Fibromyalgia

Fibromyalgia (FM/FMS) is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas. 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, and sleep is often disrupted by pain. Many FM sufferers have sleep disorders like sleep apnea and restless leg syndrome. 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". 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), menstrual cycle cramps, and digestive problems like irritable bowel syndrome (IBS).



Prevalence
FM is the second most common rheumatic disorder behind osteoarthritis and is "now considered to be a lifelong Central nervous system disorder." An estimated 10 million people in the US and 3-6% of the world population have fibromyalgia. It is seen in women, men, children, and all ethnic groups. It is often seen in families and diagnosed between the ages of 20 to 50 years; incidence increases with age.

FM has a female:male 7:1 ratio under the American College of Rheumatology (ACR) 1990 Diagnostic Criteria and 2:1 when the ACR 2010 Preliminary Diagnostic Criteria is used. See: Fibromyalgia (American College of Rheumatology (ACR) Criteria section).

Fibromyalgia in ME/CFS
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 chronic pain. However, the Canadian Consensus Criteria (CCC) requires the symptom of pain to diagnose ME/CFS. It is the pattern and significant degree of chronic pain in FM that sets it apart from other diseases that have pain.

"The most common overlapping condition with ME/CFS is fibromyalgia."

Health complications
FM is not a progressive disease 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."


 * Fibromyalgia Complications


 * "People who have fibromyalgia frequently complain of a variety of symptoms that affect other parts of the body. Many people complain of gastrointestinal issues and restless legs syndrome (RLS). Additionally, the chronic pain and discomfort of fibromyalgia may lead to depression."


 * Can fibromyalgia cause other medical conditions?


 * "Fibromyalgia is not known to cause other medical conditions. However, people who have fibromyalgia seem to be at high risk for developing other painful conditions, including osteoarthritis (the common type of arthritis caused by wear and tear on the joints) as well as other related conditions, such as rheumatoid arthritis, lupus, and ankylosing spondylitis. Also, people with fibromyalgia are frequently diagnosed with chronic fatigue syndrome, irritable bowel syndrome (IBS), and temporomandibular joint (TMJ) disorder."

Risk factors
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.

Diagnosis
Tender points, not trigger points, are used to diagnose Fibromyalgia. Tender points will be above and below the waist and on both sides of the body. (See: Illustrations of the 1990 and 2010 American College of Rheumatology (ACR) Criteria depicting tender points near the top of this page.) It is important to check for other conditions that could be causing pain such as hypothyroidism, Rheumatoid arthritis or lupus, osteoarthritis, Ankylosing spondylitis, and Polymyalgia rheumatica.

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.


 * Men do not seem to form the tender points needed for diagnosis under the 1990 criteria, the 2010 proposed criteria diagnoses more men with a F/M ratio of 2:1.
 * 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
 * There are 19 tender point areas in the widespread pain index (WPI), whereas the 1990 criteria had 18 tender points.

The Social Security Administration for SSD/SSI filings relies on the 1990 or 2010 ACR criteria to diagnose fibromyalgia.

Sleep study
Sleep dysfunction is often involved in fibromyalgia. Treating a sleep disorder can help with fibromyalgia symptoms. A diagnosed sleep disorder is also helpful if one needs to file for disability.


 * 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

World Health Organization
ICD-10

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 Version: 016).


 * M79.7 Fibromyalgia
 * Fibromyositis
 * Fibrositis
 * Myofibrositis

In 2015, the United States finally adopted ICD-10 and Fibromyalgia as a diagnosis.

ICD-11 (2019)

ICD-11 (2019) has diagnostic code MG30.1 Chronic widespread pain.


 * 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) [1]. 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 [2] and identified psychological and social contributors."

Inclusions
 * Fibromyalgia

Exclusions
 * Acute pain (MG31)

Pathophysiology
"Fibromyalgia (FM) is a chronic pain disorder with unknown etiology and unclear pathophysiology. There is no evidence that a single event “causes” FM. Rather, many physical and/or emotional stressors may trigger or aggravate symptoms. These have included certain infections, such as a viral illness or Lyme disease, as well as emotional or physical trauma." The widespread pain is severe, debilitating, and abnormal in processing its pain. There is also sleep disturbance and fatigue. Cause or causes are unproven.


 * May 2012, Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management See Table 1: "Conditions associated with fibromyalgia." Musculoskeletal, genitourianry, gastro intestinal, and miscellaneous conditions often exist among fibromyalgia patients.

"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 neuro-endocrine 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 neuro-chemical processing of sensory signals in the CNS, thus lowering the threshold of pain and amplification of normal sensory signals causing constant pain."

"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) 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."


 * May 2018, A comparison of the clinical manifestation and pathophysiology of myofascial pain syndrome and fibromyalgia: implications for differential diagnosis and management (PDF) See Table 1 "Summary of the pathophysiology of fibromyalgia and myofascial pain syndrome." pg. 29 (pg. 4 of PDF)


 * Jul 2018, Primary and Secondary Fibromyalgia Share Same Symptom Burden, Study Suggests

"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."

Immune system research
Dr. Jarred Younger believes an overactive immune system is the cause and will be conducting a study to test this hypothesis. An overactive immune system is responsible for inflammation which causes chronic pain.

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. See: Fibromyalgia (Drugs: Trials: IMC-1 section).

ProHealth reports that an old Tuberculosis vaccine, Bacille Calmette-Guerin (BCG), may be researched for treatment of Fibromyalgia spearheaded by EpicGenetics and Massachusetts General Hospital.

EpicGenetics has a blood test that is identifying the presence of specific white blood cell abnormalities of patients diagnosed with FM and has partnered with two universities to offer whole exome sequencing free of charge to those who test positive with their FM/a® test. Concerns have been raised in regards to the FM/a® EpicGenetics Blood Test. EpicGenetics is awaiting FDA approval to test the Bacille Calmette-Guerin (BCG) vaccine (an old Tuberculosis vaccine) on patients that tested positive with its FM/a® test.

Comorbidities, overlapping conditions, and common symptoms

 * Allodynia
 * Allodynia: A Rare & Distinct Type of Pain in Fibromyalgia & ME/CFS Types of Allodynia: Tactile; Mechanical; and Thermal. "Type of pain, generally on the skin, that's caused by something that wouldn't normally cause pain"
 * Autoimmune disease s "Research suggests that RA and other inflammatory diseases may somehow increase the risk for fibromyalgia."


 * Body temperature
 * 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?"
 * Costochondritis (Chest and rib cage pain.)


 * Costochondritis in Fibromyalgia


 * Depression and Anxiety Fibromyalgia sufferers are "up to three times more likely to have depression at the time of their diagnosis than someone without fibromyalgia." Up to 20 percent of Fibromyalgia patients will have either depression or anxiety.


 * Fibro fog


 * What is Fibro Fog? - Fibromyalgia and Cognitive Dysfunction 'Mental confusion along with difficulty in concentration and loss of memory is often termed “fibro fog"'.


 * What Is Fibro Fog and ME/CFS Brain Fog?


 * Gastrointestinal system
 * 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."


 * Gulf War Illness A diagnosis of GWI increases the risk of developing Fibromyalgia.


 * Interstitial Cystitis (Painful bladder)
 * Fibromyalgia, Chronic Fatigue Syndrome & Interstitial Cystitis "Fibromyalgia, chronic fatigue syndrome and interstitial cystitis (IC) -- a painful bladder condition -- frequently occur together. Women may be up to 10 times more likely than men to develop it."


 * Language Impairment
 * Word-finding problems is a symptom of ME/CFS.
 * Language Impairment in Fibromyalgia and Chronic Fatigue Syndrome Impaired Language in Fibromyalgia & Chronic Fatigue Syndrome "Searching their brains for simple words that they just can't remember. On other occasions, individuals with these diagnoses may find it hard to write or even understand language."


 * "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" but with dysphasia you will have those symptoms and trouble listening and doing numeral calculations. See also: Dyscalculia.

"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."
 * ME/CFS Fibromyalgia and ME/CFS often overlap one another.
 * Migraine Migraines and Fibromyalgia
 * Multiple Chemical Sensitivity (MCS) It is thought that both Fibromyalgia and MCS are central sensitivity syndromes.


 * OBGYN
 * Menstrual Periods with Fibromyalgia: Personal Stories
 * Fibromyalgia Tied to Hysterectomy, Gynecologic Disease.
 * "You may have heard about a possible link between gynecologic surgery (such as a hysterectomy) and the development of fibromyalgia, and doctors have long suspected that fibromyalgia has strong hormonal ties and triggers. This does not seem surprising as we've long suspected a link between endocrine disorders, gynecological conditions, and autoimmune conditions."


 * Orthostatic intolerance (OI) and Postural orthostatic tachycardia syndrome (POTS)


 * Symptoms Predict the Outcome of Tilt Table Testing in CFS/ME/FM (PDF) Symptoms can include low blood pressure and/or sudden high blood pressure, dizziness, fainting.


 * An Overlooked Issue in Fibromyalgia? Study Highlights Problems Standing (Orthostatic Intolerance)


 * Sleep dysfunction
 * 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."


 * Temporomandibular joint disorder(TMJ)


 * Temporomandibular disorders in fibromyalgia syndrome: a short-communication


 * Thyroid disease
 * Chronic Fatigue Syndrome, Fibromyalgia, and Autoimmune Thyroid Disease


 * "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."


 * Other symptoms
 * Symptoms of Fibromyalgia (A comprehensive all in one place list for the many symptoms of Fibromyalgia.)

United States
Rheumatology and primary care providers: Diagnosing and treatment


 * 2012, A Framework for Fibromyalgia Management for Primary Care Providers Rheumatologists stopped treating fibromyalgia patients and primary care providers began treatment managment although rheumatologists are most often the specialist to diagnose. (Please see disability heading about primary provider and specialists for disability cases.)

Drugs
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 or its comorbidities 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. Always check with your doctor and pharmacist for drug interactions.''

Always review a drug company's prescription drug's side effects and possible drug interactions with your doctor and pharmacist.

Pregnant women must always consult with their doctor and pharmacist when taking any prescription drug, over-the-counter drug, supplement, or herbal remedy for side effects, drug interactions, and possible miscarriage, injury, birth defect, addiction, or death to the embryo, fetus, or baby. Breastfeeding women should always talk to their doctor and pharmacist for information about breast milk being laced with the drug she has taken causing side effects, injury, addiction, or death, and drug interactions to the baby consuming her breast milk.

Check with your doctor and pharmacist before using any prescription or over-the-counter drug, supplement, or herbal remedy being administered to a child. Check with your doctor for children's side effects or drug interactions that may not be listed.

FDA approved

 * Living with Fibromyalgia, Drugs Approved to Manage Pain (FDA For Consumers)


 * Cymbalta (Duloxetine is Generic)


 * Lyrica (generic will be Pregabalin)


 * Savella (Milnacipran is Generic)

FDA approved Side effects
Not all side effects or possible drug interactions of brand name or generic name drugs are listed or linked, review EACH brand name and EACH generic name medication's side effects and possible drug interactions with your doctor and pharmacist.


 * Cymbalta 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. Cymbalta side effects and (Duloxetine side effects).


 * Lyrica is causing weight gain. Lyrica side effects and (no generic available) until after 2018 when Pregabalin will be marketed.


 * Savella has a list of side effects. (Milnacipran is Generic): Savella side effects and (Milnacipran side effects).

Off-label

 * Florinef: (Fludrocortisone is generic) Off-label use for Orthostatic intolerance (OI) and Postural orthostatic tachycardia syndrome (POTS)


 * Low dose naltrexone: Taken at bedtime for sleep. Helps pain due to better sleep.


 * Neurontin (Gabapentin is generic): Is gabapentin (Neurontin, others) an effective fibromyalgia treatment? Used for pain, sleep.


 * Low dose Seroquel (Quetiapine is Generic): Tackling Pain and Depression in Fibromyalgia: Quetiapine Scores Some Benefits in Clinical Trial Taken at bedtime for sleep.


 * Ultram and (Tramadol is Generic): For chronic ongoing pain.


 * Zanaflex (Tizanidine is Generic): Muscle relaxer for pain, sleep.

Off-label Side effects
Not all side effects or possible drug interactions of brand name or generic name drugs are listed or linked, review EACH brand name and EACH generic name medication's side effects and possible drug interactions with your doctor and pharmacist.


 * Florinef: (Fludrocortisone is generic.) Weight gain, interacts with many other medications. Fludrocortisione side effects Florinef side effects.
 * Low dose naltrexone: Insomnia, the drug must be stepped up slowly. Opioids will be rendered ineffective.
 * Neurontin (Gabapentin is generic): Neurontin side effects.
 * Low dose Seroquel (Quetiapine is generic): (Used for Chronic Insomnia.) Weight gain, suicidal ideation. Although prescribed for sleep it is not recommended. Side effects of Seroquel.
 * Ultram: (Tramadol is generic) Ultram side effects.
 * Tramadol (Generic of Ultram): Having Seizures or Blackouts? The Tramadol Connection Tramadol side effects.


 * Zanaflex (Tizanadine is generic): Zanaflex Side Effects.

Sleep medications
Not all side effects or possible drug interactions of brand name or generic name drugs are listed or linked, review EACH brand name and EACH generic name medication's side effects and possible drug interactions with your doctor and pharmacist.

Disordered sleep is a prominent symptom in FM. There are four types of sleep medications used in FM; antihistamines, benzodiazepines, nonbenzodiazepines, sedating antidepressants.

Articles and blogs on drugs

 * Having Seizures or Blackouts? The Tramadol Connection


 * Why Your Fibro Meds Aren't Working

Drug trials

 * ASP8062
 * 2017, ClinicalTrials.gov A Phase 2a, Randomized, Double-Blind Placebo-controlled, Parallel-group Study to Assess the Analgesic Efficacy and Safety of ASP8062 in Subjects With Fibromyalgia


 * Cannabinoid-based therapy
 * 2017, Intec Pharma Launches Phase 1 Trial of Cannabinoid-based Therapy for Fibromyalgia, Lower Back Pain.


 * IMC-1


 * 2016, 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."


 * 2016, 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."


 * 2017, Through the “Valley of Death”: Dr. Pridgen, Fibromyalgia and the Looming Trials


 * "First there were the anecdotal reports – FM patients were not just getting better but some, and not just a few, were getting well using something entirely new – an antiviral protocol, of all things, created not by a pain specialist or rheumatologist but by a surgeon."


 * 2017, A famciclovir + celecoxib combination treatment is safe and efficacious in the treatment of fibromyalgia


 * "IMC-1 was efficacious and safe in treating symptoms of fibromyalgia, supporting the hypothesis that herpes virus infections may contribute to this syndrome. Improved retention rates, decreased adverse event rates, and evidence of efficacy on a broad spectrum of outcome measures are suggestive that IMC-1 may represent an effective, novel treatment for fibromyalgia."


 * Bacille Calmette-Guerin (BCG) vaccine
 * 2017, Century-old vaccine gives new hope to fibromyalgia community

Drug trials failed

 * TNX-102


 * 2016, The drug failed in its primary goal in providing pain relief and Tonix Pharmaceuticals will not be moving forward in developing a Ffbromyalgia drug.


 * Phase III clinical trial of DS-5565 found ineffective


 * 2017, The Big Hurt: Second Major Fibromyalgia Drug in a Year Fails


 * "In the three 13-week, double-blind, global, phase 3 ALDAY clinical trials evaluating Mirogabalin for the treatment of pain associated with fibromyalgia, Mirogabalin did not meet the primary efficacy endpoint to demonstrate a statistically significant reduction in the weekly average of worst daily pain score from baseline to Week 13."

Exercise
Please Note: These recommendations are for fibromyalgia patients and not ME/CFS sufferers.


 * Warm water exercise is best.


 * Moderate aerobic exercise and weights with six to eight reps and then 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! Video


 * Fibromyalgia Myth vs. Fact Heading: Myth #3: People With Fibromyalgia Need More Exercise. Appropriate exercise, which each patient needs to gauge for themselves.

Massage

 * 2014, Massage Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials


 * 2016, Massage, Rolfing & Other Bodywork - Are They Effective Fibromyalgia & Chronic Fatigue Syndrome Treatments?

Acupuncture

 * 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.


 * 2005, Acupuncture Good for Fibromyalgia? "Acupuncture gave no significant pain relief to fibromyalgia patients."


 * 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."


 * 2016, Acupuncture Does Not Appear to Relieve Pain in Fibromyalgia Patients

United States
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 can provide the most up to date and the correct legal avenue for bringing a disability case.

In the United States, 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.

The Social Security Administration for SSD/SSI filings relies on the 1990 or 2010 ACR criteria to diagnose Fibromyalgia. (See: "Policy Interpretation" for the POLICY INTERPRETATION RULING.)


 * Applying for Disability With Fibromyalgia One patient's success of applying, denial, successful appeal, and a breakdown of what SSI/SSD requires for the medical determination of a favorable decision of disability.


 * Fibromyalgia: Policy Interpretation Ruling - Social Security


 * Social Security Disability (SSDI & SSI) for Fibromyalgia - Disability Secrets By NOLO


 * Fibromyalgia Disability Patient Support Forums at MDJunction

Examinations and Tests
For documentation of symptoms and co-morbidities of a FM diagnosis, you and your doctor should consider the following examinations and tests:


 * Fibromyaglia Diagnostic Examination
 * Rheumatologist examination and diagnosis of FM. (Consider having a rheumatologist order tests and coordinate referrals for other specialists for examinations and testing. Only specialists can complete the paperwork for Social Security. A primary doctor cannot complete disability paperwork but may be able to forward test results they have ordered.)
 * Arthritis
 * Whole body bone scan to rule out treatable arthritis.
 * Blood Tests
 * Routine blood tests for diabetes (fasting sugar, A1C) and a full Thyroid disease panel (TSH, T3, Free T3, T4 and Free T4).
 * Rule out Rheumatoid arthritis, lupus, Lyme disease and other diseases that can share some of the same symptoms of fibromyalgia and may be treatable.
 * Vitamin and mineral deficiencies such as B12 and Vitamin D are treatable with over the counter supplements and prescription medications which can improve fatigue and pain.
 * Gastrointestinal
 * Irritable bowel syndrome diagnosis which may require blood, upper endoscopy to rule out celiac disease and fecal tests to check for bacteria (SIBO) and intestinal parasites.
 * Mental Health and Cognition
 * Psychiatric evaluation as any depression and anxiety should be treated.
 * Cognitive dysfunction tests.
 * Sleep dysfunction
 * Sleep study for Restless legs syndrome, Sleep disturbance and rule out Narcolepsy.
 * Orthostatic Intolerance
 * Tilt table test for Orthostatic intolerance.
 * TMJ, tinnitus, vertigo, and dizziness
 * An ear, nose, and throat specialist (ENT) (Otorhinolaryngology) examination and imaging may be ordered for Temporomandibular joint disorder (TMJ).
 * (Ear, sinus, throat/lymph infections, and tinnitus can also be documented.)
 * Videonystagmography (VNG) testing if you experience vertigo and/or dizziness.

Of course, one can have arthritis, sleep apnea, chronic Lyme disease or other diseases and still have FM, but there may be a treatable condition where a patient's overall health, including their FM, improves.

There have been cases of Vitamin D deficiency being misdiagnosed as fibromyalgia as a D deficiency can cause pain. Supplementation or prescribed D treatments may alleviate this pain. However, it is possible to have both a D deficiency and fibromyalgia and correcting the deficiency will only resolve the pain stemming from it.

Blogs about navigating SSD process

 * Resources for getting approved for disability include this Guide to Social Security Disability for People with Myalgic Encephalomyelitis and Chronic Fatigue Syndrome, available on the #MEAction website.


 * How Patty’s Lawyer Never Told Her What She Needed to Know


 * Sample Doctor Letters for Disability

Notable studies

 * 2002, Fibromyalgia Pain Isn't All In Patient's Heads, New Brain Study Finds


 * 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?


 * 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, Fibromyalgia: A search for markers and their evaluation throughout a treatment


 * 2015, Normalization of aberrant resting state functional connectivity in fibromyalgia patients following a three-month physical exercise therapy


 * 2015, Researchers identify potential sleep-related treatment targets for fibromyalgia


 * 2015, Fibromyalgia has central nervous system origins


 * 2015, The Iceberg Nature of Fibromyalgia Burden: The Clinical and Economic Aspects


 * 2015, The effects of aquatic, isometric strength-stretching and aerobic exercise on physical and psychological parameters of female patients with fibromyalgia syndrome


 * 2016, Fibromyalgia syndrome: metabolic and autophagic processes in intermittent cold stress mice.


 * 2016, Fibromyalgia Is Correlated with Retinal Nerve Fiber Layer Thinning


 * 2016, The prevalence of severe fatigue in rheumatic diseases: an international study.


 * 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.


 * 2017, The degree of cardiac baroreflex involvement during active standing is associated with the quality of life in fibromyalgia patients. (Orthostatic Intollerance)


 * 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


 * 2017, Towards a neurophysiological signature for fibromyalgia.


 * 2018, A Blinded, Randomized, Placebo-Controlled Study to Investigate the Efficacy and Safety of Ferric Carboxymaltose in Iron-Deficient Patients with Fibromyalgia.

Grant awards and current research

 * Oct 2016, Chronic pain researchers to expand work with $7.5M award from NIH
 * Jun 2018, The Bateman Horne Center will be an All of Us recruitment center for people living with ME/CFS and fibromyalgia. All of Us is a ten year Precision Medicine Initiative project that has been funded $1.5 Billion to recruit one million patients for its bio-bank. The idea is to research all diseases, from the most common to the most rare while taking into account lifestyle, environment, and biology.

Psychiatric paradigm

 * 2015, Brain "fog," inflammation and obesity: key aspects of neuropsychiatric disorders improved by luteolin.


 * 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

Hyperbaric oxygen therapy

 * 2015, Hyperbaric Oxygen Therapy Can Diminish Fibromyalgia Syndrome


 * Noted in this News Medical article about the research all the women had concussions.


 * 2016, Hyperbaric Oxygen Therapy for treating Fibromyalgia: An update

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.

Fibromyalgia vs 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.


 * 2011, Is Chiari I malformation associated with fibromyalgia?
 * Conclusion: Most patients with FM do not have CIM pathology. Future studies should focus on dynamic neuroimaging of craniocervical neuroanatomy in patients with FM.


 * 2015, CFS/FM and Chiari Malformation Surgery

Learn more

 * Forum: Fibromyalgia and Connective Tissue Disorders at Science for ME
 * Verywell FMS/CFS

Ongoing process of diagnosing and categorizing

 * 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, Lyme Disease, Fibromyalgia Link Evaporates (See also: Chronic lyme disease)


 * 2015, Fibromyalgia now considered as a lifelong central nervous system disorder


 * 2015, Foundation of Fibromyalgia Is Altered Central Nervous System, New Study Validates


 * 2015, Evaluation of Antiviral Antibodies against Epstein-Barr Virus and Neurotransmitters in Patients with Fibromyalgia


 * 2015, Question: 'Is Fibromyalgia a Psychosomatic Illness?' via CelesteCooper.com Answer: "Fibromyalgia is NOT a psychosomatic illness."


 * 2015, Understanding the Association of Fatigue With Other Symptoms of Fibromyalgia: Development of a Cluster Model


 * 2016, Diagnosing Fibromyalgia May Be Possible Using Noninvasive Eye Examination


 * 2016, The association between borderline personality disorder, fibromyalgia and chronic fatigue syndrome: systematic review

"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."


 * 2016, Microglia in Fibromyalgia & Chronic Fatigue Syndrome


 * 2016, Are Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia Immune Exhaustion Disorders?


 * 2016, Why Fibromyalgia Is Neuropathic


 * 2016, Towards a neurophysiological signature for fibromyalgia (With MRI images.) "Discovered a brain signature that identifies fibromyalgia sufferers with 93 percent accuracy."


 * 2017, Study Reveals New Treatment Target for Fibromyalgia: Inflammation in the Brain


 * 2018, Primary and Secondary Fibromyalgia Are The Same: The Universality of Polysymptomatic Distress "PFM and SFM are equivalent regarding symptom burden."

Blood tests

 * 2013, New Fibromyalgia Blood Test is 99% Accurate


 * 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.


 * 2016, Blood Test for Fibromyalgia: FM/a Test Ⓡ is now available, Q&A


 * 2016, Fibromyalgia blood testing covered by rising number of insurance companies


 * 2017, EpicGenetics, with the Assistance of Leading Medical Centers, Expands Clinical Study of FM/a® Test to Diagnose Fibromyalgia, Identify Genetic Markers Unique to the Disorder and Explore Direct Treatment Approaches

Brain scans

 * 2002, Fibromyalgia Pain Isn't All In Patient's Heads, New Brain Study Finds


 * 2012, Fibromyalgia and the brain: New clues reveal how pain and therapies are processed


 * 2015, Unique Brain Connectivity in Fibromyalgia - Increased Importance Assigned to Pain


 * 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
 * 2017, AI can spot the pain from a disease some doctors still think is fake