Fibromyalgia: Difference between revisions

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[[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" />


[[Fibromyalgia]] '''(FM/FMS)''' is a chronic disorder characterized by widespread [[Musculoskeletal system|musculoskeletal]] pain, [[fatigue]], and tenderness in localized areas. [[Myalgia|Muscle pain]] is widespread, on both sides of the body, and above and below the waist.<ref name=":50" /><ref name=":51" /><ref name=":48" /><ref name=":49" />
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" />


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 dysfunction|sleep disorders]] like [[sleep apnea]] and [[restless legs syndrome]] (RLS).<ref name=":26" /><ref name=":27" /><ref name=":35" /> [[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=":17">{{Cite news|url=https://www.verywellhealth.com/brain-fibro-fog-causes-symptoms-possible-treatment-716014|title=What Is Fibro Fog and ME/CFS Brain Fog?|last=Dellwo|first=Adrienne|authorlink=Adrienne Dellwo|date=|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=|dead-url=}}</ref><ref name=":26" /><ref name=":27" /><ref name=":35" /> Some experience [[depression]], [[headache]]s, and lower [[abdominal pain]] or [[muscle cramp|cramping]]. Other symptoms include [[Paresthesia|tingling]] or [[numbness]] in hands and feet, pain in jaw and disorders of the jaw such as [[temporomandibular joint disorder|temporomandibular joint disorder]] (TMJ/TMD), [[Menstrual cycle#Health effects in other conditions|menstrual cycle]] cramps, and [[digestive problems]] like i[[Irritable bowel syndrome|rritable bowel syndrome]] (IBS).<ref name=":26">{{Cite news|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=":27">{{Cite news|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=":35" />
In fibromyalgia [[pain]] is widespread, on both sides of the body, and above and below the waist.<ref name="ACR2010" /><ref name="excerpt" />


[[Pain#Pain in Fibromyalgia|Other pain conditions are associated with FM]], such as [[rheumatoid arthritis]] (RA), [[Systemic lupus erythematosus|Lupus]], [[Ankylosing_spondylitis|ankylosing spondylitis]], [[Interstitial_cystitis|interstitial cystitis]], and more.<ref name=":05">{{Cite web|url=https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780|title=Fibromyalgia - Symptoms and causes|website=Mayo Clinic|language=en|access-date=2019-05-03}}</ref><ref name=":46">{{Cite web|url=https://www.health.com/health/gallery/0,,20520705,00.html|title=7 Conditions Linked to Fibromyalgia|last=Mann|first=Denise|authorlink=|last2=|first2=|authorlink2=|date=Sep 7, 2011|website=Health.com|language=en|archive-url=|archive-date=|dead-url=|access-date=2019-05-03}}</ref><ref name=":47">{{Cite web|url=https://www.verywellhealth.com/chronic-fatigue-syndrome-interstitial-cystitis-716168|title=Fibromyalgia, Chronic Fatigue Syndrome & Interstitial Cystitis|last=Dellwo|first=Adrienne|authorlink=Adrienne Dellwo|last2=|first2=|authorlink2=|date=Aug 21, 2018|website=Verywell Health|language=en|archive-url=|archive-date=|dead-url=|access-date=2019-05-03}}</ref>
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" />


The [[United Kingdom|United Kingdom]] (UK) [[National Health Service]] (NHS) lists FM as one of 20 most painful conditions.<ref>{{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=EDT|first=Hannah Osborne On 10/29/18 at 7:14 AM|date=2018-10-29|website=Newsweek|language=en|access-date=2019-03-26}}</ref><ref name=":39">{{Cite web|url=https://www.cambridge-news.co.uk/news/uk-world-news/nhs-gout-ulcer-endometriosis-arthritis-15339123|title=The NHS says these are the 20 most painful health conditions you can suffer from|last=Campbell|first=James|last2=Pengelly|first2=Ella|date=2019-03-26|website=cambridgenews|access-date=2019-03-26}}</ref> The NHS describes the pain as diffuse aching or burning, head to toe, and can be worse at some times than at others. The pain can change location. "The fatigue ranges from feeling tired, to the exhaustion of a [[flu-like illness]]."<ref name=":39" /> The [[United States|United States]] (US) [[Centers for Disease Control and Prevention]] (CDC) states FM "can cause pain, [[Fibromyalgia disability process|disability, and lower quality of life]]."<ref>{{Cite web|url=https://www.cdc.gov/arthritis/basics/fibromyalgia.htm|title=Fibromyalgia {{!}} Arthritis {{!}} CDC|date=2018-10-04|website=www.cdc.gov|language=en-us|access-date=2019-04-12}}</ref> The medical guide book [[Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life|''Mayo Clinic Guide to'' ''Fibromyalgia: Strategies to Take Back Your Life'']] describes fibromyalgia as "a [[Central sensitization|sensory disorder]] caused by a miscommunication between the [[Nervous system|nerves through your body and your brain]]."<ref>{{Cite web|url=https://www.amazon.com/Mayo-Clinic-Guide-Fibromyalgia-Strategies/dp/1893005496/ref=sr_1_1?keywords=Mayo+Clinic+Guide+to+Fibromyalgia%3A+Strategies+to+Take+Back+Your+Life&qid=1573669190&s=books&sr=1-1|title=Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life|last=Abril, M.D.|first=Andy|authorlink=|last2=Bruce Ph.D. L.P.|first2=Barbara K.|authorlink2=|date=|year=2019|website=www.amazon.com|publisher=Mayo Clinic Press; Paperback Original edition|page=15|archive-url=|archive-date=|dead-url=|access-date=2019-11-13}}</ref>  
[[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" />


The [[American_College_of_Rheumatology|American College of Rheumatology]] (ACR) created and updates the diagnostic criteria for FM.<ref name=":12" /><ref name=":13">{{Cite web|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=2010|website=fibroknowledge.com|type=PDF|archive-url=|archive-date=|dead-url=|access-date=|authorlink=|last2=Clauw|first2=Daniel|authorlink2=|publisher=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|others=Muhammad Yunus}}</ref><ref name=":50" /><ref name=":51" /><ref name=":48" /><ref name=":49">{{Cite web|url=https://www.rheumatology.org/Portals/0/Files/2010%20Fibromyalgia%20Diagnostic%20Criteria_Excerpt.pdf|title=2010 Fibromyalgia Diagnostic Criteria - Excerpt|last=|first=|authorlink=|last2=|first2=|authorlink2=|date=2010|website=rheumatology.org|page=|archive-url=|archive-date=|dead-url=|access-date=}}</ref> ''See:''  [[Fibromyalgia#Diagnosis|Fibromyalgia (''Diagnosis'' section)]].
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" />


[[File:Fibro_Tender_Points.png|400px|thumb|right|1990 ACR Diagnostic Criteria: 18 <u>Tender Points</u><ref name=":50">{{Cite journal|last=|first=|author-link=Frederick Wolfe|author-link2=Hugh Smythe|author-link3=Muhammad Yunnus|author-link4=Robert Bennett|author-link5=Claire Bombardier|author-link6=Don Goldenberg|author-link7=Peter Tugwell|author-link8=Stephen Campbell|author-link9=Micha Abeles|date=|others=Patricia Clark, Adel Fam,Stephen Farber, Justus Fiechtner, C.Michael Franklin, Rober Gatter, Daniel Hamaty, James Lessard, Alan Lichtbroun, Alfonse Masi, Glenn McCain, W. John Reynolds, Thomas Romano, I. Jon Russell, and Robert Sheon|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=Arthritis and Rheumatism}}</ref><ref name=":51">{{Cite web|url=https://www.rheumatology.org/Portals/0/Files/1990%20Fibromyalgia_Excerpt.pdf|title=1990 Fibromyalgia Excerpt|last=Wolfe|first=Frederick|authorlink=|last2=|first2=|authorlink2=|date=1990|website=rheumatology.org|archive-url=|archive-date=|dead-url=|access-date=}}</ref>]]
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|2010 ACR Preliminatry Diagnostic Criteria: '''Wisedpread Pain Index (WPI'''), 19 <u>Tender Point Areas</u><ref name=":48">{{Cite journal|last=|first=|author-link=Frederick Wolfe|author-link2=Daniel Clauw|author-link3=Mary Ann Fitzcharles|author-link4=Don Goldenberg|author-link5=Robert Katz|author-link6=Philip Mease|author-link7=Anthony Russell|author-link8=I. Jon Russell|author-link9=John Winfield|date=2010|others=Muhammad Yunus|title=The American College of RheumatologyPreliminary Diagnostic Criteria for Fibromyalgiaand Measurement of Symptom Severity|url=https://www.rheumatology.org/Portals/0/Files/2010_Preliminary_Diagnostic_Criteria.pdf|journal=Arthritis Care & Research|publisher=American College of Rheumatology|volume=62|issue=5|pages=600-610|quote=|via=}}</ref><ref name=":49" />]]
 
 
[[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==
==Prevalence==
FM is the second most common rheumatic disorder behind [[osteoarthritis]] and is "now considered to be a lifelong [[central nervous system]] disorder."<ref>{{Cite web|url=https://www.sciencedaily.com/releases/2015/05/150517071813.htm|title=Fibromyalgia has central nervous system origins|last=|first=|authorlink=|last2=|first2=|authorlink2=|date=May 17, 2015|website=ScienceDaily|at=Summary:|language=en|archive-url=|archive-date=|dead-url=|access-date=2019-11-13|quote=now considered to be a lifelong central nervous system disorder}}</ref><ref>{{Cite news|url=https://naidw.org/blog/members-myblogs/fibromyalgia-now-considered-as-a-lifelong-central-nervous-system-disorder|title=Fibromyalgia now considered as a lifelong central nervous system disorder|work=NAIDW.org®|access-date=2018-08-09|language=en-gb}}</ref> An estimated 10 million people in the US and 3-6% of the world population have FM. 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.<ref>{{Cite news|url=http://www.fmaware.org/about-fibromyalgia/prevalence/|title=Prevalence - National Fibromyalgia Association (NFA)|work=National Fibromyalgia Association (NFA)|access-date=2018-08-09|language=en-US}}</ref>
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 has a female:male 7:1 ratio under the ''American College of Rheumatology (ACR) 1990 Diagnostic Criteria''<ref name=":50" /><ref name=":51" /> and 2:1 when the ''ACR 2010 Preliminary Diagnostic Criteria''<ref name=":48" /><ref name=":49" /> is used.<ref>{{Cite journal|last=Boomershine|first=Chad|date=Nov 4, 2017|title=Fibromyalgia: Practice Essentials, Background, Pathophysiology|url=http://emedicine.medscape.com/article/329838-overview#a5|journal=Medscape|volume=|pages=|via=|publisher=|editor-last=Diamond|editor-first=Herbert|at=Sex-related differences in incidence}}</ref> ''See'': [[Fibromyalgia#American College of Rheumatology (ACR) Criteria|Fibromyalgia (''American College of Rheumatology (ACR) Criteria'' section)]]. A September 2018, Wolfe et al study ''Fibromyalgia diagnosis and biased assessment: Sex, prevalence and bias''<ref name=":28" /> found fewer women and more men are diagnosed under the 2010/11 criteria (this criterion further updated in 2016<ref>{{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>). They found the ratio is F/M 1.5:1.<ref name=":28">{{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>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=":28" /></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=":28" /></blockquote>
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==
==Fibromyalgia in ME/CFS==
"The most common overlapping condition with [[ME/CFS]] is fibromyalgia."<ref name=":30">{{Cite web|url=https://ammes.org/overlapping-conditions/|title=Overlapping Conditions - American Myalgic Encephalomyelitis and Chronic Fatigue Syndrome Society|last=|first=|date=|website=ammes.org|language=en-US|archive-url=|archive-date=|dead-url=|access-date=2018-08-12}}</ref><ref name=":31">{{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=":36">{{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=0|issue=0|doi=10.1016/j.clinthera.2018.12.016|issn=0149-2918|pmid=30795933}}</ref>
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 [[CFS]] do not have [[chronic pain]].<ref>{{Cite web|url=https://www.youtube.com/watch?v=wJB95m4FLa0#t=57m27s|title=Webinar with Jarred Younger, Ph.D.|last=Younger|first=Jared|date=May 20, 2016|website=YouTube|at=57:27|via=|archive-url=|archive-date=|dead-url=|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
| last1  = Carruthers    | first1 = Bruce M.      | authorlink1 = 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.    | authorlink7 = Alison Bested
| last8  = Flor-Henry    | first8 = Pierre        | authorlink8 = Pierre Flor-Henry
| last9  = Joshi        | first9 = Pradip        | authorlink9 = Pradip Joshi
| last10  = Powles        | first10 = A C Peter    | authorlink10 = A C Peter Powles
| last11  = Sherkey      | first11 = Jeffrey A.  | authorlink11 = Jeffrey Sherkey
| last12  = van de Sande  | first12 = Marjorie I.  | authorlink12 = 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 | page = 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 symptoms]] and [[unrefreshing sleep]].<ref name=":17" /><ref name=":26" /><ref name=":27" />


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=|last2=|first2=|authorlink2=|archive-url=|archive-date=|dead-url=}}</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==
==Health complications==
FM is not a [[progressive disease]] 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>
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>


*[https://www.sharecare.com/health/fibromyalgia-effects Fibromyalgia Complications]<ref name=":19" />
The [[Centers for Disease Control and Prevention|CDC]] recognizes the following complications:


:<blockquote>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]].<ref name=":19">{{Cite news|url=https://www.sharecare.com/health/fibromyalgia-effects|title=Fibromyalgia Complications - Fibromyalgia - Joint Health|work=Sharecare|access-date=2018-08-09|language=en}}</ref></blockquote>
*'''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>


*[https://www.sharecare.com/health/fibromyalgia-effects/can-fibromyalgia-cause-medical-conditions Can fibromyalgia cause other medical conditions?]<ref name=":20" />
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>


:<blockquote>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.<ref name=":20">{{Cite web|url=https://www.sharecare.com/health/fibromyalgia-effects/can-fibromyalgia-cause-medical-conditions|title=Can fibromyalgia cause other medical conditions? {{!}} Fibromyalgia Complications|last=Honor Society of Nursing|first=|date=|website=Sharecare|language=en|archive-url=|archive-date=|dead-url=|access-date=2018-08-09}}</ref></blockquote>
==Risk factors==
==Risk factors==
[[Lupus]] and [[rheumatoid arthritis]] (RA) are risk factors in developing FM. Car accidents, [[post-traumatic stress disorder]] (PTSD), [[Carpal tunnel syndrome|repetitive injuries]], illness such as a [[virus|viral infection]], [[family history]], and [[obesity]] have all been linked to FM.<ref name=":35">{{Cite web|url=https://www.cdc.gov/arthritis/basics/fibromyalgia.htm|title=Fibromyalgia {{!}} Arthritis {{!}} CDC|date=2018-04-03|website=www.cdc.gov|language=en-us|access-date=2018-08-09}}</ref><ref>{{Cite news|url=https://www.niams.nih.gov/health_info/Fibromyalgia/|title=Fibromyalgia What Causes it?|last=Director|first=Nancy Garrick, Deputy|date=2017-04-05|work=National Institute of Arthritis and Musculoskeletal and Skin Diseases|access-date=2018-08-09|archive-url=|archive-date=|dead-url=|language=en}}</ref><ref>{{Cite news|url=http://www.prohealth.com/library/showarticle.cfm?libid=22315|title=When Fibromyalgia Is More than Pain - Prohealth|date=2016-01-08|work=Prohealth|access-date=2018-08-09|language=en-US}}</ref>
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==
==Diagnosis==
[https://www.verywellhealth.com/what-are-fibromyalgia-tender-points-189768 Tender points], not [https://en.wikipedia.org/wiki/Myofascial_trigger_point trigger points], are used to diagnose FM.<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=www.healthcentral.com|language=en-US|archive-url=|archive-date=|dead-url=|access-date=2018-08-09}}</ref> 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]], RA or lupus, osteoarthritis, ankylosing spondylitis, and [[wikipedia:Polymyalgia_rheumatica|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>
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===
=====<span id="bloodtest"> Blood test </span>=====
EpicGenetics has a [[blood test]] that is identifying the presence of specific [[Leucocyte|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 [http://fmtest.com/ FM/a® test].<ref>{{Cite news|url=http://www.businesswire.com/news/home/20170419005324/en/EpicGenetics-Assistance-Leading-Medical-Centers-Expands-Clinical|title=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|last=|first=|date=Apr 19, 2017|work=|access-date=2018-08-09|archive-url=|archive-date=|dead-url=|language=en}}</ref><ref name=":38">{{Cite web|url=http://fmtest.com/|title=Home|last=perceptivadmin|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> Most insurance companies will cover the test.<ref>{{Cite web|url=https://www.painnewsnetwork.org/stories/2015/5/27/fibromyalgia-blood-test-gets-insurance-coverage|title=Fibromyalgia Blood Test Gets Insurance Coverage|last=Anson|first=Pat|authorlink=|last2=|first2=|authorlink2=|date=May 27, 2015|website=Pain News Network|language=en-US|archive-url=|archive-date=|dead-url=|access-date=2019-03-25}}</ref><ref>{{Cite web|url=http://nationalpainreport.com/more-insurance-companies-now-paying-for-fibromyalgia-blood-test-8829994.html|title=More Insurance Companies Now Paying for Fibromyalgia Blood Test|last=Gregory-Burch|first=Donna|authorlink=|last2=|first2=|authorlink2=|date=2016-04-04|website=National Pain Report|language=en-US|archive-url=|archive-date=|dead-url=|access-date=2019-03-25}}</ref> EpicGenetics offers help to determine if your insurance will [http://fmtest.com/ cover their test].<ref name=":38" />


==== American College of Rheumatology (ACR) Criteria ====
==== 2010 American College of Rheumatology (ACR) Criteria ====


=====1990 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" />


*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=":12">{{Cite web|url=https://www.rheumatology.org/Portals/0/Files/1990_Criteria_for_Classification_Fibro.pdf|title=The American College of Rheumatology Criteria for the Classification of Fibromyalgia|last=Wolfe|first=Frederick|last2=Smythe|first2=Hugh|date=1990|website=rheumatology.org|publisher=|others=Abeles, Micha; Clark, Patricia; Fam, Adel; Farber, Stephen; Fiechtner, Justus; Franklin, Michael; Gatter, Robert; Hamaty, Daniel; Lessard, James; Lightbroun, Alan; Masi, Alfonse; McCain, Glenn; Reynolds, W. John; Romano, Thomas; Russell, Jon; Sheon, Robert|archive-url=|archive-date=|dead-url=|access-date=|last3=Yunus|first3=Muhammad|last4=Bennett|first4=Robert|last5=Bombardier|first5=Claire|last6=Goldenberg|first6=Don|last7=Tugwell|first7=Peter|last8=Campbell|first8=Stephen}}</ref><ref name=":50" /><ref name=":51" /> "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>{{Cite news|url=http://www.health.com/health/gallery/0,,20345635,00.html|title=18 Points Used to Diagnose Fibromyalgia|last=|first=|date=Feb 4, 2011|work=Health.com|access-date=2018-08-09|archive-url=|archive-date=|dead-url=|language=en}}</ref><ref>{{Cite web|url=https://www.masscfids.org/8-resource-library/diagnosis/266-tender-points-might-no-longer-be-used-for-diagnosis-of-fibromyalgia|title=Tender Points might no longer be used for diagnosis of Fibromyalgia|last=Proskauer|first=Charmian|date=Feb 2011|website=www.masscfids.org|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2018-08-09}}</ref>
=====<span id="WPI">Widespread pain index=====


=====2010 ACR criteria=====
There are 19 areas in the widespread pain index (WPI) in the newer ACR criteria.<ref name="masscfids" /><ref name="ACR2010" />


*2010, The [https://www.rheumatology.org/Portals/0/Files/2010_Preliminary_Diagnostic_Criteria.pdf 2010 American College of Rheumatology (ACR) Preliminary Diagnostic Criteria for Fibromyalgia: Overview]<ref name=":48" /><ref name=":49" /> was proposed and modified in 2011<ref>{{Cite news|url=http://www.rheumatologynetwork.com/fibromyalgia/new-and-modified-fibromyalgia-diagnostic-criteria|title=New and Modified Fibromyalgia Diagnostic Criteria|last=Garg|first=Neha|date=Feb 9, 2012|work=Rheumatology Network|access-date=Aug 9, 2017|archive-url=|archive-date=|dead-url=|last2=Deodhar|first2=Atul}}</ref> with the modification being validated in 2013 and published in 2014.<ref>{{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> September of 2016, another revision has been made.<ref name=":14">{{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=|dead-url=|language=en-US}}</ref>
[[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.]]


:Men do not seem to form the tender points needed for diagnosis under the 1990 criteria,<ref>{{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 diagnoses more men with a F/M ratio of 2:1.<ref>{{Cite journal|last=Boomershine|first=Chad|date=Nov 4, 2017|title=Fibromyalgia: Practice Essentials, Background, Pathophysiology|url=http://emedicine.medscape.com/article/329838-overview#a5|journal=Medscape|volume=|pages=|via=}}</ref>
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" />
: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 name=":0">{{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=www.masscfids.org|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2018-08-09}}</ref>
 
=====<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>
 
=====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 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 name=":0" />
:*utilize an index by which to rate pain<ref name="masscfids" />  


There are 19 <u>tender point areas</u> in the widespread pain index '''''(WPI)''''', whereas the 1990 criteria had 18 <u>tender points</u>.<ref name=":0" /><ref>{{Cite news|url=https://www.verywellhealth.com/what-are-fibromyalgia-tender-points-189768|title=Why Tender Points Are No Longer Used to Diagnose Fibromyalgia|last=Eustice|first=Carol|date=Oct 3, 2018|work=Verywell Health|access-date=2018-10-04|archive-url=|archive-date=|dead-url=}}</ref>
====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" />


====== Widespread pain index and Symptom severity ======
====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]].


The '''''Widespread Pain Index (WPI)''''' and '''''Symptom Severity''' '''(SS)''''' is explained in the study ''Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management''.<ref name=":21" />
====Brain scans====
[[File:Widespread Pain Index Areas with numbers.svg|200px|thumb|right|'''''WPI''''' 19 areas of pain. Count 1 point for each area of pain<ref name=":21" /><ref name=":48" /><ref name=":49" />]]
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" />
<blockquote>In place of the tender point count, patients (or their physician) may endorse 19 body regions in which pain has been experienced during the past week. One point is given for each area, so the score is between 0-19. This number is referred to as the '''''Widespread Pain Index (WPI)''''' and it is one of the two required scores needed for a doctor to make a diagnosis of fibromyalgia.</blockquote><blockquote>The second part of the score required to assess the diagnosis of fibromyalgia involves the evaluation of a person's symptoms. The patient ranks specific symptoms on a scale of 0-3. These symptoms include: [[Fatigue]], [[Unrefreshing sleep|Waking unrefreshed]], [[Cognitive dysfunction|Cognitive symptoms]], Somatic (physical) symptoms in general (such as [[headache]], [[Weakness|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=":21" /><ref name=":53">{{Cite journal|last=Wolfe|first=Frederick|author-link=|last2=Clauw|first2=Daniel J.|author-link2=Daniel Clauw|last3=Fitzcharles|first3=Mary-Ann|author-link3=|last4=Goldenberg|first4=Don L.|author-link4=|last5=Katz|first5=Robert S.|author-link5=|last6=Mease|first6=Philip|author-link6=|last7=Russell|first7=Anthony S.|last8=Russell|first8=I. Jon|last9=Winfield|first9=John B.|date=2010-02-23|title=The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity|url=http://doi.wiley.com/10.1002/acr.20140|journal=Arthritis Care & Research|language=en|volume=62|issue=5|pages=600–610|doi=10.1002/acr.20140|pmc=|pmid=|access-date=|quote=The reference list consisted of: muscle pain, irritable bowel syndrome, fatigue/tiredness, thinking or remembering problem, muscle weakness, headache, pain/cramps in the abdomen, numbness/tingling, dizziness, insomnia, depression, constipation, pain in the upper abdomen, nausea, nervousness, chest pain, blurred vision, fever, diarrhea, dry mouth, itching, wheezing, Raynaud’s phenomenon, hives/welts, ringing in ears, vomiting, heartburn, oral ulcers, loss of/change in taste, seizures, dry eyes, shortness of breath, loss of appetite, rash, sun sensitivity, hearing difficulties, easy bruising, hair loss, frequent urination, painful urination, and bladder spasms.|via=}}</ref> The numbers assigned to each are added up, for a total of 0-12.</blockquote><blockquote>The diagnosis is based on both the '''''WPI''''' score and the '''''SS''''' score either:</blockquote>
:::<blockquote>'''''WPI''''' of at least 7 and '''''SS''''' scale score of at least 5, '''OR'''</blockquote>
:::<blockquote>'''''WPI''''' of 4-6<ref name=":14" /> and '''''SS''''' scale score of at least 9.<ref name=":21" /></blockquote>


[[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=":21" /><ref name=":53" /> 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=":21" /> ]]
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}}


====Blood tests and biomarkers====
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" />


The [[Social Security Administration]] (SSA) accepts a diagnosis of FM with the 1990<ref name=":50" /><ref name=":51" /> or 2010<ref name=":48" /><ref name=":49" /> ACR criteria.<ref>{{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,OPPS|first=|date=Jul 25, 2012|website=www.ssa.gov|language=en|archive-url=|archive-date=|dead-url=|access-date=2018-08-09}}</ref> See the [[Fibromyalgia disability process]] page.
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" />


=== Sleep study ===
IsolateFibromyalgia, IQuity's RNA based blood test for fibromyalgia, was first announced in 2018 but no peer-reviewed studies have been published.
[[Sleep dysfunction]] is often involved in FM. Treating a sleep disorder can help with FM symptoms. A diagnosed sleep disorder is also helpful if one needs to [[Fibromyalgia disability process|file for disability]].


*[https://www.verywellhealth.com/sleep-study-fibromyalgia-cfs-716054 Getting a Sleep Study with Fibromyalgia or Chronic Fatigue Syndrome]<ref>{{Cite news|url=https://www.verywellhealth.com/sleep-study-fibromyalgia-cfs-716054|title=Getting a Sleep Study with Fibromyalgia or Chronic Fatigue Syndrome|last=Dellwo|first=Adrienne|date=Feb 15, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=|dead-url=}}</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.


*[http://www.sciencedaily.com/releases/2008/09/080903134311.htm What A Sleep Study Can Reveal About Fibromyalgia]<ref>{{Cite news|url=https://www.sciencedaily.com/releases/2008/09/080903134311.htm|title=What A Sleep Study Can Reveal About Fibromyalgia|work=ScienceDaily|access-date=2018-08-09|language=en}}</ref>
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>


*[http://linkis.com/nationalpainreport.com/lzYea Fibromyalgia Sufferers Have Difficulty Maintaining Continuous Sleep, Study Says]<ref>{{Cite news|url=http://linkis.com/nationalpainreport.com/lzYea|title=Fibromyalgia Sufferers Have Difficulty Maintaining Continuous Sleep, Study Says|last=|first=|date=Mar 25, 2016|work=National Pain Report|access-date=2018-08-09|archive-url=|archive-date=|dead-url=|language=en-US}}</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" />


=== ICD Diagnostic code===
=== ICD Diagnostic code===
'''ICD-10'''
'''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).<ref name=":24">{{Cite web|url=http://apps.who.int/classifications/icd10/browse/2016/en#/M79.7|title=ICD-10 Version:2016|last=World Health Organization|first=|date=2016|website=apps.who.int|at=M79.7 Fibromyalgia|language=en|archive-url=|archive-date=|dead-url=|access-date=2018-09-15|authorlink=World Health Organization|last2=|first2=|authorlink2=}}</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=":37" /><ref name=":24" />
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" />


*'''M79.7 Fibromyalgia'''
*'''M79.7 Fibromyalgia'''
::Fibromyositis
::Fibromyositis
::Fibrositis
::Fibrositis
::Myofibrositis<ref name=":24" />
::Myofibrositis<ref name="ICD10" />


In 2015, the [[United States|US]] finally adopted ICD-10 and FM as a diagnosis.<ref name=":37">{{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=www.icd10data.com|language=en|access-date=2018-08-09|date=2018|last=World Health Organization|first=|archive-url=|archive-date=|dead-url=|authorlink=World Health Organization|last2=|first2=|authorlink2=}}</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=|dead-url=|language=en-US}}</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>


'''ICD-11 (2019)'''
'''ICD-11 (2019)'''


[https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/849253504 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=":18">{{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=icd.who.int|language=en|access-date=2018-08-09}}</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>  


*'''MG30.01 Chronic widespread pain'''
*'''MG30.01 Chronic widespread pain'''
Line 130: Line 162:


'''Description'''
'''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=":18" /></blockquote>
<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>


'''Inclusions'''
'''Inclusions'''
:*Fibromyalgia
:*Fibromyalgia
'''Exclusions'''
'''Exclusions'''
:*Acute pain (MG31)<ref name=":18" />
:*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.
 
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>
 
The limited laboratory findings along with history and physical examination can help differentiate fibromyalgia from other differentials.<ref name="PMC5741304" />


==Pathophysiology==
==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 [[Stress|stressors]] may trigger or aggravate symptoms. These have included certain [[Infection|infections]], such as a [[Viral infection|viral illness]] or [[Lyme disease]], as well as emotional or physical [[trauma]]."<ref>{{Cite web|url=https://www.uptodate.com/contents/pathogenesis-of-fibromyalgia#!|title=Pathogenesis of fibromyalgia|last=Goldenberg|first=Don L|date=|website=www.uptodate.com|archive-url=|archive-date=|dead-url=|access-date=2018-08-09|authorlink=|last2=Schur|first2=Paul H|authorlink2=|last3=Romain|first3=Paul L}}</ref> The widespread pain is severe, debilitating, and abnormal in processing its pain. There is also [[Sleep dysfunction|sleep disturbance]] and fatigue. Cause or causes are unproven.<ref>{{Cite news|url=https://www.omf.ngo/what-is-mecfs-old/fibromyalgia/|title=What is Fibromyalgia? {{!}} Open Medicine Foundation|work=Open Medicine Foundation|access-date=2018-08-09|language=en-US}}</ref>
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>


*May 2012, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/ Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management]<ref name=":21">{{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|pmc=|pmid=22811766|via=}}</ref>  ''See'' Table 1: "Conditions associated with fibromyalgia." Musculoskeletal, [[genitourianry]], [[Gastrointestinal system|gastro intestinal]], and miscellaneous conditions often exist among fibromyalgia patients.
*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.


<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 neuro-endocrine system appears to be the basis of the syndrome. Fibromyalgia is not a life-threatening, deforming, or [https://en.wikipedia.org/wiki/Progressive_disease 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.<ref name=":21" /></blockquote>
<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>


<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) 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=":21" /></blockquote>
<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>


*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]<ref>{{Cite journal|last=Bourgaize|first=Sheryl|last2=Newton|first2=Genevieve|last3=Kumbhare|first3=Dinesh|last4=Srbely|first4=John|date=2018|title=A comparison of the clinical manifestation and pathophysiology of myofascial pain syndrome and fibromyalgia: implications for differential diagnosis and management (Table 1).|url=https://www.chiropractic.ca/wp-content/uploads/2018/05/107243-2_Chiro_62_1d_Bourgaize.pdf|format=PDF|journal=Journal of the Canadian Chiropractic Assoc.|volume=|pages=26-41|at=|via=|page=}}</ref> ''See'' Table 1 "Summary of the pathophysiology of fibromyalgia and myofascial pain syndrome." pg. 29 (pg. 4 of PDF)
*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]


*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>{{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><ref>{{Cite news|url=https://fibromyalgianewstoday.com/2018/07/03/immune-system-may-play-role-fibromyalgia-study/|title=Fibromyalgia May Be Linked to Immune System, Study Suggests|last=Inacio|first=Patricia|date=2018-07-03|work=Fibromyalgia News Today|access-date=2018-08-22|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>
*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" />


<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>
<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>


*Jul 2018, [https://fibromyalgianewstoday.com/2018/07/31/primary-secondary-fibromyalgia-share-similar-symptom-burden-study/ Primary and Secondary Fibromyalgia Share Same Symptom Burden, Study Suggests]<ref name=":22">{{Cite news|url=https://fibromyalgianewstoday.com/2018/07/31/primary-secondary-fibromyalgia-share-similar-symptom-burden-study/|title=Primary, Secondary Fibromyalgia Share Same Symptom Burden, Study Says|last=Carvalho|first=John|date=2018-07-31|work=Fibromyalgia News Today|access-date=2018-08-09|archive-url=|archive-date=|dead-url=|language=en-US}}</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]


<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 name=":22" /></blockquote>
<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>


===Immune system research===
===Immune system research===


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=|dead-url=|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|date=May 24, 2017|website=YouTube|archive-url=|archive-date=|dead-url=|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=|dead-url=|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>
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>


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 also|Fibromyalgia drugs|Fibromyalgia drugs (see drug trials section for IMC-1)||||}}  
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)}}  


On September 5th, 2018, EpicGenetics announced that [http://www.massgeneral.org/ Massachusetts General Hospital] received approval from the FDA to test the [[wikipedia:BCG_vaccine|Bacille Calmette-Guerin (BCG) vaccine]] (an old Tuberculosis vaccine) on patients that tested positive with its FM/a® test.<ref>{{Cite news|url=http://nationalpainreport.com/can-an-existing-vaccine-help-treat-fibromyalgia-8837139.html|title=Can an Existing Vaccine Help Treat Fibromyalgia?|last=Coghlan|first=Ed|date=2018-09-05|work=National Pain Report|access-date=2018-09-10|archive-url=|archive-date=|dead-url=|language=en-US}}</ref><ref>{{Cite web|url=https://www.celestecooper.com/2018/07/the-fma-blood-test-and-participation-in.html#.Wz4nxdJKjIU|title=The FM/a® Blood Test and Participation in Fibromyalgia Vaccine Study|last=Cooper|first=Celeste|date=Jul 5, 2018|website=www.celestecooper.com|archive-url=|archive-date=|dead-url=|access-date=2018-08-09}}</ref> <ref>{{Cite news|url=http://www.prohealth.com/library/showArticle.cfm?libid=30644|title=Century-old Vaccine Gives New Hope to Fibromyalgia Community - Prohealth|last=Gregory Burch|first=Donna|date=2017-08-14|work=Prohealth|access-date=2018-08-09|archive-url=|archive-date=|dead-url=|language=en-US}}</ref><ref>{{Cite news|url=https://www.prohealth.com/library/century-old-vaccine-gives-new-hope-to-fibromyalgia-community-42689#comment-2286|title=Century-old Vaccine Gives New Hope to Fibromyalgia Community - Prohealth|last=Gregory Burch|first=Donna|date=2017-08-14|work=Prohealth|access-date=2018-08-09|archive-url=|archive-date=|dead-url=|at=See Comments Section: CDW12 says: June 26, 2018 at 2:05 pm|language=en-US}}</ref><ref>{{Cite news|url=http://www.prohealth.com/library/showArticle.cfm?libid=30644|title=Century-old Vaccine Gives New Hope to Fibromyalgia Community - Prohealth|last=Gregory Burch|first=Donna|date=2017-08-14|work=Prohealth|access-date=2018-08-09|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>  
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>


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=":42">{{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>
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>


=== Brain and spinal cord research ===
=== 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>{{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=3476600|pmid=15083352|quote=|author-link=|author-link2=|author-link3=|author-link4=|author-link5=|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>{{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=|author-link=|author-link2=|author-link3=|author-link4=|author-link5=|via=}}</ref> A second study in 2007 by Andrew Holman found that 71% had cervical [[spinal cord]] compression.<ref>{{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=|first=|quote=|author-link=Andrew Holman|author-link2=|author-link3=|author-link4=|author-link5=|via=}}</ref> It is important to note that in the past many patients were misdiagnosed with FM when further testing would have revealed the true source of their pain; the 2010 (updated in 2016) ACR criteria has helped curb misdiagnoses.<ref>{{Cite news|title=Fibromyalgia Expert Says Misdiagnosis is Rampant|url=http://nationalpainreport.com/fibromyalgia-expert-says-misdiagnosis-is-rampant-8832803.html|work=National Pain Report|date=2017-02-02|access-date=2018-11-26|language=en-US}}</ref><ref>{{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=|dead-url=}}</ref><ref>{{Cite web|title=Fibromyalgia Misdiagnosis: What Else Could it Be?|url=https://www.integrativepractitioner.com/topics/news/fibromyalgia-misdiagnosis-what-else-could-it-be|website=www.integrativepractitioner.com|access-date=2018-11-26|language=en|date=Jun 6, 2016|last=|first=|archive-url=|archive-date=|dead-url=}}</ref><ref name=":28" />
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" />


Various types of brain imaging are being used to research FM. (''See'': [[Fibromyalgia notable studies]] for images.)
Various types of brain imaging are being used to research FM.  
{{See also|Fibromyalgia notable studies}}


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>{{Cite web|url=https://www.sciencedaily.com/releases/2002/06/020607073056.htm|title=Fibromyalgia Pain Isn't All In Patient's Heads, New Brain Study Finds|last=|first=|date=Jun 7, 2002|website=sciencedaily.com|archive-url=|archive-date=|dead-url=|access-date=2018-08-09}}</ref> A 2007 study by Borsook et al., ''Neuroimaging revolutionizes therapeutic approaches to chronic pain'' found decreased [[gray matter]] density relative to controls in [[cingulate cortex]] (CC), medial [[prefrontal cortex]] (Med. PFC), [[parahippocampal gyrus]] (PHG) and [[insula]].<ref name=":03">{{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 [https://www.itnonline.com/article/mrpet-ultimate-imaging-hybrid MR/PET imaging]<ref>{{Cite news|url=https://www.itnonline.com/article/mrpet-ultimate-imaging-hybrid|title=MR/PET: The Ultimate Imaging Hybrid|last=Ros|first=Pablo R.|date=2012-05-29|work=Imaging Technology News|access-date=2018-10-30|archive-url=|archive-date=|dead-url=|language=en}}</ref>.<ref>{{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=":34">{{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=":52">{{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>{{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>
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=
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>


===Insulin resistance research ===
=== Fibromyalgia is not the same as depression ===
* May 2019, [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0216079Is insulin resistance the cause of fibromyalgia? A preliminary report]<ref name="a1cstudy">{{Cite journal|last=Pappolla|first=Miguel A.|last2=Manchikanti|first2=Laxmaiah|last3=Andersen|first3=Clark R.|last4=Greig|first4=Nigel H.|last5=Ahmed|first5=Fawad|last6=Fang|first6=Xiang|last7=Seffinger|first7=Michael A.|last8=Trescot|first8=Andrea M.|date=2019-05-06|title=Is insulin resistance the cause of fibromyalgia? A preliminary report|url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0216079|journal=PLOS ONE|language=en|volume=14|issue=5|pages=e0216079|doi=10.1371/journal.pone.0216079|issn=1932-6203|pmc=PMC6502334|pmid=31059525}}</ref> [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0216079 (Full text)]
* Oct 24, 2003, [https://www.webmd.com/depression/news/20031024/fibromyalgia-isnt-depression#1 Fibromyalgia Isn't Depression]<ref name="webmd-notdepress" />
:Age-normalized data was found to show a relationship between insulin resistance/[[pre-diabetes]] and Fibromyalgia. In a preliminary study, Fibromyalgia patients were treated with [[metformin]], a common medication for diabetes, and showed a large improvement in [[myofascial pain]].
<blockquote>[[Depression]] doesn't cause the pain of fibromyalgia, a new study shows.<ref name="webmd-notdepress" /></blockquote>  


=== Fibromyalgia is not depression ===
<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>
* Oct 24, 2003, [https://www.webmd.com/depression/news/20031024/fibromyalgia-isnt-depression#1 Fibromyalgia Isn't Depression]<ref name=":40">{{Cite web|url=https://www.webmd.com/depression/news/20031024/fibromyalgia-isnt-depression|title=Fibromyalgia Isn't Depression|last=DeNoon|first=Daniel J.|authorlink=|last2=|first2=|authorlink2=|date=Oct 24, 2003|website=WebMD|language=en|archive-url=|archive-date=|dead-url=|access-date=2019-04-13}}</ref>
<blockquote>[[Depression]] doesn't cause the pain of fibromyalgia, a new study shows.<ref name=":40" /></blockquote>  


<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=":40" /></blockquote>
<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>


<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=":40" /> </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>{{Cite web|url=https://www.webmd.com/depression/news/20031024/fibromyalgia-isnt-depression|title=Fibromyalgia Isn't Depression|last=DeNoon|first=Daniel J.|authorlink=|last2=|first2=|authorlink2=|date=Oct 24, 2003|website=WebMD|page=2|language=en|archive-url=|archive-date=|dead-url=|access-date=2019-04-13}}</ref></blockquote>
== Comorbidities, overlapping conditions, and common symptoms ==
* Jun 30, 2013, [https://www.healthcentral.com/article/psychiatrists-admit-fibromyalgia-is-neuropathic-not-a-form-of-depression Psychiatrists Admit Fibromyalgia is Neuropathic - Not a Form of Depression]<ref name=":41">{{Cite web|url=https://www.healthcentral.com/article/psychiatrists-admit-fibromyalgia-is-neuropathic-not-a-form-of-depression|title=Psychiatrists Admit Fibromyalgia is Neuropathic – Not a Form of Depression - Causes - Chronic Pain {{!}} HealthCentral|last=Lee Richards|first=Karen|authorlink=|last2=|first2=|authorlink2=|date=Jun 30, 2013|website=www.healthcentral.com|language=en-US|archive-url=|archive-date=|dead-url=|access-date=2019-04-13}}</ref>
[[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" />
<blockquote>The study the APA referred to was published in the June issue of [http://brain.oxfordjournals.org/content/136/6/1857.abstract ''Brain''], a journal of neurology. The researchers investigated the function and structure of small nerve fibers in 25 FM patients, 10 patients with monopolar depression without pain and with healthy control subjects. Using three different methods of testing, the researchers found that compared with control subjects, patients with fibromyalgia, but not patients with depression, had impaired small fiber function.<ref name=":41" /></blockquote><blockquote>The ''Psychiatric News'' alert quoted the study authors saying, "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 researchers said. Furthermore, the findings point "towards a neuropathic nature of pain in fibromyalgia syndrome."<ref name=":41" /></blockquote>
* Jan 10, 2019, [https://themighty.com/2019/01/do-i-have-fibromyalgia-or-depression/ 17 Signs You Have Fibromyalgia, Not 'Just' Depression]<ref name=":43">{{Cite web|url=https://themighty.com/2019/01/do-i-have-fibromyalgia-or-depression/|title=17 Signs You Have Fibromyalgia, Not 'Just' Depression|last=|first=|authorlink=|last2=|first2=|authorlink2=|date=Jan 10, 2019|website=The Mighty|language=en-US|archive-url=|archive-date=|dead-url=|access-date=2019-04-13}}</ref>
<blockquote>Fibromyalgia is [https://themighty.com/2018/05/what-fibromyalgia-gets-misdiagnosed-as/ often misdiagnosed as a number of other illnesses]. Though fibro has its own unique set of diagnostic criteria, many of its symptoms can mimic symptoms of other conditions – both physical and mental, acute and chronic.<ref name=":43" /></blockquote><blockquote>One of the most common conditions fibromyalgia gets mistaken for is depression. While each condition causes a unique set of symptoms, many of them may overlap. Like fibro, depression can cause physical symptoms such as pain, fatigue and brain fog. And living with a chronic physical symptoms can have significant effects on your mood, sometimes causing feelings of hopelessness, anxiety or general discontent – which are also symptoms of depression.<ref name=":43" /></blockquote>


== Comorbidities, overlapping conditions, and common symptoms ==
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" />]]
[[File:Fibromyalgia and comorbid conditions.JPG|700px|thumb|center|Comorbid conditions of fibromyalgia (FM) are [[ME/CFS]] which is the most common;<ref name=":30" /><ref name=":31" /> [[Autoimmune disease|autoimmune disease<nowiki/>s]]; [[Migraine|migraine<nowiki/>s]]; [[Multiple chemical sensitivity|multiple chemical sensitivities]] (MCS); and [[orthostatic intolerance]] (OI) / [[postural orthostatic tachycardia syndrome]] (POTS).<ref name=":30" /><ref name=":33">{{Cite news|url=https://www.verywellhealth.com/fibromyalgia-comorbid-overlapping-conditions-716184|title=Illness That Come Along with Fibromyalgia & Chronic Fatigue Syndrome|last=Dellwo|first=Adrienne|date=Feb 26, 2018|work=Verywell Health|access-date=2018-08-19|archive-url=|archive-date=|dead-url=}}</ref><ref name=":21" /><ref name=":44" />  Overlapping conditions are [[depression]] and [[anxiety]]; [[Digestive problems|digestive conditions]], [[Menstrual|menstrual problems]]; [[Gulf War Illness]] (GWI); [[nervous system]] disorders; [[Hypotension|low blood pressure]] (Low BP); [[Pain#Pain in Fibromyalgia|other pain conditions]]; and [[sleep dysfunction]]/disturbance<ref name=":30" /> <ref name=":33" /><ref name=":21" /><ref name=":05" /><ref name=":46" /><ref name=":47" />]]


*[[Allodynia]]
====Overlapping conditions ====
** [http://chronicfatigue.about.com/od/glossary/g/allodynia.htm Allodynia: A Rare & Distinct Type of Pain in Fibromyalgia & ME/CFS]<ref name=":1">{{Cite news|url=https://www.verywellhealth.com/allodynia-definition-and-types-fibromyalgia-715929|title=Allodynia: A Rare & Distinct Type of Pain in Fibromyalgia & ME/CFS|last=Dellwo|first=Adrienne|date=Feb 23, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=|dead-url=}}</ref> 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."<ref name=":1" />
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>
*[[Autoimmune disease]]<nowiki/>s "Research suggests that RA and other inflammatory diseases may somehow increase the risk for fibromyalgia."<ref>{{Cite news|url=https://www.health.com/health/gallery/0,,20520705,00.html#restless-legs-0|title=7 Conditions Linked to Fibromyalgia|work=Health.com|access-date=2018-08-19|language=en}}</ref>


*[[Body temperature]] (''See:'' [[small fiber peripheral neuropathy]] for temperature sensitivity; burning, tingling, and prickling due to [[paresthesia]]; [[numbness]]; [[Dry eye syndrome|dry eyes]] and [[dry mouth]]; and more.)<ref>{{Cite news|url=https://www.verywellhealth.com/small-fiber-neuropathy-may-cause-fibromyalgia-pain-3972935|title=Does Fibromyalgia Come From Small Nerves in Your Skin?|last=Dellwo|first=Adrienne|date=Feb 23, 2018|work=Verywell Health|access-date=2018-10-04|archive-url=|archive-date=|dead-url=}}</ref><ref>{{Cite news|url=https://www.verywellhealth.com/neuropathy-in-fibromyalgia-cfs-3973033|title=Does Your Pain Come From Damage to Small Nerves?|last=Dellwo|first=Adrienne|date=Feb 1, 2018|work=Verywell Health|access-date=2018-10-04|archive-url=|archive-date=|dead-url=}}</ref><ref name=":02">{{Cite news|url=https://www.healthline.com/health/small-fiber-neuropathy#symptoms|title=Small Fiber Neuropathy: Symptoms, Treatment, Causes, and More|last=Vandergriendt|first=Carly|date=Jan 4, 2018|work=Healthline|access-date=2018-10-04|archive-url=|archive-date=|dead-url=|last2=Weatherspoon|first2=Deborah|language=en}}</ref><ref>{{Cite news|url=https://www.webmd.com/brain/understanding-peripheral-neuropathy-basics#3|title=Peripheral Neuropathy -- Symptoms, Types, and Causes of Peripheral Neuropathy|last=|first=|date=|work=WebMD|access-date=2018-10-04|archive-url=|archive-date=|dead-url=|page=3|language=en-US}}</ref>
===[[Allodynia]]===
**[https://www.verywell.com/temperature-sensitivity-in-fibromyalgia-and-mecfs-716025 Temperature Sensitivity in Fibromyalgia & Chronic Fatigue Syndrome]<ref name=":2">{{Cite news|url=https://www.verywellhealth.com/temperature-sensitivity-in-fibromyalgia-and-mecfs-716025|title=Temperature Sensitivity in Fibromyalgia & ME/CFS|last=Dellwo|first=Adrienne|date=Mar 15, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=|dead-url=}}</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>


<blockquote>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?<ref name=":2" /></blockquote>
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}}


[[File:Costal cartilages.JPG|200px|thumb|left|Costochondritis is inflammation of the costal cartilages (shown in red) causing chest and ribcage pain. From BodyParts3D/Anatomography(Life Science db.jp), license CC BY-SA 2.1 JP.]]
===Anxiety===
Anxiety is more common in people with fibromyalgia than in healthy people.<ref name="PatientInfo" /><ref name="Jensen2010" />
{{See also|Anxiety}}


:* [[Costochondritis]] - What You Need To Know<ref name=":10">{{Cite web|url=https://www.drugs.com/cg/costochondritis.html|title=Costochondritis - What You Need to Know|website=Drugs.com|language=en|access-date=2020-01-27}}</ref>
===[[Body temperature]]===
<blockquote>Costochondritis is a condition that causes pain in the [[cartilage]] that connect your [[ribs]] to your [[sternum]] (breastbone). Cartilage is the tough, bendable tissue that protects your [[bones]].</blockquote>Costochondritis causes pain in the area where your sternum joins with your ribs. The pain may come and go, and may get worse over time. The pain may be sharp, or dull and aching. It may be painful to touch your chest. The pain may spread to your [[back]], [[abdomen]], or down your arm. It may get worse when you move, breathe deeply, or push or lift an object. The pain may make it hard for you to sleep or do your usual activities.<ref name=":10" /><blockquote>People tend to describe the pain as stabbing, burning, aching, confined to one spot, usually in the very center of the chest, but it may radiate outward.<ref>{{Cite web|url=https://www.medicalnewstoday.com/articles/321635.php|title=Can fibromyalgia cause chest pain?|website=Medical News Today|language=en|access-date=2020-01-27}}</ref></blockquote>
Hypersensitivity to cold or heat is common in fibromyalgia, especially in people with [[allodynia]].<ref name="Baron2010" /><br>
[[Small fiber peripheral neuropathy]] occurs in some people with fibromyalgia, causing a combination of [[temperature sensitivity]], burning, tingling, and prickling due to [[paresthesia]], [[numbness]], [[dry eye syndrome|dry eyes]] and [[dry mouth]].<ref name="ACR2010" /><ref name="PN-webmd">{{Cite web | url = https://www.webmd.com/brain/understanding-peripheral-neuropathy-basics#3 | title = Peripheral Neuropathy -- Symptoms, Types, and Causes of Peripheral Neuropathy | date = |website=WebMD|access-date=2018-10-04|archive-url=|archive-date=| page=3|language=en-US}}</ref>
{{See also|Temperature sensitivity}}


===[[Chest pain]]===
Chest pain has been reported in many people with fibromyalgia. A study of over 2,000 FM patients prescribed the popular pain drugs [[Lyrica]] or [[Cymbalta]] found that approximately 23% had chest pain.<ref name="Gore2012">{{Cite journal | last = Gore | first = Mugdha | last2 = Tai | first2 = Kei-Sing | last3 = Chandran | first3 = Arthi | last4 = Zlateva | first4 = Gergana | last5 = Leslie | first5 = Douglas| date = 2011-10-20 | title = Clinical comorbidities, treatment patterns, and healthcare costs among patients with fibromyalgia newly prescribed pregabalin or duloxetine in usual care | url =https://www.tandfonline.com/doi/pdf/10.3111/13696998.2011.629262|journal=Journal of Medical Economics|volume=15|issue=1 | pages = 19–31|doi=10.3111/13696998.2011.629262|issn=1369-6998}}</ref>


* [[Depression]] and [[Anxiety]]
===[[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>


Fibromyalgia sufferers are "up to three times more likely to have depression at the time of their diagnosis than someone without fibromyalgia."<ref>{{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> Up to 20 percent of FM patients will have either depression or anxiety.<ref>{{Cite web|url=https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/fibromyalgia|title=Fibromyalgia {{!}} Anxiety and Depression Association of America, ADAA|website=adaa.org|language=en|access-date=2018-08-19}}</ref>
====Fibro fog ====
* [[Dry eye syndrome]]
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" />
** [https://www.news-medical.net/health/Fibromyalgia-and-Dry-Eyes-and-Mouth.aspx Fibromyalgia and Dry Eyes and Mouth]<ref name=":110">{{Cite news|url=https://www.news-medical.net/health/Fibromyalgia-and-Dry-Eyes-and-Mouth.aspx|title=Fibromyalgia and Dry Eyes and Mouth|last=Mandal|first=Ananya|date=2013-06-30|work=News-Medical.net|access-date=2018-10-04|archive-url=|archive-date=|dead-url=|last2=Cashin-Garbutt|first2=April|language=en}}</ref>


* [[Fatigue]]
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>
** [https://www.docsopinion.com/2017/11/08/causes-fatigue-tiredness-chronic-fatigue/ 19 Important Causes of Fatigue – Tiredness and Chronic Fatigue Explained]<ref name=":29">{{Cite web|url=https://www.docsopinion.com/2017/11/08/causes-fatigue-tiredness-chronic-fatigue/|title=19 Important Causes of Fatigue - Tiredness and Chronic Fatigue Explained|website=www.docsopinion.com|access-date=2019-01-30}}</ref> ''See'': 3. Fibromyalgia <blockquote>Fatigue is a universal symptom of fibromyalgia. It is often most marked when arising from sleep in the morning.  A typical quote is “''No matter how much sleep I get, it feels like a truck ran me over in the morning'' (20).” Minor activities often seem to aggravate the fatigue.<ref name=":29" /></blockquote>


*[[Fibro fog]] and [[Cognitive dysfunction]]
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" />


:*[http://www.news-medical.net/health/What-is-Fibro-Fog-Fibromyalgia-and-Cognitive-Dysfunction.aspx What is Fibro Fog? - Fibromyalgia and Cognitive Dysfunction]<ref name=":3">{{Cite news|url=https://www.news-medical.net/health/What-is-Fibro-Fog-Fibromyalgia-and-Cognitive-Dysfunction.aspx|title=What is Fibro Fog? - Fibromyalgia and Cognitive Dysfunction|last=Mandal|first=Ananya|date=2013-06-03|work=News-Medical.net|access-date=2018-08-09|archive-url=|archive-date=|dead-url=|language=en}}</ref> 'Mental confusion along with difficulty in concentration and loss of memory is often termed “[[fibro fog]]"'.<ref name=":3" />
{{See also|Cognitive dysfunction}}


:* [https://www.verywellhealth.com/brain-fibro-fog-causes-symptoms-possible-treatment-716014 What Is Fibro Fog and ME/CFS Brain Fog?]<ref name=":17" />
===[[Depression]] and [[anxiety]]===
:* [https://fibromyalgianewstoday.com/2018/03/21/fibromyalgia-cognitive-dysfunction-study-identifies-main-types/ Study Identifies the Types of Cognitive Dysfunction That Are Most Prevalent in Fibromyalgia]<ref>{{Cite news|url=https://fibromyalgianewstoday.com/2018/03/21/fibromyalgia-cognitive-dysfunction-study-identifies-main-types/|title=Fibromyalgia Study Identifies Main Types of Patients' Cognitive Dysfunction|last=Pena|first=Ana|date=2018-03-21|work=Fibromyalgia News Today|access-date=2018-08-28|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>
{{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" />


*[[Gastrointestinal system]]
{{See also|Depression}}{{See also|Mental health}}
**[[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?]<ref name=":4">{{Cite news|url=https://www.verywellhealth.com/irritable-bowel-syndrome-in-fibromyalgia-cfs-716167|title=Irritable Bowel Syndrome in Fibromyalgia & ME/CFS|last=Dellwo|first=Adrienne|date=Jan 28, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=|dead-url=}}</ref>


:<blockquote>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 name=":4" /></blockquote>
====<span id="depression">Differences between depression and fibromyalgia====
* [[Gulf War Illness]]
**[https://www.publichealth.va.gov/exposures/gulfwar/fibromyalgia.asp Fibromyalgia in Gulf War Veterans]<ref>{{Cite web|url=https://www.publichealth.va.gov/exposures/gulfwar/fibromyalgia.asp|title=Fibromyalgia in Gulf War Veterans - Public Health|last=Administration|first=US Department of Veterans Affairs, Veterans Health|website=www.publichealth.va.gov|language=en|access-date=2018-08-19}}</ref> GWI increases risk of developing fibromyalgia.


*[https://en.wikipedia.org/wiki/Interstitial_cystitis Interstitial Cystitis](Painful bladder)  
* 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" />
**[https://www.verywellhealth.com/chronic-fatigue-syndrome-interstitial-cystitis-716168 Fibromyalgia, Chronic Fatigue Syndrome & Interstitial Cystitis]<ref name=":5">{{Cite news|url=https://www.verywellhealth.com/chronic-fatigue-syndrome-interstitial-cystitis-716168|title=Fibromyalgia, Chronic Fatigue Syndrome & Interstitial Cystitis|last=Dellwo|first=Adrienne|date=Feb 16, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=|dead-url=}}</ref> "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."<ref name=":5" />
* 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>
**[[pubmed:20719340|Interstitial cystitis/painful bladder syndrome and associated medical conditions with an emphasis on irritable bowel syndrome, fibromyalgia and chronic fatigue syndrome.]]<ref>{{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>
* 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" />


*Language Impairment
===[[Sjögren's syndrome|Dry eye syndrome]]===
**[[Word-finding problems]]
[[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>
:*[https://www.verywellhealth.com/language-impairment-in-fibromyalgia-cfs-716024 Language Impairment in Fibromyalgia and Chronic Fatigue Syndrome Impaired Language in Fibromyalgia & Chronic Fatigue Syndrome]<ref name=":6" /> "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."<ref name=":6">{{Cite news|url=https://www.verywellhealth.com/language-impairment-in-fibromyalgia-cfs-716024|title=Language Impairment in Fibromyalgia and Chronic Fatigue Syndrome|last=Dellwo|first=Adrienne|date=Feb 12, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=|dead-url=}}</ref>  
{{See also|Sjögren's syndrome}}


:*"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>{{Cite news|url=http://www.mayoclinic.org/diseases-conditions/aphasia/basics/definition/con-20027061|title=Aphasia - Symptoms and causes|work=Mayo Clinic|access-date=2018-08-09|language=en}}</ref> but with [[dysphasia]] you will have those symptoms and trouble listening and doing numeral calculations.<ref>{{Cite web|url=http://www.ayushveda.com/healthcare/dysphasia.htm|title=Dysphasia - Causes, Symptoms & Treatment|website=www.ayushveda.com|access-date=2018-08-09}}</ref> ''See also'': [[Dyscalculia]].
===[[Fatigue]]===
* [[ME/CFS]]
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" />
:*[https://www.verywellhealth.com/fibromyalgia-comorbid-overlapping-conditions-716184 Comorbid Conditions in Fibromyalgia & Chronic Fatigue Syndrome]<ref>{{Cite news|url=https://www.verywellhealth.com/fibromyalgia-comorbid-overlapping-conditions-716184|title=Illness That Come Along with Fibromyalgia & Chronic Fatigue Syndrome|last=Dellwo|first=Adrienne|date=Feb 26, 2018|work=Verywell Health|access-date=2018-08-19|archive-url=|archive-date=|dead-url=}}</ref><ref name=":30" /><ref name=":36" />
{{See also|Chronic fatigue}}
* [[Migraine]]  
:*[https://migrainecenters.com/blog/migraines-and-fibromyalgia/ Migraines and Fibromyalgia]<ref name=":32" />  
<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=":32">{{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>
* [[Multiple chemical sensitivity|Multiple Chemical Sensitivity]] (MCS) It is thought that both Fibromyalgia and MCS are [[Central sensitization|central sensitivity]] syndromes.<ref>{{Cite news|url=https://www.verywellhealth.com/chemical-sensitivity-in-fibromyalgia-716170|title=Multiple Chemical Sensitivity in Fibromyalgia & ME/CFS|last=Dellwo|first=Adrienne|date=Jul 23, 2018|work=Verywell Health|access-date=2018-08-19|archive-url=|archive-date=|dead-url=}}</ref>


*OBGYN
===Fibro fog===
**[https://www.verywellhealth.com/menstrual-periods-and-fibromyalgia-715596 Menstrual Periods with Fibromyalgia: Personal Stories]<ref>{{Cite news|url=https://www.verywellhealth.com/menstrual-periods-and-fibromyalgia-715596|title=Menstrual Periods with Fibromyalgia: Personal Stories|last=Dellwo|first=Adrienne|date=May 18, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=|dead-url=}}</ref>
See [[#Cognitive_dysfunction_and_Fibro_fog|cognitive dysfunction and Fibro fog]].
**[https://www.verywellhealth.com/fibromyalgia-tied-to-hysterectomy-gynecologic-disease-715626 Fibromyalgia Tied to Hysterectomy, Gynecologic Disease].<ref name=":7" />
:<blockquote>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.<ref name=":7">{{Cite news|url=https://www.verywellhealth.com/fibromyalgia-tied-to-hysterectomy-gynecologic-disease-715626|title=Fibromyalgia Tied to Hysterectomy, Gynecologic Disease|last=Dellwo|first=Adrienne|date=Feb 16, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=|dead-url=}}</ref></blockquote>


*[[Orthostatic intolerance]] (OI) and [[Postural orthostatic tachycardia syndrome]] (POTS)<ref name=":44">{{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>
===[[Digestive problems|Gastrointestinal problems]]===
[[Irritable bowel syndrome|IBS]] often occurs in people with fibromyalgia.<ref name="ScienceOfFibro" />
{{See also|Irritable bowel syndrome}}


:*[http://drlapp.com/wp-content/uploads/TTT_symptoms.pdf Symptoms Predict the Outcome of Tilt Table Testing in CFS/ME/FM]<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=|dead-url=|access-date=|last3=Smith|first3=Rebekah S.}}</ref> (PDF) Symptoms can include low blood pressure and/or sudden high blood pressure, dizziness, fainting.
===[[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.healthrising.org/blog/2017/09/21/fibromyalgia-problems-standing-orthostatic-intolerance/ An Overlooked Issue in Fibromyalgia? Study Highlights Problems Standing (Orthostatic Intolerance)]<ref>{{Cite news|url=https://www.healthrising.org/blog/2017/09/21/fibromyalgia-problems-standing-orthostatic-intolerance/|title=An Overlooked Issue in Fibromyalgia? Study Highlights Orthostatic Intolerance - Problems Standing - Health Rising|last=Johnson|first=Cort|date=2017-09-21|work=Health Rising|access-date=2018-08-09|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>
{{See also|Gulf War Illness}}
* [[Raynaud's Syndrome]]
** [https://www.verywellhealth.com/raynauds-syndrome-chronic-fatigue-716185 Raynaud's Syndrome in Fibromyalgia & Chronic Fatigue Syndrome]<ref name=":04">{{Cite news|url=https://www.verywellhealth.com/raynauds-syndrome-chronic-fatigue-716185|title=Cold Hands & Feet? Raynaud's Syndrome in Fibromyalgia & ME/CFS|last=Dellwo|first=Adrienne|date=Jan 28, 2018|work=Verywell Health|access-date=2018-10-11|archive-url=|archive-date=|dead-url=}}</ref> <blockquote>In Raynaud's syndrome, the blood vessels constrict more than they should, which allows less blood to get through. That not only makes your extremities cold, it makes them extremely difficult to warm up. The most commonly affected body parts are the fingers and toes, but your lips, nose, ear lobes, knees, and nipples may also be involved.</blockquote><blockquote>Raynaud's isn't all about the cold, though. The diminished blood flow can cause pain in the affected areas, and it may also cause the skin there to turn blue. Skin ulcers (sores) are possible, since prolonged episodes of low blood flow can damage your tissues.<ref name=":04" /></blockquote>


*[[Sleep dysfunction]]
===[[Hyperalgesia]]===
**[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 name=":23">{{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|via=|issue=|quote=|author-link=|author-link2=|author-link3=|author-link4=Roland Staud|author-link5=}}</ref>
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}}


:<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=":23" /></blockquote>
===[[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}}


:*[http://www.prohealth.com/library/showarticle.cfm?libid=22344 Fibromyalgia and Sleep]<ref name=":8">{{Cite news|url=https://www.prohealth.com/library/fibromyalgia-and-sleep-38954|title=Fibromyalgia and Sleep - Prohealth|date=2016-01-11|work=Prohealth|access-date=2018-08-09|language=en-US}}</ref> "Most people with fibromyalgia have an associated sleep disorder that makes it difficult for them to get the deep, restorative sleep they need."<ref name=":8" />
===[[Irritable bowel syndrome]] ===
IBS is a particularly common comorbidity in people with fibromyalgia. Other [[:Category:Digestive signs and symptoms|digestive system problems]] may also occur.<ref name="ScienceOfFibro" />
{{See also|Irritable bowel syndrome}}


[[File:Skull_diagram.png|350px|thumb|right|The [[wikipedia:Temporomandibular_joint#Disorders|temporomandibular joint]] is the joint between the mandible (light blue) and the temporal bone (orange) of the skull]]
===Language impairment and [[word-finding problems]]===
* [[Temporomandibular joint disorder]] (TMJ/TMD)
The [[cognitive dysfunction|"fibro fog"]] or brain fog that is a well recognized symptom of FM typically causes problems with words and language.<ref name="ACR2010" /> Cognitive impairment in fibromyalgia includes:
*[[Word-finding problems]]<ref name="Park2001">{{Cite journal | last = Park | first = Denise C. | last2 = Glass | first2 = Jennifer M. | last3 = Minear | first3 = Meredith | last4 = Crofford | first4 = Leslie J.| date = 2001 | title = Cognitive function in fibromyalgia patients | url = https://onlinelibrary.wiley.com/doi/abs/10.1002/1529-0131%28200109%2944%3A9%3C2125%3A%3AAID-ART365%3E3.0.CO%3B2-1 | journal = Arthritis & Rheumatism |language=en|volume=44|issue=9 | pages = 2125–2133|doi=10.1002/1529-0131(200109)44:9<2125::AID-ART365>3.0.CO;2-1|issn=1529-0131}}</ref><ref name="Natelson2019" />
* [[Memory problems|short-term memory problems]]
* vulnerability to distraction by irrelevant stimuli (known as "selective attention")
*[[Slowed thought|mental slowing]]
*[[information overload]], and  
*[[multi-tasking problems]]
*[[attention deficit|attention]] and [[concentration problems|concentration problems]]<ref name="Bell2019" /><ref name="Kratz2015" /><ref name="Teodoro2018">{{Cite journal | last = Teodoro | first = Tiago | author-link = | last2 = Edwards | first2 = Mark J. | authorlink2 = | last3 = Isaacs | first3 = Jeremy D. | authorlink3 = | date = 2018-12-01 | title = A unifying theory for cognitive abnormalities in functional neurological disorders, fibromyalgia and chronic fatigue syndrome: systematic review | url =https://jnnp.bmj.com/content/jnnp/89/12/1308.full.pdf | journal=Journal of Neurology, Neurosurgery & Psychiatry|language=en|volume=89|issue=12 | pages = 1308–1319|doi=10.1136/jnnp-2017-317823|issn=0022-3050|pmc=|pmid=29735513|access-date=|quote=|via=}}</ref>


:* [https://www.sciencedirect.com/science/article/pii/S2255502114001758 Temporomandibular disorders in fibromyalgia syndrome: a short-communication]<ref>{{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><ref>{{Cite news|url=https://www.whitesmilesforlife.com/blog/study-probes-pain-link-between-tmj-fibromyalgia/|title=Study Probes Pain Link Between TMJ, Fibromyalgia|date=2016-05-03|work=Kent E. White, DDS|access-date=2018-08-19|language=en-US}}</ref>
{{See also|Cognitive dysfunction}}


:Other than headaches, the symptoms are quite distinct from symptoms of FMS and ME/CFS.
===[[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" />


::They include:
===[[Mast cell activation syndrome|Mast Cell Activation Syndrome]]===
::*Jaw pain
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" />
::*Discomfort or difficulty chewing
::*Painful clicking in the jaw
::*Difficulty opening or closing the mouth
::*Headaches
::*Locking jaw
::*Teeth that don't come together properly<ref>{{Cite news|url=https://www.verywellhealth.com/tmj-in-fibromyalgia-chronic-fatigue-syndrome-716175|title=TMJ in Fibromyalgia and Chronic Fatigue Syndrome|last=Dellwo|first=Adrienne|date=Mar 31, 2018|work=Verywell Health|access-date=2018-08-22|archive-url=|archive-date=|dead-url=}}</ref>


{{See also|Mast cell activation syndrome}}


*[[Thyroid disease]]
=== Menstrual cycle effects ===
**[https://www.verywellhealth.com/relationship-between-cfs-fibromyalgia-and-aitd-3231677 Chronic Fatigue Syndrome, Fibromyalgia, and Autoimmune Thyroid Disease]<ref name=":9">{{Cite news|url=https://www.verywellhealth.com/relationship-between-cfs-fibromyalgia-and-aitd-3231677|title=A Comparison of Chronic Fatigue, Fibromyalgia, and Thyroid Disease|last=Shomon|first=Mary|date=Feb 21, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=|dead-url=}}</ref>  
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>  


:<blockquote>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.<ref name=":9" /></blockquote>
===[[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}}


*Other symptoms
===Mood disorder symptoms===
**[http://chronicfatigue.about.com/od/whatisfibromyalgia/a/fibrosymptoms.htm Symptoms of Fibromyalgia]<ref>{{Cite news|url=https://www.verywellhealth.com/fibromyalgia-symptoms-716139|title=Symptoms of Fibromyalgia|last=Dellwo|first=Adrienne|date=May 16, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=|dead-url=}}</ref> (On all the many symptoms and conditions of and related to fibromyalgia.)
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>
**''Fibromyalgia Syndrome: An Overview of Pathophysiology, Diagnosis and Management'' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3394355/ Conditions associated with fibromyalgia. (Table 1)]<ref name=":21" />
{{See also|Mental health}}


==Treatment==
===[[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}}


===United States===
===Obesity===
'''Rheumatology and primary care providers: Diagnosing and treatment'''
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" />


*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. (Please see [http://me-pedia.org/wiki/Fibromyalgia#Disability disability] heading about ''primary provider'' and ''specialists'' for disability cases.)
===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>


=== '''Drugs (See main article link below)''' ===
[[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>


{{Main article |page_name = Fibromyalgia drugs}}
[[#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}}


=== Therapies ===
===[[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]].


==== Exercise ====
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>
''Please Note'': These treatments are for fibromyalgia patients and '''not''' [[ME/CFS]] sufferers due to it's hallmark symptom of [[post-exertional malaise]].
{{See also|Orthostatic intolerance}}
[[File:Warm water exercise.JPG|200px|thumb|left|Warm water exercise is best for fibromyalgia. Start slow and don't push through the pain<ref name=":11" />]]


*[https://www.verywellhealth.com/warm-water-exercise-for-fibromyalgia-716059 Warm Water Exercise for Fibromyalgia]<ref name=":11">{{Cite news|url=http://chronicfatigue.about.com/od/treatingfmscfs/a/warmwaterFMS.htm|title=Warm Water Exercise for Fibromyalgia|last=Dellwo|first=Adrienne|date=Nov 19, 2017|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=|dead-url=}}</ref><ref>{{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><ref>{{Cite news|url=https://www.prohealth.com/fibromyalgia/library/aquatic-exercise-training-fibromyalgia-85081?utm_campaign=Social%20Media%20-%20Fibromyalgia&utm_content=76595810&utm_medium=social&utm_source=twitter|title=Aquatic exercise training for fibromyalgia. - Prohealth|date=2018-08-29|work=Prohealth|access-date=2018-09-01|language=en-US}}</ref><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>
===[[Painful bladder syndrome]] and [[chronic pelvic pain]]===
[[Painful bladder syndrome]] and [[chronic pelvic pain]] are common comorbidities in people with fibromyalgia.<ref name="ScienceOfFibro" />


<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=":45">{{Cite journal|last=Bennett|first=Robert M.|author-link=Robert Bennett|last2=Jones|first2=Jessie|author-link2=Jessie Jones|last3=Turk|first3=Dennis C.|author-link3=Dennis Turk|last4=Russell|first4=I. Jon|author-link4=I. Jon Russell|last5=Matallana|first5=Lynne|author-link5=Lynne Matallana|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=":45" /> Warm water especially important in FMS because many people with the condition are intolerant of cold. A warm-water pool is one that's kept around 89.6 degrees Fahrenheit (32 Celsius), which is several degrees warmer than most heated pools.<ref name=":11" /></blockquote>
=== 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" />  


* 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.<ref>{{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=www.arthritis.org|archive-url=|archive-date=|dead-url=|access-date=2018-08-09}}</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" />


*[https://www.youtube.com/watch?v=BauJYuJwFsI Easy fibromyalgia exercises and motivation to keep you healthy!]<ref>{{Cite web|url=https://www.youtube.com/watch?v=BauJYuJwFsI|title=Easy Fibromyalgia exercises and motivation to keep you healthy!|last=Suarez|first=Eric|date=Jun 21, 2011|website=YouTube|archive-url=|archive-date=|dead-url=|access-date=Aug 9, 2018}}</ref> Video
===[[Raynaud's syndrome]]===
In Raynaud's syndrome or Raynaud's phenomenon, the blood vessels narrow more than they should, which means less blood to get through, making your extremities cold, and making them extremely difficult to warm up. Reynauld's causes fingers, toes, lips, nose, and other parts of you go cold and numb. Fingers and toes change color to white, then blue. As you warm up, skin turns red and they feel tingle, throb or swell up. Reynauld's attacks are caused by cold or emotional [[stress]].<ref name="reynaulds">{{Cite news |url =https://www.mayoclinic.org/diseases-conditions/raynauds-disease/symptoms-causes/syc-20363571 | title = Reynauld's disease - Symptoms and causes|work=Mayo Clinic|access-date=2021-11-28|language=en}}</ref>


*[http://chronicfatigue.about.com/od/whatisfibromyalgia/a/Fibromyalgia-Myth-Vs-Fact.htm Fibromyalgia Myth vs. Fact]<ref name=":15">{{Cite news|url=https://www.verywellhealth.com/fibromyalgia-myth-vs-fact-716131|title=Fibromyalgia: What's Myth, What's Fact?|last=Dellwo|first=Adrienne|date=Jun 8, 2016|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=|dead-url=|at=Myth #3 People With Fibromyalgia Need More Exercise}}</ref> Heading: ''Myth #3: People With Fibromyalgia Need More Exercise''. Appropriate exercise, which each patient needs to gauge for themselves.<ref name=":15" />
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}}


==== Massage ====
===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" />


*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>{{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>
===[[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" />


*2016, [http://chronicfatigue.about.com/od/alternativetreatments/a/bodywork.htm Massage, Rolfing & Other Bodywork - Are They Effective Fibromyalgia & Chronic Fatigue Syndrome Treatments?]<ref>{{Cite news|url=https://www.verywellhealth.com/massage-rolfing-other-bodywork-715645|title=Massage, Rolfing, Reiki: Do They Work for Fibromyalgia & ME/CFS?|last=Dellwo|first=Adrienne|date=Aug 10, 2017|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=|dead-url=}}</ref>
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}}


==== Acupuncture ====
===[[Stress]] and [[Post-traumatic stress disorder]]===
PTSD, which is a mental illness that results from traumatic events, is a risk factor for fibromyalgia.<ref name="PatientInfo" /><ref name="NIAMScauses" />
{{See also|Stress}}{{See also|Post-traumatic stress disorder}}


*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>{{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=|dead-url=|access-date=}}</ref>
===[[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.]]


*2005, [http://acupunctureschoolonline.com/acupuncture-good-for-fibromyalgia.html Acupuncture Good for Fibromyalgia?] <ref name=":16">{{Cite web|url=http://acupunctureschoolonline.com/acupuncture-good-for-fibromyalgia.html|title=Acupuncture Good for Fibromyalgia?|last=|first=|date=Oct 2, 2012|website=Acupuncture School Online|archive-url=|archive-date=|dead-url=|access-date=2018-08-09}}</ref> "Acupuncture gave no significant pain relief to fibromyalgia patients."<ref name=":16" />
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>


*2016, [http://www.sciencedirect.com/science/article/pii/S2095496416602352 Short-term complementary and alternative medicine on quality of life in women with fibromyalgia] <ref name=":25">{{Cite journal|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=":25" />
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}}


*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]<ref>{{Cite news|url=https://fibromyalgianewstoday.com/2016/02/01/acupuncture-does-not-reduce-pain-for-women-with-fibromyalgia/|title=Acupuncture Does Not Appear to Relieve Pain in Fibromyalgia Patients - Fibromyalgia News Today|last=Semedo|first=Daniela|date=2016-02-01|work=Fibromyalgia News Today|access-date=2018-08-09|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>
===[[Thyroid disease]]===
People with [[Hashimoto's thyroiditis (hypothyroidism)|Hashimoto's autoimmune thyroid disease]] often experience significant fatigue and body aches. While these symptoms are common in Hashimoto's, they can also be markers of other diseases, like chronic fatigue syndrome or fibromyalgia.<ref name="NBK540974" /><ref name="amthyass">{{Cite web | url = https://www.thyroid.org/hashimotos-thyroiditis/ | title = Hashimoto’s Thyroiditis|website=American Thyroid Association|language=en-US|access-date=2020-08-26}}</ref>
{{See also|Hashimoto's thyroiditis (hypothyroidism)}}


== '''Disability: SSI/SSD and LTD (See main article link below)''' ==
===Other symptoms===
{{Main article |page_name = Fibromyalgia disability process}}
*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


== '''Notable studies (See main article link below)''' ==
==Treatment==
{{Main article |page_name = Fibromyalgia notable studies}}
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}}


== Controversy ==
===United States===
=== Dr. Frederick Wolfe ===
Rheumatology and primary care providers: Diagnosing and treatment:
Dr. [http://rheummd.org/members/fwolfe Frederick Wolfe], the director of the [https://www.arthritis-research.org/ 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>{{Cite news|url=http://www.nytimes.com/2008/01/14/health/14pain.html?_r=0|title=Drug Approved. Is Disease Real?|last=Berenson|first=Alex|date=Jan 14, 2008|work=The Wall Street Journal|access-date=2018-08-09|archive-url=|archive-date=|dead-url=|language=en}}</ref><ref>{{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=No. 3:27|pages=|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=|dead-url=|language=en}}</ref>


=== Fibromyalgia vs Chiari malformation ===
*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.  
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.  
{{See also|Fibromyalgia disability process}}


*2011, [https://www.ncbi.nlm.nih.gov/pubmed/21135714 Is Chiari I malformation associated with fibromyalgia?]<ref>{{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>
===Drugs===
::Conclusion:  Most patients with FM do not have [[CIM]] pathology. Future studies should focus on dynamic neuroimaging of craniocervical neuroanatomy in patients with FM.
{{Main article| page_name = Fibromyalgia drugs}}
*2015, [https://www.massmecfs.org/resource-library/9-treatment/172-cfidsfm-and-chiari-malformation-surgery CFS/FM and Chiari Malformation Surgery]<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=www.massmecfs.org|language=en-GB|archive-url=|archive-date=|dead-url=|access-date=2018-08-09}}</ref>


==See also==
=== Therapies ===
*[[Fibromyalgia disability process]]
* [[Fibromyalgia drugs]]
* [[Fibromyalgia notable studies]]
* [[Influenza vaccine]]
*[[Lady Gaga]]
*''[[Mayo Clinic Guide to Fibromyalgia: Strategies to Take Back Your Life]] - Medical guide book (2019)''


== Learn more ==
==== Exercise ====
*[https://dx.doi.org/10.4065%2Fmcp.2011.0206 The Science of Fibromyalgia] - Daniel Clauw, Lesley Arnold, and Bill McCarber for the FibroCollaborative
''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]].
*[https://www.s4me.info/forums/fibromyalgia-and-connective-tissue-disorders.35/ Forum: Fibromyalgia and Connective Tissue Disorders] at [[Science for ME]]
[[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.]]
*[[Verywell FMS/CFS]]


=== Ongoing process of diagnosing and categorizing ===
<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>


*2014, [http://www.medpagetoday.com/Rheumatology/Fibromyalgia/49114 Lyme Disease, Fibromyalgia Link Evaporates]<ref>{{Cite news|url=https://www.medpagetoday.com/Rheumatology/Fibromyalgia/49114|title=Lyme Disease, Fibromylagia Link Evaporates|last=Kuznar|first=Wayne|date=2014-12-14|work=|access-date=2018-08-09|archive-url=|archive-date=|dead-url=|language=en}}</ref> (See also: [[Chronic lyme disease]])
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, [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]<ref>{{Cite news|url=https://www.news-medical.net/news/20150518/Fibromyalgia-now-considered-as-a-lifelong-central-nervous-system-disorder.aspx|title=Fibromyalgia now considered as a lifelong central nervous system disorder|date=2015-05-18|work=News-Medical.net|access-date=2018-08-09|language=en}}</ref>
==== Massage ====


*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]<ref>{{Cite news|url=http://nationalpainreport.com/foundation-of-fibromyalgia-is-altered-central-nervous-system-new-study-validates-8827896.html|title=Foundation of Fibromyalgia Is Altered Central Nervous System, New Study Validates|date=2015-10-24|work=National Pain Report|access-date=2018-08-09|language=en-US}}</ref>
*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, ''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>{{Cite web|url=http://fmcfstriggerpoints.blogspot.com/2015/09/is-fibromyalgia-psychosomatic-illness.html|title=Is Fibromyalgia a Psychosomatic Illness? Med Student Asks Celeste Cooper|last=Cooper|first=Celeste|date=Sep 4, 2015|website=fmcfstriggerpoints.blogspot.com|archive-url=|archive-date=|dead-url=|access-date=2018-09-15}}</ref>
==== Acupuncture ====


*2016, [http://fibromyalgianewstoday.com/2016/09/09/fibromyalgia-diagnosis-using-noninvasive-eye-examination Diagnosing Fibromyalgia May Be Possible Using Noninvasive Eye Examination]<ref>{{Cite news|url=https://fibromyalgianewstoday.com/2016/09/09/fibromyalgia-diagnosis-using-noninvasive-eye-examination|title=Diagnosing Fibromyalgia May Be Possible with Noninvasive Eye Exam|date=2016-09-09|work=Fibromyalgia News Today|access-date=2018-08-09|language=en-US}}</ref>
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>


*2016, [https://www.verywellhealth.com/microglia-in-fibromyalgia-chronic-fatigue-syndrome-3862780 Microglia in Fibromyalgia & Chronic Fatigue Syndrome]<ref>{{Cite news|url=https://www.verywellhealth.com/microglia-in-fibromyalgia-chronic-fatigue-syndrome-3862780|title=Microglia in Fibromyalgia and Chronic Fatigue Syndrome|last=Dellwo|first=Adrienne|date=Feb 21, 2018|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=|dead-url=}}</ref>
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" />  


*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?]<ref>{{Cite news|url=http://simmaronresearch.com/2016/03/are-chronic-fatigue-syndrome-mecfs-and-fibromyalgia-immune-exhaustion-disorders/|title=Are Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia Immune Exhaustion Disorders? - Simmaron Research|date=2016-03-21|work=Simmaron Research|access-date=2018-08-09|language=en-US}}</ref>
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>


*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]<ref>{{Cite news|url=https://consultqd.clevelandclinic.org/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|title=Why Fibromyalgia Is Neuropathic|date=2016-03-08|work=Consult QD|access-date=2018-08-09|language=en-US}}</ref>
== 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>


*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]<ref>{{Cite news|url=http://nationalpainreport.com/study-reveals-new-treatment-target-for-fibromyalgia-inflammation-in-the-brain-8833354.html|title=Study Reveals New Treatment Target for Fibromyalgia: Inflammation in the Brain|last=Liptan|first=Ginevra|date=2017-04-11|work=National Pain Report|access-date=2018-08-09|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>
=== Fibromyalgia and Chiari malformation ===
*2017, [https://qz.com/1349854/ai-can-spot-the-pain-from-a-disease-some-doctors-still-think-is-fake/?mc_cid=669d3db241&mc_eid=c75cd86947 AI can spot the pain from a disease some doctors still think is fake]<ref>{{Cite news|url=https://qz.com/1349854/ai-can-spot-the-pain-from-a-disease-some-doctors-still-think-is-fake/?mc_cid=669d3db241&mc_eid=c75cd86947|title=AI can spot the pain from a disease some doctors still think is fake|last=Goldhill|first=Olivia|date=Aug 9, 2018|work=Quartz|access-date=2018-08-15|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>
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>
*2018, [https://www.verywellhealth.com/fibromyalgia-pain-physiological-evidence-716141 Understanding the Pathophysiology of Fibromyalgia]<ref>{{Cite news|url=https://www.verywellhealth.com/fibromyalgia-pain-physiological-evidence-716141|title=What Is the Pathophysiology of Fibromyalgia?|last=Dellwo|first=Adrienne|date=Sep 18, 2018|work=Verywell Health|access-date=2018-09-19|archive-url=|archive-date=|dead-url=}}</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" />
*2018, [https://www.prohealth.com/fibromyalgia/library/fibromyalgia-central-sensitization-syndrome-87957?utm_campaign=Social%20Media%20-%20Fibromyalgia&utm_content=80329422&utm_medium=social&utm_source=twitter Fibromyalgia: Central Sensitization Syndrome - Characterizing classes of fibromyalgia within the continuum of central sensitization syndrome.]<ref>{{Cite news|url=https://www.prohealth.com/fibromyalgia/library/fibromyalgia-central-sensitization-syndrome-87957?utm_campaign=Social%20Media%20-%20Fibromyalgia&utm_content=80329422&utm_medium=social&utm_source=twitter|title=Fibromyalgia: Central Sensitization Syndrome - Prohealth|last=Davis|first=F|date=2018-11-18|work=Prohealth|access-date=2018-11-25|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>


=== Blood tests ===
===<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" />
 
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>


*2013, [http://nationalpainreport.com/new-fibromyalgia-blood-test-is-99-accurate-8821072.html New Fibromyalgia Blood Test is 99% Accurate]<ref>{{Cite news|url=http://nationalpainreport.com/new-fibromyalgia-blood-test-is-99-accurate-8821072.html|title=New Fibromyalgia Blood Test is 99% Accurate|date=2013-07-31|work=National Pain Report|access-date=2018-08-09|language=en-US}}</ref>
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.


*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”]<ref>{{Cite news|url=https://www.prohealth.com/library/pridgen-reports-fibromyalgia-antiviral-trial-results-very-positive-predicts-new-approach-will-be-game-changer-32620|title=Pridgen Reports Fibromyalgia Antiviral Trial Results “Very Positive”: Predicts New Approach Will Be “Game-Changer”|last=|first=|date=2014-03-25|work=Prohealth|access-date=2018-08-09|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>
==Disability: SSI/SSD and LT==
{{Main article | page_name = Fibromyalgia disability process}}


*2016, [https://www.celestecooper.com/2016/05/blood-test-for-fibromyalgia-fma-test-is.html Blood Test for Fibromyalgia: FM/a Test Ⓡ is now available, Q&A]<ref>{{Cite web|url=https://www.celestecooper.com/2016/05/blood-test-for-fibromyalgia-fma-test-is.html|title=Blood Test for Fibromyalgia: FM/a Test ® Is Real, Q&A|last=Cooper|first=Celeste|date=May 3, 2016|website=www.celestecooper.com|archive-url=|archive-date=|dead-url=|access-date=2018-08-09}}</ref>
==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>


*2016, [http://www.liveinsurancenews.com/fibromyalgia-blood-testing-covered-rising-number-insurance-companies/ Fibromyalgia blood testing covered by rising number of insurance companies]<ref>{{Cite news|url=http://www.liveinsurancenews.com/fibromyalgia-blood-testing-covered-rising-number-insurance-companies/|title=Fibromyalgia blood testing covered more of insurance companies|last=Campbell|first=Julie|date=2016-04-08|work=Live Insurance News|access-date=2018-08-09|archive-url=|archive-date=|dead-url=|language=en-US}}</ref>
{{See also|Florence Nightingale}}
{{See also|Frida Kahlo}}


*2017, [http://www.businesswire.com/news/home/20170419005324/en/EpicGenetics-Assistance-Leading-Medical-Centers-Expands-Clinical 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]<ref>{{Cite news|url=https://www.businesswire.com/news/home/20170419005324/en/EpicGenetics-Assistance-Leading-Medical-Centers-Expands-Clinical|title=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|last=|first=|date=Apr 19, 2017|work=Business Wire|access-date=2018-08-09|archive-url=|archive-date=|dead-url=|language=en}}</ref>
==Notable studies ==
{{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)


=== Brain scans ===
== 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


*2002, [http://www.anapsid.org/cnd/diagnosis/brainpain.html Fibromyalgia Pain Isn't All In Patient's Heads, New Brain Study Finds]<ref>{{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|last=Kaplan|first=Melissa|date=Jan 1, 2014|website=www.anapsid.org|publisher=ANAPSID|via=Chronic Neuroimmune Diseases|archive-url=|archive-date=|dead-url=|access-date=2018-08-09}}</ref>
=== Diagnosing and categorizing 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]
*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


*2012, [https://www.sciencedaily.com/releases/2012/11/121111153426.htm Fibromyalgia and the brain: New clues reveal how pain and therapies are processed]<ref>{{Cite news|url=https://www.sciencedaily.com/releases/2012/11/121111153426.htm|title=Fibromyalgia and the brain: New clues reveal how pain and therapies are processed|last=|first=|date=Nov 11, 2012|work=ScienceDaily|access-date=2018-08-09|archive-url=|archive-date=|dead-url=|language=en}}</ref>
=== 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”]


*2015, [https://www.verywellhealth.com/how-lyrica-changes-the-fibromyalgia-brain-715767 How Lyrica Changes the Fibromyalgia Brain]<ref>{{Cite news|url=https://www.verywellhealth.com/how-lyrica-changes-the-fibromyalgia-brain-715767|title=How Lyrica Changes the Fibromyalgia Brain|last=Dellwo|first=Adrienne|date=Apr 30, 2016|work=Verywell Health|access-date=2018-08-09|archive-url=|archive-date=|dead-url=}}</ref>
=== Brain scans ===
*2018, [https://ki.se/en/news/people-with-fibromyalgia-have-inflammation-of-the-brain People with fibromyalgia have inflammation of the brain]<ref>{{Cite web|url=https://ki.se/en/news/people-with-fibromyalgia-have-inflammation-of-the-brain|title=People with fibromyalgia have inflammation of the brain|last=|first=|date=Sep 25, 2018|website=ki.se|language=en|archive-url=|archive-date=|dead-url=|access-date=2018-09-26}}</ref>
*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>
*2018, [https://fibromyalgianewstoday.com/2018/10/11/brain-inflammation-imaged-first-time-fibromyalgia-patients-study/ Brain Inflammation Imaged for First Time in Fibromyalgia Patients, Study Reports]<ref>{{Cite news|url=https://fibromyalgianewstoday.com/2018/10/11/brain-inflammation-imaged-first-time-fibromyalgia-patients-study/|title=In Fibromyalgia Patients, Brain Inflammation Imaged for First Time in Study|last=Inacio|first=Patricia|date=2018-10-11|work=Fibromyalgia News Today|access-date=2018-10-30|archive-url=|archive-date=|dead-url=|language=en-US}}</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==
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[[Category:Potential comorbidities]]
[[Category:Potential comorbidities]]
[[Category:Musculoskeletal diseases and disorders]]
[[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]

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 Wolfe, Frederick; Clauw, Daniel; Fitzcharles, Mary-Ann; Goldenberg, Don; Katz, Robert; Mease, Philip; Russel, Anthony; Russel, I. Jon; Winfield, John; Yunus, Muhammad (May 2010). "American College of Rheumatology (ACR) Preliminary Diagnostic Criteria for Fibromyalgia" (PDF). Arthritis Care & Research (PDF). 62 (5): 600–610. doi:10.1002/acr.20140. The reference list consisted of: muscle pain, irritable bowel syndrome, fatigue/tiredness, thinking or remembering problem, muscle weakness, headache, pain/cramps in the abdomen, numbness/tingling, dizziness, insomnia, depression, constipation, pain in the upper abdomen, nausea, nervousness, chest pain, blurred vision, fever, diarrhea, dry mouth, itching, wheezing, Raynaud’s phenomenon, hives/welts, ringing in ears, vomiting, heartburn, oral ulcers, loss of/change in taste, seizures, dry eyes, shortness of breath, loss of appetite, rash, sun sensitivity, hearing difficulties, easy bruising, hair loss, frequent urination, painful urination, and bladder spasms.
  2. 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 "Fibromyalgia | Arthritis". Centers for Disease Control and Prevention. January 6, 2020. Retrieved August 9, 2018.
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