diagnosed patients with fibromyalgia since 2012.|language=en-US|access-date=2019-03-25}}</ref><ref name="FMa test" /> Dr Denise Faustman at Massachusetts General Hospital, who was due to conduct the trial, stated that the test should never have been marketed as a requirement for the treatment trial, and that no patients were ever recruited to the trial.<ref name="FMa test" />


== Other diseases, illnesses and co-morbids of fibromyalgia ==
The FM/a test continues to be marketed despite the suspension of the linked treatment trial,<ref name="FMa test" /> and the fact that only two studies have been published using the test - the last being published in 2015.<ref name="PMC3534336" /><ref name="PMC4435905" /> The evidence base supporting the use of the test has been reported to be weak, and no studies have assessed whether the test can correctly determine which patients have fibromyalgia and have some fibromyalgia symptoms that are explained by another diagnosis.<ref name="controversy2021" /> One study did not include any men.<ref name="PMC3534336" />
*[http://www.news-medical.net/health/What-is-Fibro-Fog-Fibromyalgia-and-Cognitive-Dysfunction.aspx What is Fibro Fog? - Fibromyalgia and Cognitive Dysfunction] "Mental confusion along with difficulty in concentration and loss of memory is often termed “fibro fog”".<ref>[http://www.news-medical.net/health/What-is-Fibro-Fog-Fibromyalgia-and-Cognitive-Dysfunction.aspx What is Firbo Fog - Fibromyalgia and Cognitive Dysfunction - Medical.net]</ref>


*[http://www.healthcentral.com/chronic-pain/c/662034/176031/fibromyalgia-trigger/ The Difference Between Fibromyalgia Tender Points and Myofascial Trigger Points]
IsolateFibromyalgia, IQuity's RNA based blood test for fibromyalgia, was first announced in 2018 but no peer-reviewed studies have been published.


*[http://chronicfatigue.about.com/b/2009/02/03/impaired-language-in-fibromyalgia-chronic-fatigue-syndrome.htm Impaired Language in Fibromyalgia & Chronic Fatigue Syndrome - Talking, Reading & Writing] "How often do you find yourself searching your brain for a simple word that you just can't remember?"<ref>[http://chronicfatigue.about.com/b/2009/02/03/impaired-language-in-fibromyalgia-chronic-fatigue-syndrome.htm Impaired Language in Fibromyalgia & Chronic Fatigue Syndrome - Talking, Reading & Writing]</ref> "The diagnosis of Aphasia is a condition that robs you of the ability to communicate. It can affect your ability to speak, write and understand language, both verbal and written."<ref>[http://www.mayoclinic.org/diseases-conditions/aphasia/basics/definition/con-20027061 Aphasia - Mayo Clinic]</ref> and "with dysphasia will be found to having difficulty in talking, understanding, listening, writing or doing numeral calculations."<ref>[http://www.ayushveda.com/healthcare/dysphasia.htm What is Dysphasia?-Ayushveda]</ref>  
A '''non-invasive eye test''' has found eye abnormalities in people with fibromyalgia, with Garcia et al 2016 finding reduced retinal nerve fiber layer (RNFL) thickness, raising hopes of a non-invasive eye test may help  diagnose FM.<ref name="Garcia2016">{{Cite journal | last = Garcia-Martin | first = Elena | last2 = Garcia-Campayo | first2 = Javier | last3 = Puebla-Guedea | first3 = Marta | last4 = Ascaso | first4 = Francisco J. | last5 = Roca | first5 = Miguel | last6 = Gutierrez-Ruiz | first6 = Fernando | last7 = Vilades | first7 = Elisa | last8 = Polo | first8 = Vicente | last9 = Larrosa | first9 = Jose M. | date = 2016-09-01 | title = Fibromyalgia Is Correlated with Retinal Nerve Fiber Layer Thinning | url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008644/|journal=PLoS ONE|volume=11|issue=9| pages = e0161574|doi=10.1371/journal.pone.0161574|issn=1932-6203|pmc=5008644|pmid=27584145}}</ref> The findings were confirmed by Cordón et al 2021, who found that disease severity and reduced quality of life were associated with reduced RNFL.<ref name="Cordon2021">{{Cite journal | last = Cordón | first = B. | last2 = Orduna | first2 = E. | last3 = Viladés | first3 = E. | last4 = Garcia-Martin | first4 = E. | last5 = Garcia-Campayo | first5 = J. | last6 = Puebla-Guedea | first6 = M. | last7 = Polo | first7 = V. | last8 = Larrosa | first8 = J.M. | last9 = Pablo | first9 = L.E. | date = 2021-07-02 | title = Analysis of Retinal Layers in Fibromyalgia Patients with Premium Protocol in Optical Tomography Coherence and Quality of Life | url =https://doi.org/10.1080/02713683.2021.1951301|journal=Current Eye Research|volume=0|issue=0 | pages = 1–11|doi=10.1080/02713683.2021.1951301|issn=0271-3683|pmid=34213409}}</ref> The test requires optical coherence tomography (OCT), which is fast and non-invasive.<ref name="Cordon2021" /> At present, there is no eye test in clinical use for diagnosing FM.


*[https://www.verywell.com/temperature-sensitivity-in-fibromyalgia-and-mecfs-716025 Temperature Sensitivity in Fibromyalgia & Chronic Fatigue Syndrome] "When you're exposed to heat, does it feel like you're burning up? Does it seem impossible for you to cool off? Or maybe it's cold that bothers you, chilling you to the bone, leaving you unable to warm up.
In 2019, Hackshaw and colleagues found a unique metabolic fingerprint using a blood spot test that distinguished between fibromyalgia, rheumatoid arthritis and lupus, which they suggested could act as a diagnostic biomarker for FM.<ref name="Hackshaw2019">{{Cite journal | last = Hackshaw | first = Kevin V. | last2 = Aykas | first2 = Didem P. | last3 = Sigurdson | first3 = Gregory T. | last4 = Plans | first4 = Marcal | last5 = Madiai | first5 = Francesca | last6 = Yu | first6 = Lianbo | last7 = Buffington | first7 = Charles A.T. | last8 = Giusti | first8 = M. Mónica | last9 = Rodriguez-Saona | first9 = Luis | date = 2019-02-15 | title = Metabolic fingerprinting for diagnosis of fibromyalgia and other rheumatologic disorders |url =https://www.jbc.org/article/S0021-9258(20)40006-7/abstract|journal=Journal of Biological Chemistry|language=English|volume=294|issue=7 | pages = 2555–2568|doi=10.1074/jbc.RA118.005816|issn=0021-9258}}</ref>


:Or are you one of those people with fibromyalgia (FMS) and [[chronic fatigue syndrome]] ([[ME/CFS]]) who is cold all the time, or hot all the time, or alternately hot or cold while out of sync with the environment?"<ref>[https://www.verywell.com/temperature-sensitivity-in-fibromyalgia-and-mecfs-716025 Temperature Sensitivity in Fibromyalgia & Chronic Fatigue Syndrome - Very Well By Adrienne Dellwo]</ref>
[[Heart rate variability]] (HRV) measured by ECG is a possible fibromyalgia biomarker, since it is reduced in people with FM, but heart rate is affected by many different factors so this may be problematic.<ref name="Hackshaw2021" />


*[http://chronicfatigue.about.com/od/Research/fl/Fibromyalgia-Tied-to-Hysterectomy-Gynecologic-Disease.htm Fibromyalgia is tied to Hysterectomy and Gynecological Disease and Endocrine and Autoimmune Disorders]. "Did you have a gynecologic surgery, such as a hysterectomy, in the few years before you developed fibromyalgia?"<ref>[http://chronicfatigue.about.com/od/Research/fl/Fibromyalgia-Tied-to-Hysterectomy-Gynecologic-Disease.htm Fibromyalgia Tied to Hysterectomy, Gynecologic Disease]</ref>
=== ICD Diagnostic code===
'''ICD-10'''


*[https://en.wikipedia.org/wiki/Allodynia Allodynia] "Allodynia is pain, generally on the skin, caused by something that wouldn't normally cause pain." <ref>[http://chronicfatigue.about.com/od/glossary/g/allodynia.htm Allodynia - about.com definition article]</ref>
The [[World Health Organization]] (WHO) International Classification of Diseases (ICD) lists FM as a "disease of the [[musculoskeletal system]] and connective tissue", under the code M79.7 (WHO ICD-10 Version: 2016).<ref name="ICD10">{{Cite web |  url = http://apps.who.int/classifications/icd10/browse/2016/en#/M79.7 | title = ICD-10 Version:2016 | last = World Health Organization | first = | author-link = World Health Organization | date = 2016 | website = [[World Health Organization]]|at=M79.7 Fibromyalgia|language=en|archive-url=|archive-date=|access-date=2018-09-15}}</ref> The WHO's ICD-10 does not refer to FM as a syndrome and it is not classified in the category for [[Medically unexplained physical symptoms|medically unexplained symptoms]].<ref name="icd10us" /><ref name="ICD10" />


*[http://chronicfatigue.about.com/b/2009/03/07/painful-to-touch-fibromyalgia-tactile-allodynia.htm Painful to Touch: Fibromyalgia & Tactile Allodynia - Does Your Skin Hurt? Here's Why!] "It's another one of those fibromyalgia symptoms that just doesn't make sense -- pain, sometimes severe pain, from a simple touch. The closest thing it compares to is having a sunburn all the time. A lot of people don't understand this symptom, including those who have it, because while it's common in fibromyalgia, it's rare in the general population."<ref>[http://chronicfatigue.about.com/b/2009/03/07/painful-to-touch-fibromyalgia-tactile-allodynia.htm Painful to Touch: Fibromyalgia & Tactile Allodynia - Does Your Skin Hurt? Here's Why!]</ref>
*'''M79.7 Fibromyalgia'''
::Fibromyositis
::Fibrositis
::Myofibrositis<ref name="ICD10" />


*[[Thyroid disease]] - [http://thyroid.about.com/cs/fibromyalgiacfs/a/cfsfibrothyroid.htm Chronic Fatigue Syndrome, Fibromyalgia, and Autoimmune Thyroid Disease] "CFS, FMS and HAIT patients often visit their doctors complaining of a host of symptoms. (See sidebar.) Since symptoms are similar, there is a risk of misdiagnosis. Some doctors still fail to even acknowledge the existence of CFS and FMS."<ref>[http://thyroid.about.com/cs/fibromyalgiacfs/a/cfsfibrothyroid.htm Chronic Fatigue Syndrome, Fibromyalgia, and Autoimmune Thyroid Disease]</ref>  
In 2015, the [[United States|US]] finally adopted ICD-10 and FM as a diagnosis.<ref name="icd10us">{{Cite web |  url = http://www.icd10data.com/ICD10CM/Codes/M00-M99/M70-M79/M79-/M79.7 | title = 2018 ICD-10-CM Diagnosis Code M79.7: Fibromyalgia | website = icd10data.com|language=en|access-date=2018-08-09 | date = 2018 | last = World Health Organization | first = |archive-url=|archive-date= | authorlink = World Health Organization}}</ref><ref>{{Cite news |url =http://nationalpainreport.com/the-health-care-industry-finally-recognizes-fibromyalgia-8827637.html | title = The Health Care Industry Finally Recognizes Fibromyalgia | last = Liptan | first = Ginevra | date = 2015-09-30|work=National Pain Report|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref>


*[http://chronicfatigue.about.com/b/2011/09/21/thyroid-disease-in-fibromyalgia-chronic-fatigue-syndrome.htm Thyroid Disease in Fibromyalgia & Chronic Fatigue Syndrome] "Fibromyalgia and chronic fatigue syndrome are multi-system illnesses. They hit you hard in multiple ways, and confuse doctors of all specialties because not everything can be explained by the one system they focus on."<ref>[http://chronicfatigue.about.com/b/2011/09/21/thyroid-disease-in-fibromyalgia-chronic-fatigue-syndrome.htm Thyroid Disease in Fibromyalgia & Chronic Fatigue Syndrome]</ref>
'''ICD-11 (2019)'''


*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4648619/ Sleep is associated with task-negative brain activity in fibromyalgia participants with comorbid chronic insomnia]. "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>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4648619/ Sleep is associated with task-negative brain activity in fibromyalgia participants with comorbid chronic insomnia]</ref>  
The [[ICD-11]] (2019) has diagnostic code ''MG30.1 Chronic widespread pain'', and changed the category from a [[:Category:Musculoskeletal diseases and disorders|Musculoskeletal disease]], to the ''General signs and symptoms category'', sometimes referred to as [[Medically unexplained physical symptoms]].<ref name="ICD11">{{Cite web |  url = https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/849253504 | title = ICD-11 - Mortality and Morbidity Statistics|website=[[World Health Organization]]|language=en|access-date=2018-08-09}}</ref>  


*[http://www.prohealth.com/library/showarticle.cfm?libid=22344 Fibromyalgia and Sleep] "Most people with fibromyalgia have an associated sleep disorder that makes it difficult for them to get the deep, restorative sleep they need."<ref>[http://www.prohealth.com/library/showarticle.cfm?libid=22344 Fibromyalgia and Sleep - ProHealth - By: Cort Johnson]</ref>
*'''MG30.01 Chronic widespread pain'''


*[[Irritable bowel syndrome]]: [http://chronicfatigue.about.com/od/whyfmscfsarelinked/a/IBS.htm Irritable Bowel Syndrome in Fibromyalgia & Chronic Fatigue Syndrome - Why Do They Go Together?] "Fibromyalgia, chronic fatigue syndrome and irritable bowel syndrome (IBS) frequently go together. No one really knows why, but we do know that all three conditions can include imbalances of serotonin -- although in fibromyalgia (FMS) and [[Chronic Fatigue Syndrome]] ([[CFS]] or [[ME/CFS]]) it's an imbalance in the brain, while with IBS it's in the gut."<ref>[http://chronicfatigue.about.com/od/whyfmscfsarelinked/a/IBS.htm Irritable Bowel Syndrome in Fibromyalgia & Chronic Fatigue Syndrome - Why Do They Go Together?]</ref>
'''Parent'''
::MG30.0 Chronic primary pain


*[[Orthostatic intolerance]]<ref>[https://www.verywell.com/orthostatic-intolerance-715915 Orthostatic Intolerance - Very Well By: Adrienne Dellwo]</ref> [http://drlapp.com/wp-content/uploads/TTT_symptoms.pdf Symptoms Predict the Outcome of Tilt Table Testing in CFS/ME/FM] Symptoms can include low blood pressure and/or sudden high blood pressure, dizziness, fainting.
'''Description'''
<blockquote>Chronic widespread pain (CWP) is diffuse pain in at least 4 of 5 body regions and is associated with significant emotional distress (anxiety, anger/frustration or depressed mood) or functional disability (interference in daily life activities and reduced participation in social roles). CWP is multifactorial: biological, psychological and social factors contribute to the pain syndrome. The diagnosis is appropriate when the pain is not directly attributable to a nociceptive process in these regions and there are features consistent with nociplastic pain and identified psychological and social contributors.<ref name="ICD11" /></blockquote>


*[https://en.wikipedia.org/wiki/Costochondritis Costochondritis] is chest and ribcage pain. [https://www.verywell.com/costochondritis-in-fibromyalgia-716178 Costochondritis in Fibromyalgia]
'''Inclusions'''
:*Fibromyalgia
'''Exclusions'''
:*Acute pain (MG31)<ref name="ICD11" />
==Differential diagnosis ==
Conditions which have symptoms that are similar to fibromyalgia, particularly involving '''chronic widespread pain''' and [[fatigue]] should be ruled out, either by the routine tests recommended to aid fibromyalgia diagnosis, or by symptom pattern and history.


*[http://chronicfatigue.about.com/od/whatisfibromyalgia/a/fibrosymptoms.htm Fibromyalgia Symptoms - The Monster List!] " ...the list of possible symptoms is far-reaching and body-wide."<ref>[http://chronicfatigue.about.com/od/whatisfibromyalgia/a/fibrosymptoms.htm Fibromyalgia Symptoms - The Monster List!]</ref>
Differential diagnoses for fibromyalgia include:
*'''Inflammatory rheumatic diseases:'''
:[[Rheumatoid arthritis]], [[systemic lupus erythematosus]], [[Sjögren's syndrome]], mixed connective tissue disease, scleroderma, or inflammatory spondyloarthritis, inflammatory polyarthritis, polymyalgia rheumatica, inflammatory myopathy or systemic inflammatory arthropathies
*'''Musculoskeletal or spinal conditions:'''
:[[Myofascial pain syndrome]], hypermobility syndromes including [[Ehlers-Danlos Syndrome]], [[spinal stenosis]], myelopathies, myositis
*'''Endocrine and metabolic disorders:'''
:[[Hashimoto's thyroiditis (hypothyroidism)]], [[hyperparathyroidism]], acromegaly, and [[vitamin D]] deficiency
*'''Gastrointestinal diseases:'''
:[[Celiac disease]] or other forms of [[irritable bowel disease]], [[Non-celiac gluten sensitivity]]
*'''Infectious diseases::'''
:[[Lyme disease]], hepatitis C, and HIV, although these are not routinely tested for, [[Chronic Lyme disease]] may be secondary to fibromyalgia
*'''Cancers''' at the very early stages:
:fever, night sweats, and weight loss are common signs
*'''Neurological conditions:'''
:[[Multiple sclerosis]], [[Parkinson's disease]] and peripheral neuropathies
*'''Medication-induced pain conditions:'''
:statins, [[opioid]]s ([[opioid-induced hyperalgesia]]), some chemotherapy drugs, aromatase inhibitors, and bisphosphonates can cause diffuse pain <ref name="NBK540974">{{Cite book | last = Bhargava | first = Juhi | last2 = Hurley | first2 = John A. | date = 2021 | title=Fibromyalgia| url = http://www.ncbi.nlm.nih.gov/books/NBK540974/|location=Treasure Island (FL)| publisher = StatPearls Publishing|doi=|pmc=|pmid=31082018|quote=|via=}}</ref><ref name="PMC5741304">{{Cite journal | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5741304/ | title = Diagnostic confounders of chronic widespread pain: not always fibromyalgia | date = 2017 | journal=Pain Rep.|volume =2|issue = 3 | page = e598 |doi =10.1097/PR9.0000000000000598|pmid =
29392213|pmc=PMC5741304|first =Winfried | last = Häuser | first2 =Serge | last2 =Perrot | first3 = Claudia | last3 = Sommer | first4 = Yoram | last4 = Shir | first5 = Mary-Ann | last5 = Fitzcharles | pages = |quote= | last6 = | first6 =  | author-link = Winfred Häuser | authorlink2 = |access-date=|via=}}</ref>


== Rheumatology and primary care providers: Diagnosing and treatment ==
The limited laboratory findings along with history and physical examination can help differentiate fibromyalgia from other differentials.<ref name="PMC5741304" />
===United States===
 
*2012, the [https://en.wikipedia.org/wiki/Mayo_Clinic Mayo Clinic] published [http://www.mayoclinicproceedings.org/article/S0025-6196%2812%2900299-6/fulltext A Framework for Fibromyalgia Management for Primary Care Providers]. Rheumatologists stopped treating Fibromyalgia patients and Primary Care providers began treating although Rheumatologists are most often the specialist to diagnose. (Please see [http://me-pedia.org/wiki/Fibromyalgia#Disability Disability] heading about ''Primary Provider'' and ''Specialists'' for disability cases.)
==Pathophysiology==
Fibromyalgia is a '''pain processing disorder''' involving altered pain processing in the [[central nervous system]] which causes widespread pain and a constellation of additional symptoms.<ref name="ScienceOfFibro" />
 
Neuroimaging and brain imaging studies have shown that the pain and other symptoms of fibromyalgia appear to be caused by neurochemical imbalances in the [[central nervous system]] that lead to a '''central amplification''' of pain perception (Clauw et al., 2011).<ref name="ScienceOfFibro" />
 
According to the CDC, there is no evidence that a single event "causes" fibromyalgia, instead it appears to be associated with many physical and/or emotional [[Stress|stressors]]  and other [[#risk_factors|risk factors]] that may trigger or aggravate symptoms. These include certain [[Infection|infections]], such as a [[Viral infection|viruses]] or [[Lyme disease]], as well as emotional or physical [[trauma]] (injury)."<ref name="FibroBasics" /><ref name="CDC-complications" /> The widespread pain is severe, debilitating, and abnormal in processing its pain. [[Sleep dysfunction|sleep disturbance]] and [[fatigue]] are common symptoms.<ref name="omf">{{Cite news |url =https://www.omf.ngo/what-is-mecfs-old/fibromyalgia/ | title = What is Fibromyalgia?|work=Open Medicine Foundation|access-date=2018-08-09|language=en-US | last = | first = | date = |quote= | author-link = |archive-url=|archive-date=}}</ref>


== Drugs ==
*May 2012, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/ Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management]<ref name="Firdous2012">{{Cite journal | last = Jahan | first = Firdous | last2 = Nanji | first2 = Kashmira | last3 = Qidwai | first3 = Waris | last4 = Qasim | first4 = Rizwan | date = 2012  | title = Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/|journal=Oman Medical Journal|volume=27|issue=3 | pages = 192–195|doi=10.5001/omj.2012.44|issn=1999-768X|pmid=22811766|via=}}</ref>  ''See'' Table 1: "Conditions associated with fibromyalgia." Musculoskeletal, [[:Category:genitourinary signs and symptoms|genitourinary]], [[Gastrointestinal system|gastrointestinal]], and miscellaneous conditions often exist among fibromyalgia patients.
There are approved and off-label drugs for treating FM. ''Please Note: The information under "Drugs" is not meant to promote any Rx drug for Fibromyalgia but to inform you of these drugs both approved and off-label. Always consult your doctor for guidance on Rx drug use for any illness or disease.''


===United States===
<blockquote>Pathophysiology: Although the etiology remains unclear, characteristic alterations in the [[Sleep dysfunction|pattern of sleep]] and changes in neuroendocrine transmitters such as [[serotonin]], substance P, growth hormone and [[cortisol]] suggest that regulation of the [[Autonomic nervous system|autonomic]] and [[neuroendocrine system]] appears to be the basis of the syndrome. Fibromyalgia is not a life-threatening, deforming, or [progressive disease. [[Anxiety]] and [[depression]] are the most common association. Aberrant pain processing, which can result in [[chronic pain]], may be the result of several interplaying mechanisms. [[Central sensitization]], blunting of inhibitory pain pathways and alterations in [[neurotransmitter]]s lead to aberrant neurochemical processing of sensory signals in the CNS, thus lowering the threshold of pain and amplification of normal sensory signals causing constant pain." (Firdous et al, 2012)<ref name="Firdous2012" /></blockquote>
====[[Food and Drug Administration]] (FDA) approved====
*[http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm107802.htm Living with Fibromyalgia, Drugs Approved to Manage Pain] ([https://en.wikipedia.org/wiki/FDA_Consumer FDA For Consumers])


*[https://en.wikipedia.org/w/index.php?title=Cymbalta&redirect=no Cymbalta] ([https://en.wikipedia.org/wiki/Duloxetine Duloxetine is Generic])
<blockquote>The frequent co-morbidity of fibromyalgia with [[Mood swings|mood disorders]] suggests a major role for the stress response and for neuroendocrine abnormalities. The [[hypothalamic pituitary axis]] (HPA axis) is a critical component of the stress-adaptation response. In FMS, stress adaptation response is disturbed leading to stress induce symptoms. Psychiatric co-morbidity has been associated with FMS and needs to be identified during the consultation process, as this requires special consideration during treatment.<ref name="Firdous2012" /></blockquote>


*[https://en.wikipedia.org/w/index.php?title=Lyrica&redirect=no Lyrica]  
*May 2018, [https://www.chiropractic.ca/wp-content/uploads/2018/05/107243-2_Chiro_62_1d_Bourgaize.pdf A comparison of the clinical manifestation and pathophysiology of myofascial pain syndrome and fibromyalgia: implications for differential diagnosis and management]


*[https://en.wikipedia.org/w/index.php?title=Savella&redirect=no Savella]
*Jun 2018, [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198625 SNPs in inflammatory genes] [[CCL11]], [[CCL4]] and [[MEFV]] in a fibromyalgia family study.<ref name="Zhang2018" />


==== Side effects ====
<blockquote>SNPs with significant TDTs were found in 36% of the cohort for CCL11 and 12% for MEFV, along with a protein variant in CCL4 (41%) that affects CCR5 down-regulation, supporting an immune involvement for FM.</blockquote>
''Not all side effects are listed, review each medication's possible side effects with your doctor.''


*Cymbalta (Duloxetine is Generic) is facing lawsuits due to severe withdrawal symptoms.<ref>[http://www.drugwatch.com/cymbalta/lawsuits/ Cymbalta Lawsuits - Drug Watch]</ref> There is a Facebook group dedicated to questions about the drug and tapering off of it; [https://www.facebook.com/groups/Cymbaltahurtsworse/?multi_permalinks=572848582870894&notif_t=group_highlights Cymbalta Hurts Worse]. Eli Lilly has settled hundreds of personal injury lawsuits with patients experiencing severe withdrawal symptoms.<ref>[http://nationalpainreport.com/eli-lilly-settles-cymbalta-withdrawal-lawsuits-8831647.html Eli Lilly Settles Cymbalta Withdrawal Lawsuits - Donna Gregory Burch - National Pain Report - October 6, 2016]</ref>
*Jul 2018, [https://www.jrheum.org/content/early/2018/07/09/jrheum.180083 Primary and Secondary Fibromyalgia Are The Same: The Universality of Polysymptomatic Distress]


*Lyrica, (Pregabalin is Generic) is causing weight gain.<ref>[http://www.drugsdb.com/rx/lyrica/lyrica-and-weight-gain/ Lyrica and Weight Gain - Drugsdb.com]</ref>
<blockquote>Fibromyalgia can be considered either primary, or dominant, also known as idiopathic fibromyalgia, or secondary. In the primary form, the causes of the disorder are unknown, but in secondary fibromyalgia, the disorder usually occurs alongside other debilitating medical conditions, such as rheumatoid arthritis (RA), lupus, and multiple sclerosis.<ref>{{Cite journal | last = Wolfe | first = Frederick | last2 = Walitt | first2 = Brian | last3 = Rasker | first3 = Johannes J. | last4 = Häuser | first4 = Winfried | date = 2018-07-15 | title = Primary and Secondary Fibromyalgia Are The Same: The Universality of Polysymptomatic Distress |url =https://www.jrheum.org/content/early/2018/07/09/jrheum.180083|journal=The Journal of Rheumatology|volume =46|issue=2 | pages = 204-212|language=en|doi=10.3899/jrheum.180083|issn=0315-162X|pmid=30008459}}</ref></blockquote>


*Savella (Milnacipran is Generic) has a list of side effects.<ref>[http://www.drugs.com/sfx/savella-side-effects.html Savella Side Effects - Drugs.com]</ref>
===Immune system research===


====Off label====  
Dr. [[Jarred Younger]] believes an overactive [[immune system]] is the cause and will be conducting a study to test this hypothesis.<ref>{{Cite news |url =http://nationalpainreport.com/new-uab-study-could-radically-change-fibromyalgia-treatment-as-we-know-it-8833437.html | title = New UAB Study Could Radically Change Fibromyalgia Treatment As We Know It | last = Gregory Burch | first = Donna | date = 2017-04-24|work=National Pain Report|access-date=2018-08-09|archive-url=|archive-date=|language=en-US}}</ref><ref>{{Cite web |  url = https://www.youtube.com/watch?v=8e5xKX036bE | title = Testing the fibromyalgia immune system with lipopolysaccharide (LPS) | last = Younger | first = Jarred | authorlink = Jarred Younger | date = May 24, 2017 | website = YouTube | archive-url=|archive-date=|access-date=|via=Younger Lab}}</ref> An overactive immune system can cause [[inflammation]] and [[chronic pain]].<ref>{{Cite news |url =https://www.epainassist.com/autoimmune/what-is-overactive-immune-system | title = What is Overactive Immune System {{!}} Causes {{!}} Symptoms {{!}} Treatment | last = Kerkar | first = Pramod | date = 2016-09-29|work=ePainAssist|access-date=2018-10-04|archive-url=|archive-date=|language=en-gb}}</ref><ref>{{Cite news |url =https://www.webmd.com/a-to-z-guides/autoimmune-diseases | title = Autoimmune Diseases|work=WebMD|access-date=2018-10-04|language=en-US}}</ref>


*[[Low dose naltrexone]]: Taken at bedtime for sleep. Helps pain due to better sleep.
Dr. William Pridgen's research of [[Herpes simplex virus#HSV-1|HSV-1]] (cold sore virus) as being involved in FM has conducted a successful Phase III clinical trial, which had been fast-tracked by the [[Food and Drug Administration]] (FDA), of a combination drug that suppresses this virus and also helps with pain.  
{{See also|Fibromyalgia drugs|Fibromyalgia drugs (see drug trials section for IMC-1)}}


*[[Gabapentin]]: [http://www.mayoclinic.org/diseases-conditions/fibromyalgia/expert-answers/fibromyalgia-treatment/FAQ-20058273 Is gabapentin (Neurontin, others) an effective fibromyalgia treatment?] Used for pain, sleep.
Recognizing FM may involve activation of the [[immune system]] researchers performed [[Whole exome sequencing|exome sequencing]] on [[chemokine]] genes in a region of chromosome 17 identified in a genome-wide family association study. Their conclusion: "SNPs with significant TDTs were found in 36% of the cohort for [[CCL11]] and 12% for [[MEFV]], along with a protein variant in CCL4 (41%) that affects CCR5 down-regulation, supporting an immune involvement for FM."<ref name="Zhang2018">{{Cite journal | last = Zhang | first = Zhifang | last2 = Feng | first2 = Jinong | last3 = Mao | first3 = Allen | last4 = Le | first4 = Keith | last5 = Placa | first5 = Deirdre La | last6 = Wu | first6 = Xiwei | last7 = Longmate | first7 = Jeffrey | last8 = Marek | first8 = Claudia | last9 = Amand | first9 = R. Paul St | date = 2018-06-21 | title = SNPs in inflammatory genes CCL11, CCL4 and MEFV in a fibromyalgia family study| url = http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198625|journal=PLOS ONE|language=en|volume=13|issue=6| pages = e0198625|doi=10.1371/journal.pone.0198625|issn=1932-6203|pmid=29927949|via=}}</ref>


*Low dose [https://www.drugs.com/search.php?searchterm=Quetiapine Quetiapine]: [http://www.cortjohnson.org/blog/2014/02/27/tackling-pain-depression-fibromyalgia-quetiapine-scores-benefits-clinical-trial/ Tackling Pain and Depression in Fibromyalgia: Quetiapine Scores Some Benefits in Clinical Trial] Taken at bedtime for sleep.
Dr David Andersson from the Institute of Psychiatry, Psychology and Neuroscience at King's College London, led a new study into Fibromyalgia being an immune system disorder.<ref name="Goebel2021">{{Cite journal | last = Goebel | first = Andreas | last2 = Krock | first2 = Emerson | last3 = Gentry | first3 = Clive | last4 = Israel | first4 = Mathilde R. | last5 = Jurczak | first5 = Alexandra | last6 = Urbina | first6 = Carlos Morado | last7 = Sandor | first7 = Katalin | last8 = Vastani | first8 = Nisha | last9 = Maurer | first9 = Margot | date = 2021-07-07 | title = Passive transfer of fibromyalgia symptoms from patients to mice | url =https://www.jci.org/articles/view/144201?key=51bf6d85e305f6b62f87#SEC4|journal=The Journal of Clinical Investigation|language=en|volume=131|issue=13|doi=10.1172/JCI144201|issn=0021-9738}}</ref><blockquote>Andersson and his colleagues harvested blood from 44 people with fibromyalgia and injected purified antibodies from each of them into different mice. The mice rapidly became more sensitive to pressure and cold, and displayed reduced grip strength in their paws. Animals injected with antibodies from healthy people were unaffected.<ref name="Guardian2021">{{Cite web |  url = http://www.theguardian.com/society/2021/jul/01/fibromyalgia-may-be-a-condition-of-the-immune-system-not-the-brain-study | title = Fibromyalgia may be a condition of the immune system not the brain – study | date = 2021-07-01 | website = The Guardian|language=en|access-date=2021-07-08}}</ref></blockquote><blockquote>Prof Camilla Svensson from the Karolinska Institute in Sweden, who was also involved in the study, said: “Antibodies from people with fibromyalgia living in two different countries, the UK and Sweden, gave similar results, which adds enormous strength to our findings.”<ref name="Guardian2021" /></blockquote>


*[[Tramadol]]: For chronic ongoing pain.
=== Brain and spinal cord research ===
A 2004 study by Heffez et al. studied 270 patients with FM and found that 46% had [[cervical spinal stenosis]] and 20% [[chiari malformation]].<ref name="Heffez2004">{{Cite journal | last = Heffez | first = Dan S. | last2 = Ross | first2 = Ruth E. | last3 = Shade-Zeldow | first3 = Yvonne | last4 = Kostas | first4 = Konstantinos | last5 = Shah | first5 = Sagar | last6 = Gottschalk | first6 = Robert | last7 = Elias | first7 = Dean A. | last8 = Shepard | first8 = Alan | last9 = Leurgans | first9 = Sue E. | date = 2004-04-09 | title = Clinical evidence for cervical myelopathy due to Chiari malformation and spinal stenosis in a non-randomized group of patients with the diagnosis of fibromyalgia| url = https://link.springer.com/article/10.1007/s00586-004-0672-x|journal=European Spine Journal|language=en|volume=13|issue=6 | pages = 516–523|doi=10.1007/s00586-004-0672-x|issn=0940-6719|pmc=|pmid=15083352|via=}}</ref> In 2007, Heffez et al. saw significant improvement in physical and mental well-being was found in patients with cervical stenosis who received surgery.<ref name="Heffez2007">{{Cite journal | last = Heffez | first = Dan S. | last2 = Ross | first2 = Ruth E. | last3 = Shade-Zeldow | first3 = Yvonne | last4 = Kostas | first4 = Konstantinos | last5 = Morrissey | first5 = Mary | last6 = Elias | first6 = Dean A. | last7 = Shepard | first7 = Alan | date = 2007 | title=Treatment of cervical myelopathy in patients with the fibromyalgia syndrome: outcomes and implications |url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2200733/|journal=European Spine Journal|volume=16|issue=9 | pages = 1423–1433|doi=10.1007/s00586-007-0366-2|issn=0940-6719|pmc=2200733|pmid=17426987|quote=|via=}}</ref> A second study in 2007 by Andrew Holman found that 71% had cervical [[spinal cord]] compression.<ref name="Holman2008">{{Cite journal | date = 2008-07-01 | title = Positional Cervical Spinal Cord Compression and Fibromyalgia: A Novel Comorbidity With Important Diagnostic and Treatment Implications |url =https://www.sciencedirect.com/science/article/pii/S1526590008004379|journal=The Journal of Pain|language=en|volume=9|issue=7 | pages = 613–622|doi=10.1016/j.jpain.2008.01.339|issn=1526-5900 | last = Holman | first = Andrew|quote=|via=|pmc=|pmid=}}</ref> In the past many patients were misdiagnosed with FM when further testing would have revealed the correct diagnosis for the cause of their pain; the 2010 (updated in 2016) ACR criteria has helped curb misdiagnoses.<ref name="misdiagnosis">{{Cite news | title = Common Misdiagnoses of Fibromyalgia| url = https://www.webmd.com/fibromyalgia/guide/common-misdiagnoses-of-fibromyalgia#|work=WebMD|access-date=2018-11-26|language=en-US | last = | first = | date = |archive-url=|archive-date=}}</ref><ref name="Wolfe2018" />


==== Side effects ====
Various types of brain imaging are being used to research FM.  
''Not all side effects are listed, review each medication's possible side effects with your doctor.''
{{See also|Fibromyalgia notable studies}}
*Low dose naltrexone: Insomnia
*Gabapentin: [https://www.drugs.com/sfx/gabapentin-side-effects.html Gabapentin Side Effects]
*Low dose Quetiapine: Weight Gain
*Tramadol: [http://fibromapp.com/fibromyalgia-cfsme-seizuresblackouts-the-tramadol-connection/ Having Seizures or Blackouts? The Tramadol Connection]


==== Trials ====
In 2002, an [[Functional magnetic resonance imaging|fMRI]] study conducted by Richard Gracely and Daniel Claw found people with FM "have measurable pain signals in their brains, from a gentle finger squeeze that barely feels unpleasant to people without the disease."<ref name="anapsid2002">{{Cite web |  url = http://www.anapsid.org/cnd/diagnosis/brainpain.html | title = Fibromyalgia Pain Isn't All In Patient's Heads, New Brain Study Finds|website=
*Cannabinoid-based Therapy: [https://fibromyalgianewstoday.com/2017/03/27/fibromyalgia-targeted-ap-cbd-thc-therapy-undergoing-phase-1-clinical-trial/ Intec Pharma Launches Phase 1 Trial of Cannabinoid-based Therapy for Fibromyalgia, Lower Back Pain.]
Melissa Kaplan's Chronic Neuroimmune Diseases| date = 2014 |access-date=2021-11-28}}</ref> A 2007 study by Borsook et al. found decreased gray matter density relative to controls in cingulate cortex (CC), medial prefrontal cortex (Med. PFC), parahippocampal gyrus (PHG) and insula.<ref name="Borsook2007">{{Cite journal | last = Borsook | first = David | last2 = Moulton | first2 = Eric A | last3 = Schmidt | first3 = Karl F | last4 = Becerra | first4 = Lino R | date = 2007-09-11 | title = Neuroimaging Revolutionizes Therapeutic Approaches to Chronic Pain | url =https://link.springer.com/article/10.1186/1744-8069-3-25|journal=Molecular Pain|language=en|volume=3|issue=1 | pages = 1744–8069-3-25|doi=10.1186/1744-8069-3-25|issn=1744-8069|pmid=17848191|via=}}</ref> In 2015, Loggia et al. imaged [[neuroinflammation]] due to [[Glial cell|glial]] activation using MR/PET imaging.<ref name="Loggia2015">{{Cite journal | last = Loggia | first = Marco L. | last2 = Chonde | first2 = Daniel B. | last3 = Akeju | first3 = Oluwaseun | last4 = Arabasz | first4 = Grae | last5 = Catana | first5 = Ciprian | last6 = Edwards | first6 = Robert R. | last7 = Hill | first7 = Elena | last8 = Hsu | first8 = Shirley | last9 = Izquierdo-Garcia | first9 = David | date = 2015-01-08 | title = Evidence for brain glial activation in chronic pain patients |url =https://academic.oup.com/brain/article/138/3/604/333527?searchresult=1|journal=Brain|language=en|volume=138|issue=3 | pages = 604–615|doi=10.1093/brain/awu377|issn=1460-2156}}</ref> In 2017, López-Solà et al. identified three [[brain]] patterns based on [[Functional magnetic resonance imaging|fMRI]] responses to pressure pain and non-painful multisensory stimulation. "These patterns, taken together, discriminate FM from matched healthy controls with 92% sensitivity and 94% specificity."<ref name="Lopez2017">{{Cite journal | last = López-Solà | first = Marina | last2 = Woo | first2 = Choong-Wan | last3 = Pujol | first3 = Jesus | last4 = Deus | first4 = Joan | last5 = Harrison | first5 = Ben J. | last6 = Monfort | first6 = Jordi | last7 = Wager | first7 = Tor D. | date = 2017 | title=Towards a neurophysiological signature for fibromyalgia| url = https://www.ncbi.nlm.nih.gov/pubmed/27583567|journal=Pain|volume=158|issue=1 | pages = 34–47|doi=10.1097/j.pain.0000000000000707|issn=1872-6623|pmid=27583567|via=}}</ref> In 2018, Albrecht et al used [[Positron emission tomography|PET]] scans to document [[Glial cell|glial]] activation.<ref name="Albrecht2018">{{Cite journal | last = Albrecht | first = Daniel S. | last2 = Forsberg | first2 = Anton | last3 = Sandstrom | first3 = Angelica | last4 = Bergan | first4 = Courtney | last5 = Kadetoff | first5 = Diana | last6 = Protsenko | first6 = Ekaterina | last7 = Lampa | first7 = Jon | last8 = Lee | first8 = Yvonne C. | last9 = Höglundi | first9 = Caroline Olgart | date = 2018-09-14|others=Catana, Ciprian; Cervenka, Simon; Akeju, Oluwaseun; Lekander, Mats; Cohen, George; Halldin, Christer; Taylor, Norman; Kim, Minhae; Hooker, Jacob M.; Loggia, Marco L. | title = Brain glial activation in fibromyalgia – A multi-site positron emission tomography investigation | url =https://www.sciencedirect.com/science/article/pii/S0889159118302423|journal=Brain, Behavior, and Immunity|language=en|volume= | pages = |doi=10.1016/j.bbi.2018.09.018|issn=0889-1591|via=}}</ref> Also in 2018, Martucci et al. found unbalanced activity between the ventral and dorsal cervical spinal cord. Ventral neural processes were increased and dorsal neural processes were decreased which may reflect the presence of [[central sensitization]] contributing to [[fatigue]] and other bodily symptoms in FM.<ref name="Martucci2018">{{Cite journal | last = Martucci | first = Katherine T | last2 = Weber | first2 = Kenneth A | last3 = Mackey | first3 = Sean C | date = 2018-10-03 | title = Altered Cervical Spinal Cord Resting State Activity in Fibromyalgia| url = https://onlinelibrary.wiley.com/doi/abs/10.1002/art.40746|journal=Arthritis & Rheumatology|language=en|doi=10.1002/art.40746|issn=2326-5191}}</ref>


*IMC-1: [http://fibromyalgianewstoday.com/2016/02/02/combo-tx-fast-tracked-for-fibromyalgia/ Novel Fibromyalgia Treatment Granted FDA Fast Track Designation] "In the successful Phase II trial in fibromyalgia, IMC-1 was studied to confirm the hypothesis that chronic tissue-resident herpes simplex virus type 1 ([[HSV-1]]) may be one of the underlying causes of fibromyalgia and causally related to fibromyalgia symptoms or recurrence. IMC-1 is a novel fixed-dose oral combination antiviral medication designed to suppress this suspected virus and thus alleviate fibromyalgia symptoms."<ref>[http://fibromyalgianewstoday.com/2016/02/02/combo-tx-fast-tracked-for-fibromyalgia/ Novel Fibromyalgia Treatment Granted FDA Fast Track Designation - Fibromyalgia News Today By Charles Moore]</ref>
=== Fibromyalgia is not the same as depression ===
:[http://simmaronresearch.com/2016/10/pridgen-antiviral-treatment-fibromyaligia/ The Pridgen Revolution? Dr. Pridgen on Bringing His Antiviral Approach to Fibromyalgia To Market] "Almost three years ago, Dr. Pridgen threatened to turn the world of fibromyalgia treatment on its head. Few had connected fibromyalgia with viruses or even immune problems when Pridgen announced that a) FM is caused herpes simplex virus reactivation and b) that it could be treated with antivirals."<ref>[http://simmaronresearch.com/2016/10/pridgen-antiviral-treatment-fibromyaligia/ The Pridgen Revolution? Dr. Pridgen on Bringing His Antiviral Approach to Fibromyalgia To Market]</ref>
* Oct 24, 2003, [https://www.webmd.com/depression/news/20031024/fibromyalgia-isnt-depression#1 Fibromyalgia Isn't Depression]<ref name="webmd-notdepress" />
<blockquote>[[Depression]] doesn't cause the pain of fibromyalgia, a new study shows.<ref name="webmd-notdepress" /></blockquote>  


*TNX-102: [http://www.tonixpharma.com/research-development/tnx-102-sl-for-fibromyalgia TNX-102 SL for Fibromyalgia] "... designed to increase the probability that a patient will have a night of restful sleep, which Tonix believes will provide broad symptom relief."<ref>[http://www.tonixpharma.com/research-development/tnx-102-sl-for-fibromyalgia TNX-102 SL for Fibromyalgia - Tonix Pharmaceuticals]</ref> The drug failed in its primary goal in providing pain relief and ''Tonix Pharmaceuticals'' will not be moving forward in developing a Fibromyalgia drug.<ref>[http://nationalpainreport.com/potential-fibromyalgia-treatment-is-put-on-hold-8831410.html Potential Fibromyalgia Treatment is Put on Hold - National Pain Report - September 2016]</ref>  
<blockquote>"People still doubt fibromyalgia is a disease," Giesecke tells WebMD. "Previously, we found that fibromyalgia patients really do have increased central pain processing. Now we can show this is not affected by depression. Something is wrong here, and it is not at all connected with depression."<ref name="webmd-notdepress" /></blockquote>


*DS-5565: [http://nationalpainreport.com/three-new-fibromyalgia-drugs-could-be-on-the-way-8830514.html Three New Fibromyalgia Drugs Could Be On The Way] "Japanese drugmaker Daiichi Sankyo is now testing what could be Lyrica 2.0."<ref>[http://nationalpainreport.com/three-new-fibromyalgia-drugs-could-be-on-the-way-8830514.html Three New Fibromyalgia Drugs Could Be On The Way By Donna Gregory Burch]</ref>
<blockquote>"Giesecke's group looked at [[brain]] responses to painful stimuli, and then checked to see if there was any difference between depressed and nondepressed fibromyalgia patients. They showed the activation of areas of the brain related to pain were not different in patients with and without depression." But there is a difference between people with and without fibromyalgia, he says.<ref name="webmd-notdepress" /> </blockquote><blockquote>The researchers use an imaging device called [[functional magnetic resonance imaging]], or fMRI, to look at how the brain responds to pain. Study participants get a mildly painful pressure on their thumb, which makes the brain's pain centers "light up" on the image. Thumb pressure -- at a level healthy people hardly feel -- sets off a firestorm in the pain centers of fibromyalgia patients' brains.<ref name="webmd-notdepress" /></blockquote>
* 2013, Small fibre pathology in patients with fibromyalgia syndrome<ref name="brain-1857" />
:A study involving skin biopsies funds that fibromyalgia is neuropathic - and not a form of [[depression]] or a [[Psychosomatic illness|Psychosomatic Disorder]]
<blockquote>The study authors stated, "This strengthens the notion that fibromyalgia syndrome is not a variant of depression, but rather represents an independent entity that may be associated with depressive symptoms". The findings also point "towards a neuropathic nature of pain in fibromyalgia syndrome... with regard to the persistent somatoform pain disorder that is sometimes assumed to be underlying in patients with fibromyalgia syndrome, our study shows a clear distinction to fibromyalgia syndrome: persistent somatoform pain disorder (ICD-10 F45.40) may be present in patients with fibromyalgia syndrome, however, in the majority of cases the definition of pain starting in connection with an emotional conflict situation or psycho-social stress strong enough to be taken as a crucial aetiological influence and pain in the course of a primary depressive disorder or schizophrenia in addition to chronic widespread pain lasting longer than 6 months is not fulfilled."<ref name="brain-1857">{{Cite journal | last = Üçeyler | first = Nurcan | last2 = Zeller | first2 = Daniel | last3 = Kahn | first3 = Ann-Kathrin | last4 = Kewenig | first4 = Susanne | last5 = Kittel-Schneider | first5 = Sarah | last6 = Schmid | first6 = Annina | last7 = Casanova-Molla | first7 = Jordi | last8 = Reiners | first8 = Karlheinz | last9 = Sommer | first9 = Claudia | date = 2013-03-09 | title = Small fibre pathology in patients with fibromyalgia syndrome | url =https://doi.org/10.1093/brain/awt053|journal=Brain|volume=136|issue=6 | pages = 1857–1867|doi=10.1093/brain/awt053|issn=1460-2156}}</ref></blockquote>
===Insulin resistance ===
In 2019 a small observation study by Pappolla et al. was published that found insulin resistance was associated with fibromyalgia, however the study was quickly retracted due to both criticisms of the methodology and issues with ethics approval requirements. Some of the same authors, including Pappolla, published a second observational study in 2021, again showing a likely association between having insulin resistance and fibromyalgia.<ref name="Fang2021">{{Cite journal | title = Insulin Resistance is Associated with Central Pain in Patients with Fibromyalgia | date = Mar 2021| url = https://www.painphysicianjournal.com/linkout?issn&vol=24&page=175|journal=Pain Physician|volume=24|issue=2 | pages = 175–184 | last = Pappolla | first = Miguel A.  | author-link = | last2 = Manchikanti | first2 = Laxmaiah | authorlink2 = | last3 = Candido | first3 = Kenneth D. | authorlink3 = | last4 = Grieg | first4 = Nigel | authorlink4 = | last5 = Seffinger | first5 = Michael | authorlink5 = | last6 = Ahmed | first6 = Fauwad | authorlink6 = | last7 = Fang | first7 = Xiang | last8 = Andersen | first8 = Clark | last9 = Trescot | first9 = Andrea M.|doi=|pmc=|pmid=33740353|access-date=|issn=2150-1149|quote=|via=}}</ref>


===Articles and blogs on drugs===
== 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" />


*[http://fibromapp.com/fibromyalgia-cfsme-seizuresblackouts-the-tramadol-connection/ Having Seizures or Blackouts? The Tramadol Connection]
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" />]]


*[http://curetogether.com/blog/2011/08/10/patients-say-fibromyalgia-drugs-make-things-worse-rest-is-best/ Patients Say Fibromyalgia Drugs Make Things Worse, Rest is Best] - Graph of Patient-Rated Drugs - ''Cure Together Blog''
====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>


== Sleep study ==
===[[Allodynia]]===
*[http://chronicfatigue.about.com/od/treatingfmscfs/a/sleepstudy.htm Getting a Sleep Study with Fibromyalgia or Chronic Fatigue Syndrome] "Sleep disorders frequently come along with these conditions, and studies have shown that poor sleep correlates to more severe symptoms, especially FMS pain."<ref>[http://chronicfatigue.about.com/od/treatingfmscfs/a/sleepstudy.htm Getting a Sleep Study with Fibromyalgia or Chronic Fatigue Syndrome]</ref>  
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>


*[http://www.sciencedaily.com/releases/2008/09/080903134311.htm What A Sleep Study Can Reveal About Fibromyalgia] "Research engineers and sleep medicine specialists from two Michigan universities have joined technical and clinical hands to put innovative quantitative analysis, signal-processing technology and computer algorithms to work in the sleep lab. One of their recent findings is that a new approach to analyzing sleep fragmentation appears to distinguish fibromyalgia patients from healthy controls."<ref>[http://www.sciencedaily.com/releases/2008/09/080903134311.htm What A Sleep Study Can Reveal About Fibromyalgia]</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}}


*[http://linkis.com/nationalpainreport.com/lzYea Fibromyalgia Sufferers Have Difficulty Maintaining Continuous Sleep, Study Says] "A new study published in the Clinical Journal of Pain concludes that people with fibromyalgia have difficulty maintaining continuous sleep as compared to patients with primary insomnia and patients who do not report disturbed sleep."<ref>[http://linkis.com/nationalpainreport.com/lzYea Fibromyalgia Sufferers Have Difficulty Maintaining Continuous Sleep, Study Says]</ref>
===Anxiety===
Anxiety is more common in people with fibromyalgia than in healthy people.<ref name="PatientInfo" /><ref name="Jensen2010" />
{{See also|Anxiety}}


===Sleep medications===
===[[Body temperature]]===
Disordered sleep is a prominent symptom in FM. There are four
Hypersensitivity to cold or heat is common in fibromyalgia, especially in people with [[allodynia]].<ref name="Baron2010" /><br>
types of Sleep Medications used in FM; Antihistamines, Benzodiazepines, Nonbenzodiazepines, Sedating Antidepressants.<ref>[http://www.fibrodaze.com/sleep-medications/ Sleep Medications For Fibromyalgia Fibrodaze.com]</ref>
[[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}}


Low dose naltrexone and Low dose Seroquel (see under the heading: [http://me-pedia.org/wiki/Fibromyalgia#Drugs Drugs]) can also help with sleep when taken at bedtime.
===[[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>


== Therapies ==
===[[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>


=== Exercise ===
====Fibro fog ====
''Please Note'': These recommendations are for Fibromyalgia patients and '''not''' [[ME/CFS]] sufferers.
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" />


*Warm water exercise is best.<ref>[http://chronicfatigue.about.com/od/treatingfmscfs/a/warmwaterFMS.htm Warm-Water Exercise for Fibromyalgia - About.com Health FMS/ME/CFS]</ref><ref>[https://www.ncbi.nlm.nih.gov/pubmed/18173915 Exercise in warm water decreases pain and improves cognitive function in middle-aged women with fibromyalgia. - PubMED]</ref>
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>


*Moderate aerobic exercise and weights with as fewer reps possible with a day or two of rest in between. Do not start a program if you are in a flare.<ref>[http://www.arthritis.org/living-with-arthritis/tools-resources/expert-q-a/fibromyalgia-questions/fibromyalgia-exercise.php Exercising With Fibromyalgia - By Ronenn Roubenoff, MD]</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" />


*[https://www.youtube.com/watch?v=BauJYuJwFsI Easy Fibromyalgia exercises and motivation to keep you healthy!] Videos on YouTube from Eric Suarez, CPT.
{{See also|Cognitive dysfunction}}


*[http://chronicfatigue.about.com/od/whatisfibromyalgia/a/Fibromyalgia-Myth-Vs-Fact.htm Fibromyalgia Myth vs. Fact] Heading: ''Myth #3: People With Fibromyalgia Need More Exercise''. Appropriate exercise, which each patient needs to gauge for themselves.
===[[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" />


=== Massage ===
{{See also|Depression}}{{See also|Mental health}}
*2016, [http://chronicfatigue.about.com/od/alternativetreatments/a/bodywork.htm Massage, Rolfing & Other Bodywork - Are They Effective Fibromyalgia & Chronic Fatigue Syndrome Treatments?]


*2014, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930706/ Massage Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials]
====<span id="depression">Differences between depression and fibromyalgia====


=== Acupuncture ===
* 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" />
*2016, [http://www.sciencedirect.com/science/article/pii/S2095496416602352 Short-term complementary and alternative medicine on quality of life in women with fibromyalgia] "There was no significant improvement in pain or reduction of tender points in any of the groups studied, at the end of the 8th session."<ref>[http://www.sciencedirect.com/science/article/pii/S2095496416602352 Short-term complementary and alternative medicine on quality of life in women with fibromyalgia - JIM, Elsevier, Science Direct]</ref>  
* 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" />


*2016, [https://fibromyalgianewstoday.com/2016/02/01/acupuncture-does-not-reduce-pain-for-women-with-fibromyalgia/ Acupuncture Does Not Appear to Relieve Pain in Fibromyalgia Patients]
===[[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}}


*2005, [http://acupunctureschoolonline.com/acupuncture-good-for-fibromyalgia.html Acupuncture Good for Fibromyalgia?] "acupuncture gave no significant pain relief to fibromyalgia patients."<ref>[http://acupunctureschoolonline.com/acupuncture-good-for-fibromyalgia.html Acupuncture Good for Fibromyalgia? Acupuncture School Online]</ref>
===[[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}}


*2004, [[U.S. Department of Health and Human Services]] (HHS) and [https://en.wikipedia.org/wiki/Centers_for_Medicare_and_Medicaid_Services Centers for Medicare and Medicaid Services] (CMS) ruled April 16, 2004 a noncoverage determination for acupuncture.<ref>[https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R11NCD.pdf CMS.gov Regulations and Guidance]</ref>
===Fibro fog===
See [[#Cognitive_dysfunction_and_Fibro_fog|cognitive dysfunction and Fibro fog]].


== Disability ==
===[[Digestive problems|Gastrointestinal problems]]===
===United States===
[[Irritable bowel syndrome|IBS]] often occurs in people with fibromyalgia.<ref name="ScienceOfFibro" />
''Please Note'': The following is NOT legal advice and it should not be relied upon in taking steps for a disability case. Only ''[https://www.ssa.gov/ Social Security]'' and a Disability Lawyer practicing ''[https://en.wikipedia.org/wiki/Category:Disability_law_in_the_United_States Disability Law]'' can provide the most up to date and the correct legal avenue for bringing a disability case.''
{{See also|Irritable bowel syndrome}}


In the US, [https://www.ssa.gov/ssi/ Social Security Insurance] and [https://www.ssa.gov/disability/ Social Security Disability]  (SSI) and (SSD) benefits are available for Fibromyalgia. Generally for SSI/SSD, notes and tests from a ''Primary Provider'' '''may''' be allowed for submission but ''Specialists'' such as a Rheumatologist, Neurologist, Psychiatrist, etc. are required for diagnosis, ongoing treatment and completing SSI/SSD paperwork.
===[[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>


*[https://www.socialsecurity.gov/OP_Home/rulings/di/01/SSR2012-02-di-01.html Fibromyalgia: Policy Interpretation Ruling - Social Security]
{{See also|Gulf War Illness}}


*[http://www.disabilitysecrets.com/social_security_disability_fibromyalgia.html Social Security Disability (SSDI & SSI) for Fibromyalgia - Disability Secrets By NOLO]
===[[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}}


*[http://www.mdjunction.com/fibromyalgia/fibromyalgia-disability Fibromyalgia Disability Patient Support Forums] at [[MDJunction]]
===[[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}}


==== Examination and tests ====
===[[Irritable bowel syndrome]] ===
For documentation of symptoms and providing proof of Fibromyalgia (FM), you may want to have results from the following tests:
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}}


*Rheumatologist examination and diagnosis of FM. (It would be best to have a Rheumatologist order tests and coordinate the paperwork from tests done by other specialists as a Primary doctor cannot complete disability paperwork although ''may'' be able to forward test results.)
===Language impairment and [[word-finding problems]]===
*Sleep study for restless leg syndrome, sleep disturbances and rule out Narcolepsy.
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:
*An Ear, Nose, and Throat Specialist (ENT) examination and imaging may be ordered for TMJ. (Ear, sinus, and throat/lymph infections can also be documented.)
*[[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" />
*Blood tests that rule out RA, Lupus and other diseases that can have the same symptoms of Fibromyalgia and may be treatable.
* [[Memory problems|short-term memory problems]]
*IBS diagnosis which may require blood, upper endoscopy to rule out Celiac disease and fecal tests to check for bacteria and parasites.
* vulnerability to distraction by irrelevant stimuli (known as "selective attention")
*Psychiatric testing to evaluate depression and anxiety which can also be treated.
*[[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>


Of course, one can have Narcolepsy, depression or Celiac disease and still have FM, but there may be a treatable condition where a patient's overall condition, including FM, improves.
{{See also|Cognitive dysfunction}}


You may be required to see a specialist assigned by the SSA/SSD for cognitive testing. Even if you already have had cognitive testing they may still require you to see their specialist.
===[[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" />


These tests will be accepted and reviewed but are not a validation of one being disabled. They will be considered as part of the picture of an FM diagnosis.
===[[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" />


== Ongoing process of diagnosing and categorizing ==
{{See also|Mast cell activation syndrome}}
*2017, [http://nationalpainreport.com/study-reveals-new-treatment-target-for-fibromyalgia-inflammation-in-the-brain-8833354.html Study Reveals New Treatment Target for Fibromyalgia: Inflammation in the Brain]


*2016, [https://www.ncbi.nlm.nih.gov/pubmed/27583567 Towards a neurophysiological signature for fibromyalgia]. This study has "discovered a brain signature that identifies fibromyalgia sufferers with 93 percent accuracy". (MRI images.)<ref>[http://www.colorado.edu/today/2016/10/17/neural-signature-fibromyalgia-may-aid-diagnosis-treatment?platform=hootsuite Neural signature for fibromyalgia may aid diagnosis, treatment]</ref>
=== 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>  


*2016, [http://fibromyalgianewstoday.com/2016/09/09/fibromyalgia-diagnosis-using-noninvasive-eye-examination Diagnosing Fibromyalgia May Be Possible Using Noninvasive Eye Examination]
===[[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}}


*2016, [http://bjpo.rcpsych.org/content/2/4/275 The association between borderline personality disorder, fibromyalgia and chronic fatigue syndrome: systematic review] ''BJ Psych Open'' states under heading ''[[Borderline Personality Disorder]] in patients with fibromyalgia'': " ...there does not appear to be firm and consistent evidence to support the hypothesis that the prevalence of BPD (Borderline Personality Disorder) would be higher in individuals with fibromyalgia compared with the general population."<ref>[http://bjpo.rcpsych.org/content/2/4/275 British Journal of Psychiatry Open Sep 2016, 2 (4) 275-279; DOI: 10.1192/bjpo.bp.115.002808 - Sarah Penfold, Emily St. Denis, Mir Nadeem Mazhar]</ref>
===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}}


*2016, [http://chronicfatigue.about.com/od/glossary/fl/Microglia-in-Fibromyalgia-amp-Chronic-Fatigue-Syndrome.htm Microglia in Fibromyalgia & Chronic Fatigue Syndrome]
===[[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}}


*2016, [http://simmaronresearch.com/2016/03/are-chronic-fatigue-syndrome-mecfs-and-fibromyalgia-immune-exhaustion-disorders/ Are Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia Immune Exhaustion Disorders?]
===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" />


*2016, [https://consultqd.clevelandclinic.org/2016/03/why-fibromyalgia-is-neuropathic/?utm_campaign=qd+tweets&utm_medium=social&utm_source=twitter&utm_content=160308+fibromyalgia+neuropathic&dynid=twitter-_-qd+tweets-_-social-_-social-_-160308+fibromyalgia+neuropathic Why Fibromyalgia Is Neuropathic]
===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>


*2015, [http://www.news-medical.net/news/20150518/Fibromyalgia-now-considered-as-a-lifelong-central-nervous-system-disorder.aspx Fibromyalgia now considered as a lifelong central nervous system disorder]
[[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>


*2015, [http://nationalpainreport.com/foundation-of-fibromyalgia-is-altered-central-nervous-system-new-study-validates-8827896.html Foundation of Fibromyalgia Is Altered Central Nervous System, New Study Validates]
[[#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}}


*2015, [http://www.jneuro.com/neurology-neuroscience/evaluation-of-antiviral-antibodies-against-epsteinbarr-virus-and-neurotransmitters-in-patients-with-fibromyalgia.pdf Evaluation of Antiviral Antibodies against Epstein-Barr Virus and Neurotransmitters in Patients with Fibromyalgia]
===[[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]].


*2015, Question: [http://fmcfstriggerpoints.blogspot.com/2015/09/is-fibromyalgia-psychosomatic-illness.html 'Is Fibromyalgia a Psychosomatic Illness?'] Answer: "Fibromyalgia is NOT a psychosomatic illness."<ref>[http://fmcfstriggerpoints.blogspot.com/2015/09/is-fibromyalgia-psychosomatic-illness.html Is Fibromyalgia a Psychosomatic Illness? Med Student Asks Celeste Cooper]</ref>
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}}


*2015, [http://onlinelibrary.wiley.com/doi/10.1002/acr.22626/full Understanding the Association of Fatigue With Other Symptoms of Fibromyalgia: Development of a Cluster Model]
===[[Painful bladder syndrome]] and [[chronic pelvic pain]]===
[[Painful bladder syndrome]] and [[chronic pelvic pain]] are common comorbidities in people with fibromyalgia.<ref name="ScienceOfFibro" />


*2014, [http://www.medpagetoday.com/Rheumatology/Fibromyalgia/49114 Lyme Disease, Fibromyalgia Link Evaporates] (See also: [[Chronic lyme disease]])
=== 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" />


*2012, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3447191/ Personality and Fibromyalgia Syndrome] Conclusion: "No specific fibromyalgia personality is defined but it is proposed that personality is an important filter that modulates a person’s response to psychological stressors. Certain personalities may facilitate translation of these stressors to physiological responses driving the fibromyalgia mechanism."<ref>[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3447191/ Personality and Fibromyalgia Syndrome]</ref>
===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" />


== Blood tests ==
===[[Raynaud's syndrome]]===
*2016, [https://fmcfstriggerpoints.blogspot.com/2016/05/blood-test-for-fibromyalgia-fma-test-is.html Blood Test for Fibromyalgia: FM/a Test Ⓡ is now available, Q&A]
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>


*2016, [http://www.liveinsurancenews.com/fibromyalgia-blood-testing-covered-rising-number-insurance-companies/ Fibromyalgia blood testing covered by rising number of insurance companies]
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}}


*2014, [http://www.prohealth.com/library/showarticle.cfm?libid=18837 Pridgen Reports Fibromyalgia Antiviral Trial Results “Very Positive”: Predicts New Approach Will Be “Game-Changer”]
===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" />


*2015, [http://www.ncbi.nlm.nih.gov/pubmed/25377646 Cytokine and chemokine profiles in fibromyalgia, rheumatoid arthritis, and systemic lupus erythematosus: a potentially useful tool in differential diagnosis.]
===[[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" />


*2013, [http://nationalpainreport.com/new-fibromyalgia-blood-test-is-99-accurate-8821072.html New Fibromyalgia Blood Test is 99% Accurate]
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}}


== Brain scans ==
===[[Stress]] and [[Post-traumatic stress disorder]]===
*2015, [https://www.verywell.com/unique-brain-connectivity-in-fibromyalgia-715630 Unique Brain Connectivity in Fibromyalgia - Increased Importance Assigned to Pain]
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}}


*2015, [http://onlinelibrary.wiley.com/doi/10.1002/art.39043/abstract The Somatosensory Link in Fibromyalgia: Functional Connectivity of the Primary Somatosensory Cortex Is Altered by Sustained Pain and Is Associated With Clinical/Autonomic Dysfunction] (Study with brain images and tables.)
===[[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.]]


*2012, [https://www.sciencedaily.com/releases/2012/11/121111153426.htm Fibromyalgia and the brain: New clues reveal how pain and therapies are processed]
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>


*2002, [http://www.anapsid.org/cnd/diagnosis/brainpain.html Fibromyalgia Pain Isn't All In Patient's Heads, New Brain Study Finds]
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}}


== Notable studies ==
===[[Thyroid disease]]===
*2017, [https://www.dovepress.com/evidence-of-both-systemic-inflammation-and-neuroinflammation-in-fibrom-peer-reviewed-fulltext-article-JPR Evidence of both systemic inflammation and neuroinflammation in fibromyalgia patients, as assessed by a multiplex protein panel applied to the cerebrospinal fluid and to plasma]
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)}}


*2017, [https://www.ncbi.nlm.nih.gov/pubmed/27583567 Towards a neurophysiological signature for fibromyalgia.]
===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


*2016, [https://www.ncbi.nlm.nih.gov/pubmed/27713820 Fibromyalgia syndrome: metabolic and autophagic processes in intermittent cold stress mice.]
==Treatment==
Main treatment approaches for fibromyalgia include patient education, exercise including stretching, message, [[Fibromyalgia drugs|medication]], alternative treatments for [[pain management]], and stress management or mental health treatments for any related depression or anxiety.{{citation needed | date = 2021}}<ref name="FibroBasics" /><ref name="ScienceOfFibro" />
{{See also|Fibromyalgia drugs}}


*2016, [http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0161574 Fibromyalgia Is Correlated with Retinal Nerve Fiber Layer Thinning]
===United States===
Rheumatology and primary care providers: Diagnosing and treatment:


*2016, [https://www.ncbi.nlm.nih.gov/pubmed/26272057 The prevalence of severe fatigue in rheumatic diseases: an international study.]
*2012, [https://www.mayoclinicproceedings.org/article/S0025-6196(12)00299-6/abstract A Framework for Fibromyalgia Management for Primary Care Providers]<ref>{{Cite journal | last = Arnold | first = Lesley M. | last2 = Clauw | first2 = Daniel J. | last3 = Dunegan | first3 = L. Jean | last4 = Turk | first4 = Dennis C.| date = 2012  | title = A Framework for Fibromyalgia Management for Primary Care Providers |url =https://www.mayoclinicproceedings.org/article/S0025-6196(12)00299-6/abstract|journal=Mayo Clinic Proceedings|language=English|volume=87|issue=5 | pages = 488–496|doi=10.1016/j.mayocp.2012.02.010|issn=0025-6196|via=}}</ref> Rheumatologists stopped treating fibromyalgia patients and primary care providers began treatment managment although rheumatologists are most often the specialist to diagnose.  
{{See also|Fibromyalgia disability process}}


*2016, [http://journals.lww.com/clinicalpain/Abstract/2016/04000/Characteristics_of_Disturbed_Sleep_in_Patients.4.aspx Characteristics of Disturbed Sleep in Patients With Fibromyalgia Compared With Insomnia or With Pain-Free Volunteers]
===Drugs===
{{Main article| page_name = Fibromyalgia drugs}}


*2016, [https://www.ncbi.nlm.nih.gov/pubmed/26218005 Is Efficacy of Milnacipran in Fibromyalgia Predictable? A Data Mining Analysis of Baseline and Outcome Variables.]
=== Therapies ===


*2015, [http://onlinelibrary.wiley.com/doi/10.1111/1756-185X.12550/abstract Some oxidative and antioxidative parameters and their relationship with clinical symptoms in women with fibromyalgia syndrome]
==== Exercise ====
''Please Note'': The research supporting these treatments are for fibromyalgia patients '''without''' [[ME/CFS]] sufferers due to it's hallmark symptom of [[post-exertional malaise]].
[[File:Warm water exercise.JPG|200px|thumb|left|Warm water exercise can be helpful for fibromyalgia. Start slow and don't push through the pain.<ref name="Ronenn" /><ref>{{Cite journal | last = Bidonde | first = Julia | last2 = Busch | first2 = Angela J. | last3 = Webber | first3 = Sandra C. | last4 = Schachter | first4 = Candice L. | last5 = Danyliw | first5 = Adrienne | last6 = Overend | first6 = Tom J. | last7 = Richards | first7 = Rachel S. | last8 = Rader | first8 = Tamara | date = 2014-10-28 | title = Aquatic exercise training for fibromyalgia| url = https://www.ncbi.nlm.nih.gov/pubmed/25350761|journal=The Cochrane Database of Systematic Reviews|issue=10 | pages = CD011336|doi=10.1002/14651858.CD011336|issn=1469-493X|pmid=25350761}}</ref> Image source: [https://commons.wikimedia.org/wiki/File:Water_aerobics_in_a_swimmingpool_Gambia.jpg Wikimedia Commons]. Author: Peter van der Sluijs, cropped, license: CC-BY-SA-2.5.]]


*2015, [http://onlinelibrary.wiley.com/doi/10.1002/acr.22626/full Understanding the Association of Fatigue With Other Symptoms of Fibromyalgia: Development of a Cluster Model]
<blockquote>Several studies have found that warm-water pool exercise is a beneficial treatment for fibromyalgia. A very large survey of patients found that 26% have used pool therapy, rating it as very effective.<ref name="Bennett2007">{{Cite journal | last = Bennett | first = Robert M.  | author-link = | last2 = Jones | first2 = Jessie | authorlink2 = | last3 = Turk | first3 = Dennis C. | authorlink3 = | last4 = Russell | first4 = I. Jon | authorlink4 = | last5 = Matallana | first5 = Lynne | authorlink5 = | date = Mar 9, 2007 | title = An internet survey of 2,596 people with fibromyalgia| url = https://doi.org/10.1186/1471-2474-8-27|journal=BMC Musculoskeletal Disorders|volume=8|issue=1 | pages = 27|doi=10.1186/1471-2474-8-27|issn=1471-2474|pmc=1829161|pmid=17349056|quote=|via=}}</ref> The same survey found 74% of patients found heat helpful - either warm water or heat packs.<ref name="Bennett2007" /> Warm water especially important in FMS because the vasodilatory effect of the heating may improve blood flow to muscles, helping to reduce pain, and many people with FM are also intolerant of cold. A warm-water pool is one that's kept around 89.6 to 93 degrees Fahrenheit (32 to 34 Celsius), which is several degrees warmer than most heated pools.<ref name="Munguia2007">{{Cite journal | last = Munguía-Izquierdo | first = D. | last2 = Legaz-Arrese | first2 = A. | date = 2007 | title=Exercise in warm water decreases pain and improves cognitive function in middle-aged women with fibromyalgia| url = https://www.ncbi.nlm.nih.gov/pubmed/18173915|journal=Clinical and Experimental Rheumatology|volume=25|issue=6 | pages = 823–830|issn=0392-856X|pmid=18173915|via=}}</ref></blockquote>


*2015, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4648619/ Sleep is associated with task-negative brain activity in fibromyalgia participants with comorbid chronic insomnia]
Dr Roubenoff Ronenn recommends moderate aerobic exercise and weights with six to eight reps, and then a day or two of rest in between. He cautions  people not to start a program if they are in a flare.<ref name="Ronenn">{{Cite web |  url = http://www.arthritis.org/living-with-arthritis/tools-resources/expert-q-a/fibromyalgia-questions/fibromyalgia-exercise.php | title = Fibromyalgia Exercise {{!}} Exercising with Fibromyalgia | last = Ronenn | first = Roubenoff | date = | website = arthritis.org|archive-url=|archive-date=|access-date=2018-08-09}}</ref>
{{See also|Exercise}}


*2015, [https://biblio.ugent.be/publication/6993821 Cognitive performance is related to central sensitization in patients with chronic whiplash-associated disorders and fibromyalgia: a case-control study]
==== Massage ====


*2015, [http://eujournal.org/index.php/esj/article/viewFile/6167/5952 Fibromyalgia: A search for markers and their evaluation throughout a treatment]
*2014, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930706/ Massage Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials]<ref name="Yan2014">{{Cite journal | last = Li | first = Yan-hui | last2 = Wang | first2 = Feng-yun | last3 = Feng | first3 = Chun-qing | last4 = Yang | first4 = Xia-feng | last5 = Sun | first5 = Yi-hua | date = 2014-02-20 | title = Massage Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930706/|journal=PLoS ONE|volume=9|issue=2|doi=10.1371/journal.pone.0089304|issn=1932-6203|pmc=|pmid=24586677 | pages = |via=}}</ref>


*2015, [http://www.sciencedirect.com/science/article/pii/S2213158215001394 Normalization of aberrant resting state functional connectivity in fibromyalgia patients following a three-month physical exercise therapy]
==== Acupuncture ====


*2015, [https://www.sciencedaily.com/releases/2015/08/150819172431.htm Researchers identify potential sleep-related treatment targets for fibromyalgia]
Manual acupuncture (skin penetration without stimulation) is the most common form of acupuncture but gives no clinically significant pain relief to fibromyalgia patients, but a [[Cochrane]] review found '''electro-acupuncture''', which involves an electrical current, significantly reduced [[pain]], stiffness, and [[fatigue]] and improve sleep quality and global well-being in people with fibromyalgia for a one-month period, but not long term.<ref name="NBK279092" /><ref name="Cochrane-acupuncture">{{Cite journal | last = Deare | first = JC | last2 = Zheng | first2 = Z | last3 = Xue | first3 = CCL | first4 = Jian Ping | last4 = Liu | first5 = Jingsheng | last5 = Shang | first6 = Sean W | last6 = Scott | first7 = Geoff | last7 = Littlejohn | url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4105202 | title = Acupuncture for treating fibromyalgia]|journal=Cochrane Database Syst Rev. | date = May 31, 2013|issue=5 | pages = CD007070 |volume=2013|doi=10.1002/14651858.CD007070.pub2|pmc=PMC4105202|pmid=
23728665}}</ref>


*2015, [https://www.sciencedaily.com/releases/2015/05/150517071813.htm Fibromyalgia has central nervous system origins]
2016 reviewed acupuncture (AC), electroacupuncture (EAC) and moxibustion, but found none improved quality of life in women with fibromyalgia.<ref name="CAM">{{Cite journal|
first = Paulo Araujo | last = Diasa | first2 =André Brito Bastos | last2 = Guimarães | first3 = Andrea | last3 = de Oliveir Albuquerque | first4 =  Karoline Lucas | last4 = de Oliveir | first5 = Maria Luzete Costa | last5 = Cavalcante | first6 = Sergio Botelho | last6 = Guimarães | date = 2016-01-01 | title = Short-term complementary and alternative medicine on quality of life in women with fibromyalgia| url = https://www.sciencedirect.com/science/article/pii/S2095496416602352|journal=Journal of Integrative Medicine|language=en|volume=14|issue=1 | pages = 29–35|doi=10.1016/S2095-4964(16)60235-2|issn=2095-4964}}</ref> "There was no significant improvement in pain or reduction of tender points in any of the groups studied, at the end of the 8th session."<ref name="CAM" />


*2015, [http://synapse.koreamed.org/search.php?where=aview&id=10.3344/kjp.2015.28.3.169&code=0047KJP&vmode=FULL The Iceberg Nature of Fibromyalgia Burden: The Clinical and Economic Aspects]
In 2004, [[U.S. Department of Health and Human Services]] (HHS) and Centers for Medicare and Medicaid Services (CMS) ruled a noncoverage determination for acupuncture.<ref>{{Cite web |  url = https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R11NCD.pdf | title=CMS Manual System Pub. 100-03 Medicare National Coverage Determinations | last = | first = | date = Apr 16, 2004 | website = CMS.gov|format = PDF | archive-url=|archive-date=|access-date=}}</ref>


*2015, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499983/ The effects of aquatic, isometric strength-stretching and aerobic exercise on physical and psychological parameters of female patients with fibromyalgia syndrome]
== Controversies ==
=== Dr. Frederick Wolfe ===
Dr. Frederick Wolfe, the director of the [[National Databank for Rheumatic Diseases]] and the lead author of the 1990 paper that first defined the diagnostic guidelines for fibromyalgia, says he has become cynical and discouraged about the diagnosis. He now considers the condition a physical response to stress, depression, and economic and social anxiety.<ref name="Wolfe2016">{{Cite journal | last = Wolfe | first = Frederick | last2 = Walitt | first2 = Brian | date = 2016 | title=Fibromyalgia: A Short Commentary| url = http://headache.imedpub.com/fibromyalgia-a-short-commentary.pdf | journal=Journal of Headache & Pain Management|volume=1|issue= 3 | pages = 27|via=iMedPubJournals}}</ref><ref>{{Cite news |url =https://www.news-medical.net/news/20130322/Fibromyalgia-an-interview-with-Dr-Frederick-Wolfe-University-of-Kansas-School-of-Medicine.aspx | title = Fibromyalgia: an interview with Dr Frederick Wolfe, University of Kansas School of Medicine | last = Cashin-Garbutt | first = April | date = 2013-03-22|work=News-Medical.net|access-date=2018-08-09|archive-url=|archive-date=|language=en}}</ref>


*2004, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1754959/ A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing]
=== Fibromyalgia and Chiari malformation ===
Some individuals diagnosed with FMS were undergoing surgery for [[chiari malformation]] (CM). These are two separate conditions; FMS cannot be resolved by undergoing a risky CM surgery.<ref name="Chiari">{{Cite journal | last = Watson | first = Nathaniel F. | last2 = Buchwald | first2 = Dedra | last3 = Goldberg | first3 = Jack | last4 = Maravilla | first4 = Kenneth R. | last5 = Noonan | first5 = Carolyn | last6 = Guan | first6 = Qingyan | last7 = Ellenbogen | first7 = Richard G. | date = 2011 | title = Is Chiari I malformation associated with fibromyalgia?| url = https://www.ncbi.nlm.nih.gov/pubmed/21135714|journal=Neurosurgery|volume=68|issue=2 | pages = 443–448; discussion 448–449|doi=10.1227/NEU.0b013e3182039a31|issn=1524-4040|pmid=21135714|via=}}</ref><ref>{{Cite web |  url = https://www.massmecfs.org/resource-library/9-treatment/172-cfidsfm-and-chiari-malformation-surgery | title = CFS/FM and Chiari Malformation Surgery | last = Casanova | first = Ken | date = Nov 15, 2015 | website = massmecfs.org|language=en-GB|archive-url=|archive-date=|access-date=2018-08-09}}</ref>
::Most patients with FM do not have [[Chiari malformation|CIM]] pathology. Future studies should focus on dynamic neuroimaging of [[craniocervical instability|craniocervical neuroanatomy]] in patients with FM.<ref name="Chiari" />


*2012, [https://www.researchgate.net/publication/230626400_Dysfunctional_endogenous_analgesia_during_exercise_in_patients_with_chronic_pain_To_exercise_or_not_to_exercise Dysfunctional endogenous analgesia during exercise in patients with chronic pain: To exercise or not to exercise?]
===<span id="bloodtest">Blood test </span>===
EpicGenetics developed a blood test to identifying the presence of specific [[Leucocyte|white blood cell]] abnormalities of patients diagnosed with FM - '''FM/a® test''' - and announces a linked treatment trial although the trial never started and is now suspended.<ref name="FMa test" /> EpicGenetics offers help to determine if your insurance will cover their test.<ref name="fmtest" />


*2002, [http://www.anapsid.org/cnd/diagnosis/brainpain.html Fibromyalgia Pain Isn't All In Patient's Heads, New Brain Study Finds]
The FM/a test continues to be marketed despite the suspension of the linked treatment trial,<ref name="FMa test">{{Cite web | last = Faustman | first = Denise Louise | authorlink = | date = 2021-05-27|others=Massachusetts General Hospital | title = Phase II Clinical Trial: Multi-dosing the BCG Vaccine for Fibromyalgia| url = https://clinicaltrials.gov/ct2/show/NCT03582085|pmc=|pmid=|access-date=2021-11-27|quote=|via=}}</ref> and the fact that only two studies have been published using the test - one comparing fibromyalgia patients with healthy controls, and another with lupus and rheumatoid arthritis patients.<ref name="PMC3534336">{{Cite journal | last = Behm | first = Frederick G | last2 = Gavin | first2 = Igor M | last3 = Karpenko | first3 = Oleksiy | last4 = Lindgren | first4 = Valerie | last5 = Gaitonde | first5 = Sujata | last6 = Gashkoff | first6 = Peter A | last7 = Gillis | first7 = Bruce S | date = 2012-12-17 | title = Unique immunologic patterns in fibromyalgia| url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3534336/|journal=BMC Clinical Pathology|volume=12 | pages = 25|doi=10.1186/1472-6890-12-25|issn=1472-6890|pmc=3534336|pmid=23245186}}</ref><ref name="PMC4435905">{{Cite journal | last = Wallace | first = Daniel J. | last2 = Gavin | first2 = Igor M. | last3 = Karpenko | first3 = Oleksly | last4 = Barkhordar | first4 = Farnaz | last5 = Gillis | first5 = Bruce S. | date = 2015 | title=Cytokine and chemokine profiles in fibromyalgia, rheumatoid arthritis and systemic lupus erythematosus: a potentially useful tool in differential diagnosis |url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4435905/|journal=Rheumatology International|volume=35|issue=6 | pages = 991–996|doi=10.1007/s00296-014-3172-2|issn=0172-8172|pmc=4435905|pmid=25377646}}</ref> In the 6 years since the last study was published, no further research has appeared on the FM/a test, leaving many to conclude that the evidence base is weak.<ref name="controversy2021">{{Cite web | last = Boodman | first = Eric | date = Oct 20, 2021 | url =https://www.statnews.com/2021/10/20/selling-certainty-epicgenetics-physician-was-one-of-fibromyalgia-patients-few-true-allies-or-was-he/| title = In a sea of skeptics, this physician was one of fibromyalgia patients’ few true allies. Or was he?| publisher = STAT News}}</ref>


===Awards and current research===
IsolateFibromyalgia, IQuity's RNA based blood test for fibromyalgia, was first announced in 2018 but has insufficient data supporting its use: no peer-reviewed studies had been published by 2021.
*2016, [http://www.uofmhealth.org/news/archive/201610/chronic-pain-researchers-expand-work-75m-award-nih Chronic pain researchers to expand work with $7.5M award from NIH]


=== Psychiatric paradigm ===
==Disability: SSI/SSD and LT==
*2016, [http://bjp.sagepub.com/content/10/3/156.full.pdf+html Explaining unexplained pain to fibromyalgia patients: finding a narrative that is acceptable to patients and provides a rationale for evidence-based interventions]
{{Main article | page_name = Fibromyalgia disability process}}


*2016, [http://headache.imedpub.com/fibromyalgia-a-short-commentary.pdf Fibromyalgia: A Short Commentary iMedPub Journals - Journal of Headache & Pain Management - Frederick Wolfe and Brian Walitt]
==Famous people ==
Celebrities and famous people with fibromyalgia include:
*[[Frida Kahlo]], famous Mexican painter
*[[Florence Nightingale]], founder of modern nursing
*[[Lady Gaga]] (Stefani Germanotta), American singer/artist
*Morgan Freeman, American actor
*Jo Guest, British model
*[[Janeane Garofalo]], actor and comedienne<ref name="cnn-fibromyalgia">{{Cite web |  url = https://www.cnn.com/2017/08/01/health/gallery/famous-people-with-fibromyalgia/index.html | title = Celebrities face fibromyalgia|website=CNN | date = August 1, 2017|access-date=2021-11-20}}</ref><ref name="celebrities-fm">{{Cite web |  url = https://www.womansday.com/health-fitness/wellness/g3329/celebrities-with-fibromyalgia/| title =  7 Celebrities You Didn't Know Have Fibromyalgia|website =Woman's Day | last = Murtaugh | first = Taysha | date = 2018-01-18}}</ref>


*2015, [https://www.ncbi.nlm.nih.gov/pubmed/26190965 Brain "fog," inflammation and obesity: key aspects of neuropsychiatric disorders improved by luteolin.]
{{See also|Florence Nightingale}}
{{See also|Frida Kahlo}}


===Hyperbaric oxygen therapy===
==Notable studies ==
*2015, [http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0127012 Hyperbaric Oxygen Therapy Can Diminish Fibromyalgia Syndrome]
{{Main article | page_name = Fibromyalgia notable studies}}
==News articles and features ==
*2021, [https://www.statnews.com/2021/10/20/selling-certainty-epicgenetics-physician-was-one-of-fibromyalgia-patients-few-true-allies-or-was-he/ In a sea of skeptics, this physician was one of fibromyalgia patients' few true allies. Or was he?] - STAT news reports on the marketing of the FM/a test, and the linked treatment that never started.
*2021, [http://www.theguardian.com/society/2021/jul/01/fibromyalgia-may-be-a-condition-of-the-immune-system-not-the-brain-study Fibromyalgia may be a condition of the immune system not the brain – study] - The Guardian
*2017, [https://www.the-rheumatologist.org/article/fmri-can-help-diagnose-fibromyalgia/ fMRI Can Help Diagnose Fibromyalgia] - The Rheumatologist, 2017
==See also==
* [[Fibromyalgia disability process]]
* [[Fibromyalgia drugs]]
* [[Fibromyalgia notable studies]]
* [[Influenza vaccine]]
* [[List of famous people with ME, CFS, and/or FMS]]
* [[Lady Gaga]]
* [[Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life]] - book (2019)


:[http://www.news-medical.net/news/20150603/Women-who-suffer-from-fibromyalgia-benefit-from-hyperbaric-oxygen-therapy.aspx Noted in this News Medical article about the research all the women had concussions.]
== Learn more ==
*[https://www.cdc.gov/arthritis/basics/fibromyalgia.htm Fibromyalgia] - CDC
*[https://dx.doi.org/10.4065%2Fmcp.2011.0206 The Science of Fibromyalgia] - Daniel Clauw, Lesley Arnold, and Bill McCarber for the FibroCollaborative
*[https://www.aarp.org/health/conditions-treatments/info-11-2013/fibromyalgia-what-you-need-to-know.html 8 Things to Know About Fibromyalgia] - AARP
*[https://www.webmd.com/depression/news/20031024/fibromyalgia-isnt-depression Fibromyalgia isn't depression] - WebMD
*2012, [https://web.archive.org/web/20180530191907/https://www.nhs.uk/live-well/healthy-body/20-painful-health-conditions/|archive-date=2018-05-30 | title = 20 Painful Health Conditions 20 Painful Health Conditions] - NHS (archived copy)
*2017, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5741304/ Diagnostic confounders of chronic widespread pain: not always fibromyalgia]
*[https://www.s4me.info/forums/fibromyalgia-and-connective-tissue-disorders.35/ Forum: Fibromyalgia and Connective Tissue Disorders] at [[Science for ME]]
*[https://www.verywellhealth.com/chronic-fatigue-syndrome-vs-fibromyalgia-5213420 2022, What’s the Difference Between Chronic Fatigue Syndrome and Fibromyalgia?] - Verywell Health


== Other resources ==
=== Diagnosing and categorizing fibromyalgia===
*[https://voat.co/v/Fibromyalgia/new VOAT: Fibromyalgia]
*2017, [http://nationalpainreport.com/study-reveals-new-treatment-target-for-fibromyalgia-inflammation-in-the-brain-8833354.html Study Reveals New Treatment Target for Fibromyalgia: Inflammation in the Brain]
*[[About.com Health FMS/ME/CFS]]
*2017, [https://qz.com/1349854/ai-can-spot-the-pain-from-a-disease-some-doctors-still-think-is-fake/? AI can spot the pain from a disease some doctors still think is fake]
:Refers to [https://www.ncbi.nlm.nih.gov/pubmed/27583567 Towards a neurophysiological signature for fibromyalgia (2017)]
*2018, [https://www.prohealth.com/fibromyalgia/library/fibromyalgia-central-sensitization-syndrome-87957? Fibromyalgia: Central Sensitization Syndrome - Characterizing classes of fibromyalgia within the continuum of central sensitization syndrome] - ProHealth


== Controversies ==
=== Blood tests ===
*2021, [https://www.statnews.com/2021/10/20/selling-certainty-epicgenetics-physician-was-one-of-fibromyalgia-patients-few-true-allies-or-was-he/ In a sea of skeptics, this physician was one of fibromyalgia patients' few true allies. Or was he?] - STAT News on the FM/a test
*2014, [http://www.prohealth.com/library/showarticle.cfm?libid=18837 ICM-1: Fibromyalgia Antiviral Trial Results “Very Positive”: Predicts New Approach Will Be “Game-Changer”]


Dr. Frederick Wolfe, the director of the National Databank for Rheumatic Diseases and the lead author of the 1990 paper that first defined the diagnostic guidelines for fibromyalgia, says he has become cynical and discouraged about the diagnosis. He now considers the condition a physical response to stress, depression, and economic and social anxiety.<ref>[http://www.nytimes.com/2008/01/14/health/14pain.html?_r=0 Drug Approved. Is Disease Real? - New York Times]</ref>
=== Brain scans ===
*2002, Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia<ref name="Gracely2002">{{Cite journal | last = Gracely | first = Richard H.  | author-link = | last2 = Petzke | first2 = Frank | authorlink2 = | last3 = Wolf | first3 = Julie M. | authorlink3 = | last4 = Clauw | first4 = Daniel J. | authorlink4 = Daniel Clauw | date = 2002 | title = Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia| url = https://onlinelibrary.wiley.com/doi/abs/10.1002/art.10225|journal=Arthritis & Rheumatism|language=en|volume=46|issue=5 | pages = 1333–1343|doi=10.1002/art.10225|issn=1529-0131|pmc=|pmid=|access-date=|quote=|via=}}</ref>
::[http://www.anapsid.org/cnd/diagnosis/brainpain.html Fibromyalgia Pain Isn't All In Patient's Heads, New Brain Study Finds]
*2012, [https://www.sciencedaily.com/releases/2012/11/121111153426.htm Fibromyalgia and the brain: New clues reveal how pain and therapies are processed]{{citation needed | date = 2021}}
*2018, Brain glial activation in fibromyalgia – A multi-site positron emission tomography investigation<ref name="Albrecth2019">{{Cite journal | last = Albrecht | first = Daniel S.  | author-link = | last2 = Forsberg | first2 = Anton | authorlink2 = | last3 = Sandström | first3 = Angelica | authorlink3 = | last4 = Bergan | first4 = Courtney | authorlink4 = | last5 = Kadetoff | first5 = Diana | authorlink5 = | last6 = Protsenko | first6 = Ekaterina | authorlink6 = | last7 = Lampa | first7 = Jon | last8 = Lee | first8 = Yvonne C. | last9 = Höglund | first9 = Caroline Olgart | date = 2019-01-01 | title = Brain glial activation in fibromyalgia – A multi-site positron emission tomography investigation | url =https://www.sciencedirect.com/science/article/pii/S0889159118302423|journal=Brain, Behavior, and Immunity|language=en|volume=75|issue= | pages = 72–83|doi=10.1016/j.bbi.2018.09.018|issn=0889-1591|pmc=|pmid=|access-date=|quote=|via=}}</ref>  
::[https://ki.se/en/news/people-with-fibromyalgia-have-inflammation-of-the-brain People with fibromyalgia have inflammation of the brain]


==References==
==References==
<references/>
{{reflist}}


[[Category:Diagnoses]]
[[Category:Diagnoses]]
[[Category:Comorbidities]]
[[Category:Potential comorbidities]]
[[Category:Musculoskeletal diseases and disorders]]
[[Category:Neurological diseases and disorders]]

Latest revision as of 20:04, July 29, 2023

Fibromyalgia or FM or fibromyalgia syndrome or FMS is a chronic, debilitating disorder characterized by widespread pain with additional symptoms such as cognitive dysfunction or "fibro fog", waking unrefreshed and fatigue.[1][2] Fibromyalgia is relatively common, affecting between 2-5% of the population.[3]

Brain imaging and neuroimaging studies have shown fibromyalgia to be a pain processing disorder involving altered pain processing in the central nervous system.[3] The pain and other symptoms of fibromyalgia appear to be caused by neurochemical imbalances in the central nervous system that lead to a "central amplification" of pain perception (Clauw et al., 2011).[3]

In fibromyalgia pain is widespread, on both sides of the body, and above and below the waist.[1][4]

Sufferers are fatigued (excessively tired) even after sleeping for long periods of time, and sleep is often disrupted by pain. Many FM sufferers have sleep disorders like sleep apnea and restless legs syndrome (RLS).[5][6][2] Cognitive impairment, when one cannot focus or pay attention and the patient has difficulty concentrating on mental tasks, is known by FM sufferers as "fibro fog".[5][6][2] Some people with fibromyalgia experience digestive system problems like irritable bowel syndrome or gastric-oesophagael reflux disease, depression, headaches or migraines, a painful bladder, or muscle cramps. Other symptoms may include tingling or numbness in hands and feet, pain in jaw and disorders of the jaw such as temporomandibular joint disorder (TMJ), and menstrual cycle cramps.[3][5][6][2]

Other pain conditions are associated with FM, such as rheumatoid arthritis (RA), systemic lupus erythematosus (Lupus), ankylosing spondylitis, interstitial cystitis, and more.[6]

In 2017, the United Kingdom's National Health Service listed fibromyalgia as one of 20 most painful conditions.[7][8] Fibromyalgia pain may be described as diffuse aching or burning, head to toe, and can be worse at some times than at others. The pain can change location and fluctuate in intensity.[7][9][2] The United States (US) Centers for Disease Control and Prevention (CDC) states fibromyalgia is a serious disorder, and "can cause pain, disability, and lower quality of life."[2]

The American College of Rheumatology (ACR) created and updates the diagnostic criteria for fibromyalgia.[1][10][11][1][4] See: Fibromyalgia (Diagnosis).


2010 ACR Preliminatry Diagnostic Criteria: Widespread Pain Index (WPI), 19 Tender Point Areas[1][4]
Image: Wikimedia Commons by author Jmarchn. License: CC-by-sa-3.0

Prevalence[edit | edit source]

An estimated 4 million people in the US[2] and 2-5% of the world population have fibromyalgia (Clauw et al, 2011). Fibromyalgia is the second most common rheumatic disorder behind osteoarthritis[3] and is considered by many pain experts to be a central nervous system disorder which is most often lifelong[12] that is not fatal.[13] It is occurs in women, men, children, and all ethnic groups. Fibromyalgia is often seen in families and most commonly diagnosed in middle aged people, and prevalence increases with age.[14][3]

FM is a female predominant disease, diagnosed with female:male of between 7:1 and 1.5:1, depending on the criteria used.[10][11][1][4][15] See: Fibromyalgia (American College of Rheumatology (ACR) Criteria). A September 2018 study by Wolfe et al. found fewer women and more men are diagnosed under the 2010/11 criteria[16] (this criterion further updated in 2016[17]).

What we did not find in our unbiased CritFM samples was 9:1 female to male fibromyalgia ratios that are widely described by expert sources [11–13]. We believe that such findings only occur in the presence of selection bias or biased ascertainment.[16]

As unbiased epidemiological studies show only a small increase in the female to male sex ratio (~1.5:1) as opposed to the observed ratio in clinical studies of 9:1, we believe that the over-identification of fibromyalgia in women and the consequent under-identification of men is the result of bias.[16]

Fibromyalgia in ME/CFS[edit | edit source]

The most common overlapping condition with ME/CFS is fibromyalgia.[18][19] While some have posited ME/CFS and FM are variants of the same illness, Benjamin Natelson, MD summoned considerable amounts of data that suggest the two illnesses differ with different pathophysiologic processes leading to different treatments.[20]

Dr. Jarred Younger has said that many patients that meet the criteria for FM also meet criteria for chronic fatigue syndrome (CFS) but the reverse is not necessarily true as a lot of people with CFS do not have widespread pain.[21] However, the Canadian Consensus Criteria (CCC) requires the symptom of pain to diagnose ME/CFS.[22] It is the pattern (on both sides of the body, and above and below the waist) of chronic widespread musculoskeletal pain (involving muscle, cartilage, ligaments, and connective tissue) in FM that sets it apart from other diseases that have pain; it also causes cognitive symptoms and unrefreshing sleep.[5][6]

A Swedish study of 234 ME/CFS patients meeting the Canadian Consensus Criteria found that 96% had trigger point pain consistent with fibromyalgia and 67% met the diagnostic criteria for fibromyalgia.[23]

Health complications[edit | edit source]

Fibromyalgia is not considered a progressive disease[24] but according to Dr. Dan Clauw the "slow gradual worsening of chronic pain patients over time is due to downstream consequences of poorly controlled pain and other symptoms, wherein individuals then progressively get less active, sleep worse, are under more stress and unknowingly develop bad habits which worsen pain and other symptoms."[25]

The CDC recognizes the following complications:

  • Lower quality of life
Especially for women with fibromyalgia
  • More hospitalizations
In the United States people with fibromyalgia are twice as likely to be hospitalized
Adults with fibromyalgia are more than 3 times more likely to have major depression than adults without fibromyalgia, and rates of depression and other mood disorder symptoms are higher than in most other illnesses.[14][26]
  • Death rates from suicide and injuries are higher in people with FM
Overall life span remains similar to the general population.
  • Higher rates of other rheumatic conditions
Comorbidities include other types of arthritis such as osteoarthritis, rheumatoid arthritis, lupus, and ankylosing spondylitis.[14]

The American College of Rheumatology states that:

Risk factors[edit | edit source]

Fibromyalgia is more likely to occur in middle-aged people but can affect any age group, including children. It is more common in women and girls, in obese people and in people with a family history.[28]

Rheumatic illnesses are risk factors in developing FM, especially lupus and rheumatoid arthritis (RA).[14]

Events linked to causing fibromyalgia to develop include car accidents, post-traumatic stress disorder (PTSD), repetitive injuries, and illnessss such as a virus.[2][28]

Diagnosis[edit | edit source]

The American College of Rheumatology publishes the most widely used diagnostic criteria for fibromyalgia.[1][2] Tender points, not trigger points, are used to diagnose fibromyalgia.[29]

In fibromyalgia, painful areas of the body will be both above and below the waist, and on both sides of the body. (See: 1990 ACR and 2010 ACR images above right depicting tender points.) It is important for clinicians to check for other conditions that could be causing pain such as hypothyroidism, rheumatoid arthritis, lupus, osteoarthritis, ankylosing spondylitis, and polymyalgia rheumatica.[30]

United States[edit | edit source]

2010 American College of Rheumatology (ACR) Criteria[edit | edit source]

The new ACR criteria for fibromyalgia assesses:

Widespread pain index[edit | edit source]

There are 19 areas in the widespread pain index (WPI) in the newer ACR criteria.[31][1]

WPI 19 areas of pain. Count 1 point for each area of pain present at least once a week.[24][1][4]
Image source: Wikimedia Commons by author Jmarchn. License: CC-by-sa-3.0.

This Widespread Pain Index (WPI) is scored out of 19, and is one of the two required scores needed for a doctor to make a diagnosis of fibromyalgia, and is considered in combination with the SS score.[24][1]

Symptom severity[edit | edit source]

The Symptom Severity score ranks each of the following groups of fibromyalgia symptoms on a scale of 0-3, giving a SS score out of 12:

Table 2: SS scale score. Add a 4th column for Somatic (physical) symptoms in general (such as Headache, weakness, bowel problems, nausea, dizziness, numbness/tingling, hair loss, dry eyes, Raynaud's phenomenon, painful urination, and more)[24][1] The patient ranks specific symptoms on a scale of 0-3. The numbers assigned to each column are added up, for a total of 0-12.[24]
Source: Jahan F, Nanji K, Qidwai W, Qasim R. Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management. Oman Med J 2012 May; 27(3):192-195. doi: 10.5001/omj.2012.44 license: CC-BY-NC

A fibromyalgia diagnosis is based on both the WPI score and the SS score either:

  • WPI of at least 7 and SS scale score of at least 5, or
  • WPI of at least 4 and SS scale score of at least 9
  • with symptoms present for at least three months[24][32]

The 2010 American College of Rheumatology (ACR) proposed diagnostic criteria for fibromyalgia[1][4] was modified in 2011,[17] with the modification being validated in 2013 and published in 2014.[33] In September 2016, another revision was been made.[32]

Take the online Fibromyalgia test[edit | edit source]

This online test by fibromyalgiaforums.org uses the ACR 2010 Criterion to help diagnose fibromyalgia.

Tender point test phased out[edit | edit source]

The older 1990 criteria's tender point examination was replaced because men often do not seem to form the tender points needed for diagnosis.[34] The 2010 proposed criteria correctly diagnosed more men, with a female:male ratio of 2:1.[15]

Tender point examination was also problematic because "considerable skill is needed to correctly check for a patient's tender points (i.e., digital palpation that is done with certain amount of applied pressure)", but this technique was not taught at most medical schools.[35][31]

The new standards were designed to:
  • eliminate the use of a tender point examination
  • include a severity scale by which to identify and measure characteristic FM symptoms
  • utilize an index by which to rate pain[31]

1990 ACR criteria[edit | edit source]

1990 ACR Diagnostic Criteria: 18 Tender Points[10][11]
Image source: WikiMedia Commons, authors Sav vas and Jmarchn, license: CC0 / public domain.

US Social Security Administration[edit | edit source]

The United States Social Security Administration (SSA) accepts a diagnosis of FM with either the 2010 or 1990 ACR criteria.[10][11][1][4][36]

Sleep studies[edit | edit source]

Sleep dysfunction is often involved in FM. Treating a sleep disorder or sleep problems may help with FM symptoms, for example fatigue. Sleep apnea, restless legs syndrome and nocturnal myclonus are often found in fibromyalgia patients, and waking unrefreshed is a diagnostic symptom of fibromyalgia.[35][1] A diagnosed sleep disorder is also helpful if one needs to file for disability.

Brain scans[edit | edit source]

Brain scans are a potential aid to help diagnose fibromyalgia.[37][38] A small study by López-Solà et al. (2017) using a combination of fMRI brain scans and artificial intelligence (machine learning) correctly diagnosed 95% of fibromyalgia patients.[39]

A number of brain imaging studies have found significant results in patients with fibromyalgia, including a fMRI study that found patients with FM "have measurable pain signals in their brains, from a gentle finger squeeze that barely feels unpleasant to people without the disease"[40] and MR/PET imaging by Loggia et al 2015 found neuroinflammation due to glial activation.[41]

Blood tests and biomarkers[edit | edit source]

EpicGenetics developed the FM/a test blood test to diagnose FM in 2017 - and announced a linked treatment trial involving the BCG vaccine soon after; the trial has since been suspended indefinitely.[42][43][44] Dr Denise Faustman at Massachusetts General Hospital, who was due to conduct the trial, stated that the test should never have been marketed as a requirement for the treatment trial, and that no patients were ever recruited to the trial.[44]

The FM/a test continues to be marketed despite the suspension of the linked treatment trial,[44] and the fact that only two studies have been published using the test - the last being published in 2015.[45][46] The evidence base supporting the use of the test has been reported to be weak, and no studies have assessed whether the test can correctly determine which patients have fibromyalgia and have some fibromyalgia symptoms that are explained by another diagnosis.[42] One study did not include any men.[45]

IsolateFibromyalgia, IQuity's RNA based blood test for fibromyalgia, was first announced in 2018 but no peer-reviewed studies have been published.

A non-invasive eye test has found eye abnormalities in people with fibromyalgia, with Garcia et al 2016 finding reduced retinal nerve fiber layer (RNFL) thickness, raising hopes of a non-invasive eye test may help diagnose FM.[47] The findings were confirmed by Cordón et al 2021, who found that disease severity and reduced quality of life were associated with reduced RNFL.[48] The test requires optical coherence tomography (OCT), which is fast and non-invasive.[48] At present, there is no eye test in clinical use for diagnosing FM.

In 2019, Hackshaw and colleagues found a unique metabolic fingerprint using a blood spot test that distinguished between fibromyalgia, rheumatoid arthritis and lupus, which they suggested could act as a diagnostic biomarker for FM.[49]

Heart rate variability (HRV) measured by ECG is a possible fibromyalgia biomarker, since it is reduced in people with FM, but heart rate is affected by many different factors so this may be problematic.[37]

ICD Diagnostic code[edit | edit source]

ICD-10

The World Health Organization (WHO) International Classification of Diseases (ICD) lists FM as a "disease of the musculoskeletal system and connective tissue", under the code M79.7 (WHO ICD-10 Version: 2016).[50] The WHO's ICD-10 does not refer to FM as a syndrome and it is not classified in the category for medically unexplained symptoms.[51][50]

  • M79.7 Fibromyalgia
Fibromyositis
Fibrositis
Myofibrositis[50]

In 2015, the US finally adopted ICD-10 and FM as a diagnosis.[51][52]

ICD-11 (2019)

The ICD-11 (2019) has diagnostic code MG30.1 Chronic widespread pain, and changed the category from a Musculoskeletal disease, to the General signs and symptoms category, sometimes referred to as Medically unexplained physical symptoms.[53]

  • MG30.01 Chronic widespread pain

Parent

MG30.0 Chronic primary pain

Description

Chronic widespread pain (CWP) is diffuse pain in at least 4 of 5 body regions and is associated with significant emotional distress (anxiety, anger/frustration or depressed mood) or functional disability (interference in daily life activities and reduced participation in social roles). CWP is multifactorial: biological, psychological and social factors contribute to the pain syndrome. The diagnosis is appropriate when the pain is not directly attributable to a nociceptive process in these regions and there are features consistent with nociplastic pain and identified psychological and social contributors.[53]

Inclusions

  • Fibromyalgia

Exclusions

  • Acute pain (MG31)[53]

Differential diagnosis[edit | edit source]

Conditions which have symptoms that are similar to fibromyalgia, particularly involving chronic widespread pain and fatigue should be ruled out, either by the routine tests recommended to aid fibromyalgia diagnosis, or by symptom pattern and history.

Differential diagnoses for fibromyalgia include:

  • Inflammatory rheumatic diseases:
Rheumatoid arthritis, systemic lupus erythematosus, Sjögren's syndrome, mixed connective tissue disease, scleroderma, or inflammatory spondyloarthritis, inflammatory polyarthritis, polymyalgia rheumatica, inflammatory myopathy or systemic inflammatory arthropathies
  • Musculoskeletal or spinal conditions:
Myofascial pain syndrome, hypermobility syndromes including Ehlers-Danlos Syndrome, spinal stenosis, myelopathies, myositis
  • Endocrine and metabolic disorders:
Hashimoto's thyroiditis (hypothyroidism), hyperparathyroidism, acromegaly, and vitamin D deficiency
  • Gastrointestinal diseases:
Celiac disease or other forms of irritable bowel disease, Non-celiac gluten sensitivity
  • Infectious diseases::
Lyme disease, hepatitis C, and HIV, although these are not routinely tested for, Chronic Lyme disease may be secondary to fibromyalgia
  • Cancers at the very early stages:
fever, night sweats, and weight loss are common signs
  • Neurological conditions:
Multiple sclerosis, Parkinson's disease and peripheral neuropathies
  • Medication-induced pain conditions:
statins, opioids (opioid-induced hyperalgesia), some chemotherapy drugs, aromatase inhibitors, and bisphosphonates can cause diffuse pain [54][55]

The limited laboratory findings along with history and physical examination can help differentiate fibromyalgia from other differentials.[55]

Pathophysiology[edit | edit source]

Fibromyalgia is a pain processing disorder involving altered pain processing in the central nervous system which causes widespread pain and a constellation of additional symptoms.[3]

Neuroimaging and brain imaging studies have shown that the pain and other symptoms of fibromyalgia appear to be caused by neurochemical imbalances in the central nervous system that lead to a central amplification of pain perception (Clauw et al., 2011).[3]

According to the CDC, there is no evidence that a single event "causes" fibromyalgia, instead it appears to be associated with many physical and/or emotional stressors and other risk factors that may trigger or aggravate symptoms. These include certain infections, such as a viruses or Lyme disease, as well as emotional or physical trauma (injury)."[2][14] The widespread pain is severe, debilitating, and abnormal in processing its pain. sleep disturbance and fatigue are common symptoms.[56]

Pathophysiology: Although the etiology remains unclear, characteristic alterations in the pattern of sleep and changes in neuroendocrine transmitters such as serotonin, substance P, growth hormone and cortisol suggest that regulation of the autonomic and neuroendocrine system appears to be the basis of the syndrome. Fibromyalgia is not a life-threatening, deforming, or [progressive disease. Anxiety and depression are the most common association. Aberrant pain processing, which can result in chronic pain, may be the result of several interplaying mechanisms. Central sensitization, blunting of inhibitory pain pathways and alterations in neurotransmitters lead to aberrant neurochemical processing of sensory signals in the CNS, thus lowering the threshold of pain and amplification of normal sensory signals causing constant pain." (Firdous et al, 2012)[24]

The frequent co-morbidity of fibromyalgia with mood disorders suggests a major role for the stress response and for neuroendocrine abnormalities. The hypothalamic pituitary axis (HPA axis) is a critical component of the stress-adaptation response. In FMS, stress adaptation response is disturbed leading to stress induce symptoms. Psychiatric co-morbidity has been associated with FMS and needs to be identified during the consultation process, as this requires special consideration during treatment.[24]

SNPs with significant TDTs were found in 36% of the cohort for CCL11 and 12% for MEFV, along with a protein variant in CCL4 (41%) that affects CCR5 down-regulation, supporting an immune involvement for FM.

Fibromyalgia can be considered either primary, or dominant, also known as idiopathic fibromyalgia, or secondary. In the primary form, the causes of the disorder are unknown, but in secondary fibromyalgia, the disorder usually occurs alongside other debilitating medical conditions, such as rheumatoid arthritis (RA), lupus, and multiple sclerosis.[58]

Immune system research[edit | edit source]

Dr. Jarred Younger believes an overactive immune system is the cause and will be conducting a study to test this hypothesis.[59][60] An overactive immune system can cause inflammation and chronic pain.[61][62]

Dr. William Pridgen's research of HSV-1 (cold sore virus) as being involved in FM has conducted a successful Phase III clinical trial, which had been fast-tracked by the Food and Drug Administration (FDA), of a combination drug that suppresses this virus and also helps with pain.

Recognizing FM may involve activation of the immune system researchers performed exome sequencing on chemokine genes in a region of chromosome 17 identified in a genome-wide family association study. Their conclusion: "SNPs with significant TDTs were found in 36% of the cohort for CCL11 and 12% for MEFV, along with a protein variant in CCL4 (41%) that affects CCR5 down-regulation, supporting an immune involvement for FM."[57]

Dr David Andersson from the Institute of Psychiatry, Psychology and Neuroscience at King's College London, led a new study into Fibromyalgia being an immune system disorder.[63]

Andersson and his colleagues harvested blood from 44 people with fibromyalgia and injected purified antibodies from each of them into different mice. The mice rapidly became more sensitive to pressure and cold, and displayed reduced grip strength in their paws. Animals injected with antibodies from healthy people were unaffected.[64]

Prof Camilla Svensson from the Karolinska Institute in Sweden, who was also involved in the study, said: “Antibodies from people with fibromyalgia living in two different countries, the UK and Sweden, gave similar results, which adds enormous strength to our findings.”[64]

Brain and spinal cord research[edit | edit source]

A 2004 study by Heffez et al. studied 270 patients with FM and found that 46% had cervical spinal stenosis and 20% chiari malformation.[65] In 2007, Heffez et al. saw significant improvement in physical and mental well-being was found in patients with cervical stenosis who received surgery.[66] A second study in 2007 by Andrew Holman found that 71% had cervical spinal cord compression.[67] In the past many patients were misdiagnosed with FM when further testing would have revealed the correct diagnosis for the cause of their pain; the 2010 (updated in 2016) ACR criteria has helped curb misdiagnoses.[68][16]

Various types of brain imaging are being used to research FM.

In 2002, an fMRI study conducted by Richard Gracely and Daniel Claw found people with FM "have measurable pain signals in their brains, from a gentle finger squeeze that barely feels unpleasant to people without the disease."[69] A 2007 study by Borsook et al. found decreased gray matter density relative to controls in cingulate cortex (CC), medial prefrontal cortex (Med. PFC), parahippocampal gyrus (PHG) and insula.[70] In 2015, Loggia et al. imaged neuroinflammation due to glial activation using MR/PET imaging.[41] In 2017, López-Solà et al. identified three brain patterns based on fMRI responses to pressure pain and non-painful multisensory stimulation. "These patterns, taken together, discriminate FM from matched healthy controls with 92% sensitivity and 94% specificity."[39] In 2018, Albrecht et al used PET scans to document glial activation.[71] Also in 2018, Martucci et al. found unbalanced activity between the ventral and dorsal cervical spinal cord. Ventral neural processes were increased and dorsal neural processes were decreased which may reflect the presence of central sensitization contributing to fatigue and other bodily symptoms in FM.[72]

Fibromyalgia is not the same as depression[edit | edit source]

Depression doesn't cause the pain of fibromyalgia, a new study shows.[73]

"People still doubt fibromyalgia is a disease," Giesecke tells WebMD. "Previously, we found that fibromyalgia patients really do have increased central pain processing. Now we can show this is not affected by depression. Something is wrong here, and it is not at all connected with depression."[73]

"Giesecke's group looked at brain responses to painful stimuli, and then checked to see if there was any difference between depressed and nondepressed fibromyalgia patients. They showed the activation of areas of the brain related to pain were not different in patients with and without depression." But there is a difference between people with and without fibromyalgia, he says.[73]

The researchers use an imaging device called functional magnetic resonance imaging, or fMRI, to look at how the brain responds to pain. Study participants get a mildly painful pressure on their thumb, which makes the brain's pain centers "light up" on the image. Thumb pressure -- at a level healthy people hardly feel -- sets off a firestorm in the pain centers of fibromyalgia patients' brains.[73]

  • 2013, Small fibre pathology in patients with fibromyalgia syndrome[74]
A study involving skin biopsies funds that fibromyalgia is neuropathic - and not a form of depression or a Psychosomatic Disorder

The study authors stated, "This strengthens the notion that fibromyalgia syndrome is not a variant of depression, but rather represents an independent entity that may be associated with depressive symptoms". The findings also point "towards a neuropathic nature of pain in fibromyalgia syndrome... with regard to the persistent somatoform pain disorder that is sometimes assumed to be underlying in patients with fibromyalgia syndrome, our study shows a clear distinction to fibromyalgia syndrome: persistent somatoform pain disorder (ICD-10 F45.40) may be present in patients with fibromyalgia syndrome, however, in the majority of cases the definition of pain starting in connection with an emotional conflict situation or psycho-social stress strong enough to be taken as a crucial aetiological influence and pain in the course of a primary depressive disorder or schizophrenia in addition to chronic widespread pain lasting longer than 6 months is not fulfilled."[74]

Insulin resistance[edit | edit source]

In 2019 a small observation study by Pappolla et al. was published that found insulin resistance was associated with fibromyalgia, however the study was quickly retracted due to both criticisms of the methodology and issues with ethics approval requirements. Some of the same authors, including Pappolla, published a second observational study in 2021, again showing a likely association between having insulin resistance and fibromyalgia.[75]

Comorbidities, overlapping conditions, and common symptoms[edit | edit source]

The most common comorbid conditions in fibromyalgia are ME/CFS, which is the most common comorbidity,[19] irritable bowel syndrome (IBS), tension-type headaches, migraine, temporomandibular joint disorder, chronic pelvic pain, vulvodynia in women, interstitial cystitis, painful bladder syndrome, and in men chronic prostatitis, and prostadynia.[3] Also common are autoimmune diseases, migraines, multiple chemical sensitivity (MCS), and orthostatic intolerance (OI) / postural orthostatic tachycardia syndrome (POTS).[24][76][77] Overlapping conditions are ME/CFS, IBS, Temporomandibular joint disorder (TMD), interstitial cystitis, multiple chemical sensitivity, chronic tension-type headache, and chronic low back pain.[24][6][78]

Overlapping conditions[edit | edit source]

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[78]

Allodynia[edit | edit source]

Allodynia is when ordinary sensations cause pain, and is common in people with fibromyalgia.[79][80]

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.[81]

Anxiety[edit | edit source]

Anxiety is more common in people with fibromyalgia than in healthy people.[27][82]

Body temperature[edit | edit source]

Hypersensitivity to cold or heat is common in fibromyalgia, especially in people with allodynia.[80]
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 eyes and dry mouth.[1][83]

Chest pain[edit | edit source]

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.[84]

Cognitive dysfunction and Fibro fog[edit | edit source]

The cognitive problems or "fibro fog" in fibromyalgia are part of the diagnostic criteria, although brain fog in general occurs in a number of different health conditions.[1] Cognitive dysfunction in fibromyalgia includes problems with thinking and memory.[85] Fibromyalgia is known to cause multiple types of cognitive impairment.[86]

Fibro fog[edit | edit source]

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".[87] 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.[85]

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".[87]

Improving pain and sleep may reduce cognitive impairment. Treatment for cognitive dysfunction in FM including "fibro fog" include transcranial direct current stimulation, physical activity, and CBT for sleep although studies are limited.[88] One randomized controlled trial found CBT for sleep difficulties in FM improved executive functions and alertness but sleep hygiene did not.[88]

Depression and anxiety[edit | edit source]

Fibromyalgia sufferers are "up to three times more likely to have depression at the time of their diagnosis than someone without fibromyalgia."[89] Anxiety is also more common.[27]

Differences between depression and fibromyalgia[edit | edit source]

  • 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[10][1]
  • 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.[90]
  • Fibromyalgia is a diagnosis of chronic widespread pain, but pain is part of the diagnostic criteria for depression.[91][73]
  • 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.[82]

Dry eye syndrome[edit | edit source]

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.[24][92]

Fatigue[edit | edit source]

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.[27][1]

Fibro fog[edit | edit source]

See cognitive dysfunction and Fibro fog.

Gastrointestinal problems[edit | edit source]

IBS often occurs in people with fibromyalgia.[3]

Gulf War Illness[edit | edit source]

GWI increases risk of developing fibromyalgia.[93]

Hyperalgesia[edit | edit source]

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.[3]

Interstitial cystitis[edit | edit source]

Interstitial cystitis is a common comorbidity in people with fibromyalgia, and causes a painful bladder.[3][94]

Irritable bowel syndrome[edit | edit source]

IBS is a particularly common comorbidity in people with fibromyalgia. Other digestive system problems may also occur.[3]

Language impairment and word-finding problems[edit | edit source]

The "fibro fog" or brain fog that is a well recognized symptom of FM typically causes problems with words and language.[1] Cognitive impairment in fibromyalgia includes:

Lower back pain[edit | edit source]

Mechanical lower back pain is more common in patients with FM.[55] 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.[84]

Mast Cell Activation Syndrome[edit | edit source]

Migratory bone pain, joint pain or 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.[96][97] 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.[96]

Menstrual cycle effects[edit | edit source]

Schertzinger et al. (2017) found that levels of the sex hormones progesterone and testosterone were linked to pain severity in fibromyalgia.[98]

Migraine and headaches[edit | edit source]

Both tension-type headaches and migraines are commonly in patients with fibromyalgia.[3][27]

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.[99]

Mood disorder symptoms[edit | edit source]

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.[26]

Multiple Chemical Sensitivity[edit | edit source]

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.[100][101][102] MCS has been referred to as a partially overlapping condition, with fatigue and headaches occurring in both FM and MCS, and muscle or joint pain being reported in some people with MCS.[78][103]

Obesity[edit | edit source]

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.[104][84] A few studies have reported positive effects from weight loss in FM, either by bariatric surgery, a combination of diet and exercise combination or behavioral weight loss.[104]

Obstetrics and gynaecology[edit | edit source]

Chronic pelvic pain and vulvodynia, which is chronic pain around the opening of the vagina, are particularly common in women with FM.[3][55][105]

Early menopause and hysterectomy are linked to increased risk of fibromyalgia.[106] 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.[107] 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.[108]

Pregnancy complications have been found to be more common in women with fibromyalgia,[109] and the menstrual cycle has been found to be related to pain fluctuations in fibromyalgia.[98]

Orthostatic intolerance (OI)[edit | edit source]

Postural orthostatic tachycardia syndrome (POTS) and other forms of orthostatic intolerance often occur in people with fibromyalgia.[76] Symptoms can include low blood pressure on standing and/or sudden high blood pressure, dizziness, fainting.

Dr Charles Lapp found that fibromyalgia symptoms and ME/CFS symptoms predicted the outcome of tilt table testing for orthostatic intolerance.[110] Orthostatic intolerance may often be l overlooked in fibromyalgia patients.[111]

Painful bladder syndrome and chronic pelvic pain[edit | edit source]

Painful bladder syndrome and chronic pelvic pain are common comorbidities in people with fibromyalgia.[3]

Pregnancy complications[edit | edit source]

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.[109]

Prostrate symptoms[edit | edit source]

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.[3][112] Frequent and urgent urination are common.[112]

Raynaud's syndrome[edit | edit source]

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.[113]

Raynaud's symptoms have been commonly reported in people with fibromyalgia.[24][1][114]

Rheumatic conditions - other rheumatic conditions[edit | edit source]

Osteoarthritis, rheumatoid arthritis, lupus, and ankylosing spondylitis are more common in people with fibromyalgia.[14]

Sleep dysfunction[edit | edit source]

Sleep problems occur in most people with FM.[27] Waking unrefreshed is a diagnostic symptom, and the sleep disorders sleep apnea, restless legs syndrome and nocturnal myclonus are common in people with fibromyalgia.[1][35]

Vatthauer et al. (2015) found that sleep was associated with task-negative brain activity in fibromyalgia participants with comorbid chronic insomnia.[115]

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.[115]

Stress and Post-traumatic stress disorder[edit | edit source]

PTSD, which is a mental illness that results from traumatic events, is a risk factor for fibromyalgia.[27][28]

Temporomandibular disorder or temporomandibular joint disorder (TMD/TMJ)[edit | edit source]

The temporomandibular joint is the joint between the mandible (light blue) and the temporal bone (orange) of the skull.
Source: LadyofHats on Wikimedia Commons, public domain image.

TMD, previously known as TMJ, is common in people with fibromyalgia.[3] TMD symptoms other than headaches include:

  • Jaw pain
  • Discomfort or difficulty chewing
  • Painful clicking in the jaw
  • Difficulty opening or closing the mouth
  • Locking jaw
  • Ringing in the ears[116]

A review by Soares et al (2015) found fibromyalgia has "characteristics that constitute predisposing and triggering factors for TMD".[117]

Thyroid disease[edit | edit source]

People with 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.[54][118]

Other symptoms[edit | edit source]

Treatment[edit | edit source]

Main treatment approaches for fibromyalgia include patient education, exercise including stretching, message, medication, alternative treatments for pain management, and stress management or mental health treatments for any related depression or anxiety.[citation needed][2][3]

United States[edit | edit source]

Rheumatology and primary care providers: Diagnosing and treatment:

Drugs[edit | edit source]

Therapies[edit | edit source]

Exercise[edit | edit source]

Please Note: The research supporting these treatments are for fibromyalgia patients without ME/CFS sufferers due to it's hallmark symptom of post-exertional malaise.

Warm water exercise can be helpful for fibromyalgia. Start slow and don't push through the pain.[120][121] Image source: Wikimedia Commons. Author: Peter van der Sluijs, cropped, license: CC-BY-SA-2.5.

Several studies have found that warm-water pool exercise is a beneficial treatment for fibromyalgia. A very large survey of patients found that 26% have used pool therapy, rating it as very effective.[122] The same survey found 74% of patients found heat helpful - either warm water or heat packs.[122] Warm water especially important in FMS because the vasodilatory effect of the heating may improve blood flow to muscles, helping to reduce pain, and many people with FM are also intolerant of cold. A warm-water pool is one that's kept around 89.6 to 93 degrees Fahrenheit (32 to 34 Celsius), which is several degrees warmer than most heated pools.[123]

Dr Roubenoff Ronenn recommends moderate aerobic exercise and weights with six to eight reps, and then a day or two of rest in between. He cautions people not to start a program if they are in a flare.[120]

Massage[edit | edit source]

Acupuncture[edit | edit source]

Manual acupuncture (skin penetration without stimulation) is the most common form of acupuncture but gives no clinically significant pain relief to fibromyalgia patients, but a Cochrane review found electro-acupuncture, which involves an electrical current, significantly reduced pain, stiffness, and fatigue and improve sleep quality and global well-being in people with fibromyalgia for a one-month period, but not long term.[35][125]

2016 reviewed acupuncture (AC), electroacupuncture (EAC) and moxibustion, but found none improved quality of life in women with fibromyalgia.[126] "There was no significant improvement in pain or reduction of tender points in any of the groups studied, at the end of the 8th session."[126]

In 2004, U.S. Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) ruled a noncoverage determination for acupuncture.[127]

Controversies[edit | edit source]

Dr. Frederick Wolfe[edit | edit source]

Dr. Frederick Wolfe, the director of the National Databank for Rheumatic Diseases and the lead author of the 1990 paper that first defined the diagnostic guidelines for fibromyalgia, says he has become cynical and discouraged about the diagnosis. He now considers the condition a physical response to stress, depression, and economic and social anxiety.[128][129]

Fibromyalgia and Chiari malformation[edit | edit source]

Some individuals diagnosed with FMS were undergoing surgery for chiari malformation (CM). These are two separate conditions; FMS cannot be resolved by undergoing a risky CM surgery.[130][131]

Most patients with FM do not have CIM pathology. Future studies should focus on dynamic neuroimaging of craniocervical neuroanatomy in patients with FM.[130]

Blood test [edit | edit source]

EpicGenetics developed a blood test to identifying the presence of specific white blood cell abnormalities of patients diagnosed with FM - FM/a® test - and announces a linked treatment trial although the trial never started and is now suspended.[44] EpicGenetics offers help to determine if your insurance will cover their test.[43]

The FM/a test continues to be marketed despite the suspension of the linked treatment trial,[44] and the fact that only two studies have been published using the test - one comparing fibromyalgia patients with healthy controls, and another with lupus and rheumatoid arthritis patients.[45][46] In the 6 years since the last study was published, no further research has appeared on the FM/a test, leaving many to conclude that the evidence base is weak.[42]

IsolateFibromyalgia, IQuity's RNA based blood test for fibromyalgia, was first announced in 2018 but has insufficient data supporting its use: no peer-reviewed studies had been published by 2021.

Disability: SSI/SSD and LT[edit | edit source]

Famous people[edit | edit source]

Celebrities and famous people with fibromyalgia include:

Notable studies[edit | edit source]

News articles and features[edit | edit source]

See also[edit | edit source]

Learn more[edit | edit source]

Diagnosing and categorizing fibromyalgia[edit | edit source]

Refers to Towards a neurophysiological signature for fibromyalgia (2017)

Blood tests[edit | edit source]

Brain scans[edit | edit source]

  • 2002, Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia[40]
Fibromyalgia Pain Isn't All In Patient's Heads, New Brain Study Finds
People with fibromyalgia have inflammation of the brain

References[edit | edit source]

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