Fibromyalgia (FM/FMS) is the second most common rheumatic disorder behind osteoarthritis and is "now considered to be a lifelong Central nervous system disorder." Sufferers experience "amplified pain that shoots through the body."
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 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. 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. 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. Fibromyalgia has a F/M 7:1 ratio.
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.
- 1 Diagnostic criteria and code
- 2 Other diseases, illnesses and co-morbids of fibromyalgia
- 3 Rheumatology and primary care providers: Diagnosing and treatment
- 4 Drugs
- 5 Sleep study
- 6 Therapies
- 7 Disability
- 8 Ongoing process of diagnosing and categorizing
- 9 Blood tests
- 10 Brain scans
- 11 Notable studies
- 12 Other resources
- 13 Controversies
- 14 References
Diagnostic criteria and code
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).
American College of Rheumatology (ACR) Criteria
- 1990, 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." 
- 2010, The 2010 American College of Rheumatology (ACR) Preliminary Diagnostic Criteria for Fibromyalgia: Overview was proposed and modified in 2011 with the modification being validated in 2013 and published in 2014. September of 2016, another revision has been made.
- 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."
- 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
- The 2010 preliminary diagnostic criteria has never been officially implemented.
Other diseases, illnesses and co-morbids of fibromyalgia
- What is Fibro Fog? - Fibromyalgia and Cognitive Dysfunction "Mental confusion along with difficulty in concentration and loss of memory is often termed “fibro fog”".
- 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?" "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." and "with dysphasia will be found to having difficulty in talking, understanding, listening, writing or doing numeral calculations."
- 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.
- 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?"
- 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?"
- Allodynia "Allodynia is pain, generally on the skin, caused by something that wouldn't normally cause pain." 
- 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."
- Thyroid disease - 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."
- 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."
- 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."
- 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."
- Irritable bowel syndrome: 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."
- Orthostatic intolerance 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.
- Fibromyalgia Symptoms - The Monster List! " ...the list of possible symptoms is far-reaching and body-wide."
Rheumatology and primary care providers: Diagnosing and treatment
- 2012, the Mayo Clinic published 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 Disability heading about Primary Provider and Specialists for disability cases.)
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.
Food and Drug Administration (FDA) approved
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. There is a Facebook group dedicated to questions about the drug and tapering off of it; Cymbalta Hurts Worse. Eli Lilly has settled hundreds of personal injury lawsuits with patients experiencing severe withdrawal symptoms.
- Lyrica, (Pregabalin is Generic) is causing weight gain.
- Savella (Milnacipran is Generic) has a list of side effects.
- Low dose naltrexone: Taken at bedtime for sleep. Helps pain due to better sleep.
- Gabapentin: Is gabapentin (Neurontin, others) an effective fibromyalgia treatment? Used for pain, sleep.
- Low dose Quetiapine: Tackling Pain and Depression in Fibromyalgia: Quetiapine Scores Some Benefits in Clinical Trial Taken at bedtime for sleep.
- Tramadol: For chronic ongoing pain.
Not all side effects are listed, review each medication's possible side effects with your doctor.
- Low dose naltrexone: Insomnia
- Gabapentin: Gabapentin Side Effects
- Low dose Quetiapine: Weight Gain
- Tramadol: Having Seizures or Blackouts? The Tramadol Connection
- Cannabinoid-based Therapy: Intec Pharma Launches Phase 1 Trial of Cannabinoid-based Therapy for Fibromyalgia, Lower Back Pain.
- IMC-1: 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."
- 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."
- TNX-102: 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." The drug failed in its primary goal in providing pain relief and Tonix Pharmaceuticals will not be moving forward in developing a Fibromyalgia drug.
- DS-5565: Three New Fibromyalgia Drugs Could Be On The Way "Japanese drugmaker Daiichi Sankyo is now testing what could be Lyrica 2.0."
Articles and blogs on drugs
- Patients Say Fibromyalgia Drugs Make Things Worse, Rest is Best - Graph of Patient-Rated Drugs - Cure Together Blog
- 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."
- 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."
- 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."
Disordered sleep is a prominent symptom in FM. There are four types of Sleep Medications used in FM; Antihistamines, Benzodiazepines, Nonbenzodiazepines, Sedating Antidepressants.
Low dose naltrexone and Low dose Seroquel (see under the heading: Drugs) can also help with sleep when taken at bedtime.
Please Note: These recommendations are for Fibromyalgia patients and not ME/CFS sufferers.
- 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.
- Easy Fibromyalgia exercises and motivation to keep you healthy! Videos on YouTube from Eric Suarez, CPT.
- Fibromyalgia Myth vs. Fact Heading: Myth #3: People With Fibromyalgia Need More Exercise. Appropriate exercise, which each patient needs to gauge for themselves.
- 2016, Massage, Rolfing & Other Bodywork - Are They Effective Fibromyalgia & Chronic Fatigue Syndrome Treatments?
- 2014, Massage Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
- 2016, 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."
- 2005, Acupuncture Good for Fibromyalgia? "acupuncture gave no significant pain relief to fibromyalgia patients."
- 2004, U.S. Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) ruled April 16, 2004 a noncoverage determination for acupuncture.
Please Note: The following is NOT legal advice and it should not be relied upon in taking steps for a disability case. Only Social Security and a Disability Lawyer practicing Disability Law can provide the most up to date and the correct legal avenue for bringing a disability case.
In the US, Social Security Insurance and 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.
Examination and tests
For documentation of symptoms and providing proof of Fibromyalgia (FM), you may want to have results from the following tests:
- 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.)
- Sleep study for restless leg syndrome, sleep disturbances and rule out Narcolepsy.
- 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.)
- Blood tests that rule out RA, Lupus and other diseases that can have the same symptoms of Fibromyalgia and may be treatable.
- IBS diagnosis which may require blood, upper endoscopy to rule out Celiac disease and fecal tests to check for bacteria and parasites.
- Psychiatric testing to evaluate depression and anxiety which can also be treated.
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.
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.
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.
Ongoing process of diagnosing and categorizing
- 2016, Towards a neurophysiological signature for fibromyalgia. This study has "discovered a brain signature that identifies fibromyalgia sufferers with 93 percent accuracy". (MRI images.)
- 2016, 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."
- 2015, Evaluation of Antiviral Antibodies against Epstein-Barr Virus and Neurotransmitters in Patients with Fibromyalgia
- 2015, Question: 'Is Fibromyalgia a Psychosomatic Illness?' Answer: "Fibromyalgia is NOT a psychosomatic illness."
- 2015, Understanding the Association of Fatigue With Other Symptoms of Fibromyalgia: Development of a Cluster Model
- 2012, 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."
- 2014, Pridgen Reports Fibromyalgia Antiviral Trial Results “Very Positive”: Predicts New Approach Will Be “Game-Changer”
- 2015, Cytokine and chemokine profiles in fibromyalgia, rheumatoid arthritis, and systemic lupus erythematosus: a potentially useful tool in differential diagnosis.
- 2015, 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.)
- 2017, 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
- 2016, Characteristics of Disturbed Sleep in Patients With Fibromyalgia Compared With Insomnia or With Pain-Free Volunteers
- 2016, Is Efficacy of Milnacipran in Fibromyalgia Predictable? A Data Mining Analysis of Baseline and Outcome Variables.
- 2015, Some oxidative and antioxidative parameters and their relationship with clinical symptoms in women with fibromyalgia syndrome
- 2015, Understanding the Association of Fatigue With Other Symptoms of Fibromyalgia: Development of a Cluster Model
- 2015, Sleep is associated with task-negative brain activity in fibromyalgia participants with comorbid chronic insomnia
- 2015, Cognitive performance is related to central sensitization in patients with chronic whiplash-associated disorders and fibromyalgia: a case-control study
- 2015, Normalization of aberrant resting state functional connectivity in fibromyalgia patients following a three-month physical exercise therapy
- 2015, The effects of aquatic, isometric strength-stretching and aerobic exercise on physical and psychological parameters of female patients with fibromyalgia syndrome
- 2004, A link between irritable bowel syndrome and fibromyalgia may be related to findings on lactulose breath testing
- 2012, Dysfunctional endogenous analgesia during exercise in patients with chronic pain: To exercise or not to exercise?
Awards and current research
- 2016, Explaining unexplained pain to fibromyalgia patients: finding a narrative that is acceptable to patients and provides a rationale for evidence-based interventions
- 2016, Fibromyalgia: A Short Commentary iMedPub Journals - Journal of Headache & Pain Management - Frederick Wolfe and Brian Walitt
- 2015, Brain "fog," inflammation and obesity: key aspects of neuropsychiatric disorders improved by luteolin.
Hyperbaric oxygen therapy
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.
- Fibromyalgia now considered as a lifelong central nervous system disorder NAIDW.org
- Fibromyalgia now considered as a lifelong central nervous system disorder - News Medical Source: American Pain Society
- Fibromyalgia - Mayo Clinic
- Fibromyalgia Fact Sheet - CDC
- Fibromyalgia:Epidemiology - Medscape
- Webinar with Jarred Younger, Ph.D.
- World Health Organisation, International Classification of Diseases - Fibromyalgia M79.7, ICD-10, 2016
- 18 Points Used to Diagnose Fibromyalgia - Health.com
- Tender Points might no longer be used for diagnosis of Fibromyalgia - Massachusettes CFIDS/ME FM Association
- 2011 Modification of 2010 ACR Fibromyalgia Criteria - CelesteCooper.com
- Criteria for the diagnosis of fibromyalgia: validation of the modified 2010 preliminary American College of Rheumatology criteria and the development of alternative criteria. - PubMed
- 2016 Revisions to the 2010/2011 Fibromyalgia Diagnostic Criteria
- 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
- Tender Points might no longer be used for diagnosis of Fibromyalgia - The new criteria for FM diagnosis - Massachusettes CFIDS/ME FM Association
- 2015/16 ICD-10-CM Diagnosis Code M79.7
- The Health Care Industry Finally Recognizes Fibromyalgia
- What is Firbo Fog - Fibromyalgia and Cognitive Dysfunction - Medical.net
- Impaired Language in Fibromyalgia & Chronic Fatigue Syndrome - Talking, Reading & Writing
- Aphasia - Mayo Clinic
- What is Dysphasia?-Ayushveda
- Temperature Sensitivity in Fibromyalgia & Chronic Fatigue Syndrome - Very Well By Adrienne Dellwo
- Fibromyalgia Tied to Hysterectomy, Gynecologic Disease
- Allodynia - about.com definition article
- Painful to Touch: Fibromyalgia & Tactile Allodynia - Does Your Skin Hurt? Here's Why!
- Chronic Fatigue Syndrome, Fibromyalgia, and Autoimmune Thyroid Disease
- Thyroid Disease in Fibromyalgia & Chronic Fatigue Syndrome
- Sleep is associated with task-negative brain activity in fibromyalgia participants with comorbid chronic insomnia
- Fibromyalgia and Sleep - ProHealth - By: Cort Johnson
- Irritable Bowel Syndrome in Fibromyalgia & Chronic Fatigue Syndrome - Why Do They Go Together?
- Orthostatic Intolerance - Very Well By: Adrienne Dellwo
- Fibromyalgia Symptoms - The Monster List!
- Cymbalta Lawsuits - Drug Watch
- Eli Lilly Settles Cymbalta Withdrawal Lawsuits - Donna Gregory Burch - National Pain Report - October 6, 2016
- Lyrica and Weight Gain - Drugsdb.com
- Savella Side Effects - Drugs.com
- Novel Fibromyalgia Treatment Granted FDA Fast Track Designation - Fibromyalgia News Today By Charles Moore
- The Pridgen Revolution? Dr. Pridgen on Bringing His Antiviral Approach to Fibromyalgia To Market
- TNX-102 SL for Fibromyalgia - Tonix Pharmaceuticals
- Potential Fibromyalgia Treatment is Put on Hold - National Pain Report - September 2016
- Three New Fibromyalgia Drugs Could Be On The Way By Donna Gregory Burch
- Getting a Sleep Study with Fibromyalgia or Chronic Fatigue Syndrome
- What A Sleep Study Can Reveal About Fibromyalgia
- Fibromyalgia Sufferers Have Difficulty Maintaining Continuous Sleep, Study Says
- Sleep Medications For Fibromyalgia Fibrodaze.com
- Warm-Water Exercise for Fibromyalgia - About.com Health FMS/ME/CFS
- Exercise in warm water decreases pain and improves cognitive function in middle-aged women with fibromyalgia. - PubMED
- Exercising With Fibromyalgia - By Ronenn Roubenoff, MD
- Short-term complementary and alternative medicine on quality of life in women with fibromyalgia - JIM, Elsevier, Science Direct
- Acupuncture Good for Fibromyalgia? Acupuncture School Online
- CMS.gov Regulations and Guidance
- Neural signature for fibromyalgia may aid diagnosis, treatment
- 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
- Is Fibromyalgia a Psychosomatic Illness? Med Student Asks Celeste Cooper
- Personality and Fibromyalgia Syndrome
- Drug Approved. Is Disease Real? - New York Times