Fibromyalgia is a long-term condition that causes widespread pain, increased sensitivity, fatigue and disrupted sleep. It can also affect concentration, memory, digestion and emotional wellbeing. Symptoms vary considerably, so two people with fibromyalgia may have quite different experiences.
The condition is sometimes misunderstood because it does not usually cause visible joint damage and routine scans or blood tests may be normal. However, fibromyalgia is a recognised medical condition. The pain and exhaustion are real, and they can have a substantial effect on work, relationships and ordinary daily activities.
Although there is currently no cure, a combination of treatment, carefully chosen activity and practical support can make symptoms easier to manage. This guide explains what fibromyalgia feels like, what may cause it, how it is diagnosed and what treatment is available in the UK.
This article provides general information and should not replace advice from a doctor or another qualified healthcare professional.
What is fibromyalgia?
Fibromyalgia is a chronic pain condition. Its main feature is pain affecting several areas of the body for at least three months, usually alongside symptoms such as fatigue, unrefreshing sleep and difficulty thinking clearly.
It is generally considered a form of chronic primary pain. This means the pain is not simply a symptom of damage or inflammation in one particular body part. Instead, there appear to be changes in how the nervous system processes and regulates pain and other sensory information.
You may hear this described as altered pain processing, pain amplification or nociplastic pain. In simple terms, the body’s pain system has become unusually sensitive. Sensations that would normally be mildly uncomfortable can feel very painful, while pain may continue even when there is no ongoing injury to explain its intensity.
This does not mean that the pain is imagined or “all in the mind”. Pain is always produced and experienced through the nervous system. With fibromyalgia, that system appears to respond differently.
Fibromyalgia can occur by itself, but it can also exist alongside conditions such as rheumatoid arthritis, osteoarthritis, lupus, migraine, irritable bowel syndrome and endometriosis. A diagnosis of fibromyalgia should not automatically be used to explain every new symptom or prevent another condition from being investigated.
What are the symptoms of fibromyalgia?
Symptoms differ from person to person and may change over time. There are often periods when they become more intense, commonly called flare-ups, followed by periods when they are more manageable.
Widespread pain
The central symptom is pain affecting multiple regions of the body. It may be felt in the neck, shoulders, back, chest, hips, arms and legs rather than being limited to one joint or muscle.
People describe the pain in different ways. It may feel like a deep ache, burning, stabbing, throbbing or persistent muscle soreness. Some areas may be especially tender, and even gentle pressure, a hug or tight clothing can sometimes hurt.
The location and intensity may shift. Pain that is mainly in the shoulders one day may be more noticeable in the legs or lower back on another. Our guides to neck pain and lower back pain explain other common causes that may need to be considered when symptoms are concentrated in one area.
Fatigue
Fibromyalgia fatigue can be much more severe than ordinary tiredness. Someone may wake feeling exhausted despite spending enough time in bed, or find that a routine task leaves them drained for the rest of the day.
Fatigue may affect physical energy, motivation, conversation and concentration. It can make showering, cooking, shopping or working a full day unexpectedly difficult. Because many conditions cause persistent tiredness, a doctor may also investigate other possibilities. Our guide to fatigue and why you may feel tired all the time explains these in more detail.
Sleep problems
Many people with fibromyalgia have difficulty falling asleep, wake frequently or sleep lightly. Others sleep for a long time but still feel unrefreshed in the morning. Pain can interrupt sleep, while poor sleep can increase sensitivity to pain, creating a difficult cycle.
Restless legs, teeth grinding and sleep apnoea may also disturb sleep and should be assessed separately when symptoms suggest them. Loud snoring, choking or gasping during sleep and severe daytime sleepiness deserve particular attention. See our guide to snoring and sleep apnoea for more information.
Fibro fog
“Fibro fog” is the informal term used for cognitive difficulties associated with fibromyalgia. It may involve poor concentration, forgetfulness, slower thinking, difficulty finding words or feeling overwhelmed when trying to process several things at once.
Fibro fog may become worse when pain, fatigue or sleep problems are more severe. It can affect work and confidence, but it does not usually mean that someone is developing dementia.
Other possible symptoms
Fibromyalgia can be associated with a wide range of additional symptoms, including:
- headaches or migraine;
- muscle stiffness, particularly after waking or staying in one position;
- increased sensitivity to touch, temperature, light, sound or smell;
- pins and needles or numb sensations;
- dizziness or feeling unsteady;
- irritable bowel symptoms, including bloating, constipation or diarrhoea;
- jaw or facial pain;
- painful periods;
- urinary frequency or pelvic discomfort;
- anxiety, low mood or irritability.
Not everyone develops all of these problems. Some symptoms may also have a separate cause, so it is worth discussing new or changing symptoms with a healthcare professional rather than assuming fibromyalgia is responsible.
What causes fibromyalgia?
The exact cause is not fully understood, and there is unlikely to be one explanation that applies to everyone. Current evidence suggests that fibromyalgia develops through a combination of biological, psychological and social factors that affect pain regulation, sleep, stress responses and overall nervous-system sensitivity.
Researchers have identified differences in the way people with fibromyalgia process pain signals. The brain and spinal cord may become more responsive to sensory information, while the systems that normally help dampen pain may be less effective. This may explain why pain can feel widespread and out of proportion to an obvious injury.
Sleep disturbance may contribute as well. Poor-quality sleep can increase pain sensitivity, reduce energy and make concentration more difficult. Pain then makes sleep harder, reinforcing the cycle.
Genes may play a role because fibromyalgia sometimes occurs in several members of the same family. This does not mean that it is directly inherited in a simple way. Rather, some people may inherit a greater susceptibility that combines with environmental and life factors.
For some people, symptoms appear after a particular event, such as:
- an infection;
- a significant injury or accident;
- an operation or difficult recovery;
- childbirth;
- a period of intense physical strain;
- severe or prolonged emotional stress.
For others, symptoms develop gradually with no identifiable trigger. Not finding a cause does not make the condition less valid, and identifying a stressful event does not mean that stress alone caused the illness.
Who gets fibromyalgia?
Anyone can develop fibromyalgia, although it is diagnosed more often in women than in men. It most commonly becomes apparent during adulthood, but younger and older people can also be affected.
Estimates of how common it is vary because symptoms overlap with many other conditions and diagnostic approaches have changed. Some people may remain undiagnosed for years, while others may initially be given several different explanations for individual symptoms.
Fibromyalgia is sometimes overlooked in men because it is commonly perceived as a women’s condition. Men may describe fewer areas of tenderness or may be less likely to seek help for persistent pain and fatigue. Diagnosis should be based on the clinical picture, not on gender stereotypes.
Having another long-term pain condition, a rheumatic disease, persistent sleep problems or a family history of fibromyalgia may increase the likelihood of developing it. However, none of these factors can confirm that someone has the condition.
How is fibromyalgia diagnosed?
There is no single scan or laboratory test for fibromyalgia. Diagnosis is based on the pattern and duration of symptoms, their impact on daily life and a clinical assessment of whether another condition could better explain them.
A GP will usually ask where you experience pain, how long it has been present and whether you also have fatigue, poor sleep or concentration problems. They may ask about headaches, digestive symptoms, mood, previous illnesses, medication and how symptoms affect work and ordinary activities.
Current diagnostic criteria consider the number of body areas affected by pain and the severity of symptoms such as fatigue, unrefreshing sleep and cognitive difficulty. Widespread symptoms should generally have been present for at least three months.
The old idea that fibromyalgia can only be diagnosed by pressing a fixed number of “tender points” is no longer the main approach. Tenderness may still be relevant, but diagnosis involves a broader assessment.
The Royal College of Physicians’ UK fibromyalgia guideline provides detailed diagnostic guidance for clinicians.
Tests that may be carried out
Tests are mainly used to look for other conditions rather than to prove that fibromyalgia is present. Depending on your symptoms and examination, a GP may arrange blood tests for:
- anaemia or iron deficiency;
- thyroid problems;
- vitamin B12, folate or vitamin D deficiency;
- inflammation;
- liver or kidney problems;
- diabetes or abnormal blood glucose.
These tests do not need to be repeated endlessly when the clinical picture is clear. Normal results do not mean nothing is wrong; they may support the conclusion that another condition is less likely.
If you are being investigated for persistent tiredness, our guide to blood tests for tiredness and fatigue explains what different tests can and cannot show.
Conditions that can resemble fibromyalgia
Symptoms can overlap with underactive thyroid, inflammatory arthritis, polymyalgia rheumatica, lupus, multiple sclerosis, muscle disorders, vitamin deficiencies, sleep apnoea and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).
Fibromyalgia can also coexist with another illness. For example, someone with rheumatoid arthritis may have inflammatory joint pain as well as the more widespread pain sensitivity of fibromyalgia. Treating one does not necessarily resolve the other.
You do not always need to see a rheumatologist to receive a diagnosis. A GP or another suitably experienced healthcare professional may be able to diagnose fibromyalgia. Specialist referral may be appropriate when the diagnosis is uncertain, symptoms suggest an inflammatory or neurological condition, or treatment needs are complex.
How is fibromyalgia treated?
There is currently no cure, and no single treatment works for everyone. Management usually combines several approaches chosen around the person’s symptoms, priorities, abilities and wider health.
The aim is not necessarily to remove every symptom. A more realistic plan may focus on improving sleep, increasing manageable activity, reducing flare-ups, supporting emotional wellbeing and making daily life more predictable.
The main approaches recommended by the NHS include appropriately tailored exercise, talking therapies and medication. The wider management of fibromyalgia as chronic primary pain is covered by the NICE guideline on chronic pain.
Physical activity and exercise
Regular physical activity can reduce pain and improve function and quality of life for some people with fibromyalgia. Suitable activities might include walking, swimming, cycling, water-based exercise, gentle strengthening, yoga or tai chi.
The difficult part is finding the right starting point. Beginning at a level based on what you could do before becoming unwell may lead to a significant flare. A physiotherapist or supervised programme can help you choose an activity and build it up according to your present ability.
Exercise should be personalised and sustainable. Some initial aching does not necessarily mean harm, but severe or prolonged worsening suggests that the programme may be advancing too quickly. The goal is regular, manageable movement rather than repeatedly pushing to exhaustion.
Talking therapies
Cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT) may help people manage chronic pain, difficult thoughts, sleep problems and the emotional effects of living with an unpredictable condition.
These therapies do not suggest that the pain is imagined. They are intended to provide practical ways of responding to symptoms, reducing distress and protecting activities that are important to the person.
Access varies by area. Your GP may be able to refer you to a pain-management programme or another suitable service. In England, some people can self-refer to NHS Talking Therapies, although not every service is designed specifically for chronic pain.
Medication
Some antidepressant medicines are used for chronic pain even when a person does not have depression. They can influence chemical messengers involved in pain and may also help sleep or mood. Medicines sometimes considered include amitriptyline or duloxetine, depending on the person’s symptoms, health and other medication.
Benefits are often modest and vary between individuals. Side effects can include drowsiness, dry mouth, dizziness, constipation, nausea or sexual difficulties. Treatment should be reviewed to check whether it is producing a worthwhile improvement.
Common painkillers do not always work well for fibromyalgia because the condition does not primarily result from inflammation or ongoing tissue damage. NICE advises against starting several medicines—including opioids, paracetamol, anti-inflammatory medicines and gabapentinoids—for chronic primary pain. This does not mean you should abruptly stop prescribed medication. Withdrawal from some medicines needs to be gradual and supervised by a clinician.
Medicines may still be appropriate for another diagnosed condition or a particular type of pain. Ask your doctor or pharmacist what each treatment is intended to address and how its benefit will be assessed.
Acupuncture and pain-management programmes
NICE says a limited course of acupuncture may be considered for chronic primary pain in some circumstances. It can help certain people in the short term, although the longer-term benefit is uncertain and NHS availability varies.
A pain-management programme may bring together physiotherapy, psychology, occupational therapy and medical support. Its aim is usually to improve function and confidence rather than promise complete pain relief.
Managing fibromyalgia day to day
Fibromyalgia management is often about finding a sustainable rhythm. On a relatively good day, it can be tempting to complete every postponed job. This may be followed by a flare that makes activity difficult for several days—a pattern sometimes described as “boom and bust”.
Pacing can help reduce these extremes. This involves dividing demanding tasks into smaller parts, alternating different types of activity and taking planned breaks before pain and fatigue become overwhelming.
A simple diary may help identify patterns. Record sleep, activity, stress, pain and fatigue without trying to document every sensation. Over time, you may notice that symptoms are more likely to worsen after several busy days, disturbed sleep or prolonged periods in one position.
Other practical strategies include:
- planning essential activities for your more reliable times of day;
- sitting for tasks such as showering or preparing food;
- using reminders and notes when concentration is poor;
- changing position regularly rather than remaining completely still;
- keeping a broadly consistent sleep and waking routine;
- asking for help before a flare becomes unmanageable;
- building recovery time into plans for work or social occasions.
There is no special fibromyalgia diet proven to cure the condition. A balanced diet, adequate fluids and regular meals can support general health and energy. Be cautious about restrictive diets, expensive supplements and detox programmes that make broad promises without reliable evidence.
Fibromyalgia flare-ups
A flare-up is a period when pain, fatigue, sleep disturbance or cognitive symptoms become noticeably worse. Flares can last for hours, days or sometimes longer.
Possible triggers include doing more activity than usual, emotional stress, poor sleep, an infection, changes in routine or prolonged inactivity. Some people report sensitivity to weather changes, although this is not consistent for everyone. A flare can also happen without an obvious reason.
During a flare, it may help to reduce non-essential demands, use previously agreed symptom-relief measures and keep up gentle movement within what feels manageable. Complete bed rest for long periods can increase stiffness and deconditioning, but forcing normal activity despite severe symptoms may also be unhelpful.
A flare plan can include which commitments to postpone, who can help, which medicines are safe to use and when to contact a healthcare professional. As symptoms settle, return to usual activities gradually rather than trying to catch up immediately.
Not every worsening should be treated as a routine flare. Seek medical advice if pain is significantly different from usual or accompanied by symptoms such as a swollen hot joint, unexplained fever, progressive weakness, substantial weight loss or new bladder or bowel problems.
Work, relationships and emotional wellbeing
Fibromyalgia can be particularly difficult because other people may not see the symptoms. Someone may appear well during a brief meeting while needing considerable rest before and afterwards. Explaining this fluctuating pattern can help family members, friends and colleagues understand why your capacity changes.
If symptoms affect work, possible adjustments might include flexible hours, a phased return after sickness absence, more frequent breaks, an adapted workstation, some home working or changes to physically demanding duties.
Fibromyalgia may count as a disability under the Equality Act 2010 if it has a substantial and long-term negative effect on normal daily activities. The decision depends on its impact, not simply on having the diagnosis. Occupational health can sometimes help identify appropriate adjustments.
Persistent pain and exhaustion can contribute to anxiety, depression, frustration and social isolation. These emotional effects are not evidence that fibromyalgia is psychological. Physical symptoms and emotional wellbeing influence each other, and both deserve support.
If low mood or anxiety is becoming difficult to manage, our guides to depression symptoms and treatment and anxiety disorders explain where to seek help.
When should you see a GP?
Arrange a GP appointment if you have persistent widespread pain, fatigue or sleep problems, especially when they have lasted for several weeks or are interfering with work and daily life.
Tell the GP how symptoms affect you rather than describing pain alone. Examples such as being unable to complete a normal workday, needing to rest after showering or regularly forgetting conversations can help communicate the overall impact.
Seek more urgent advice if you develop symptoms that are not typical of your usual pattern, including:
- a hot, red or markedly swollen joint;
- new or progressive muscle weakness;
- unexplained fever or significant weight loss;
- chest pain or serious breathing difficulty;
- loss of bladder or bowel control;
- numbness around the genitals or bottom;
- thoughts of harming yourself.
These symptoms may have another cause and should not automatically be attributed to fibromyalgia.
Frequently asked questions about fibromyalgia
Is fibromyalgia an autoimmune disease?
Fibromyalgia is not currently classified as an autoimmune disease. Unlike conditions such as rheumatoid arthritis or lupus, it does not usually produce the same pattern of inflammation or tissue damage. Research into the biological mechanisms is continuing, but findings should not be confused with a confirmed autoimmune diagnosis.
Does fibromyalgia cause joint or muscle damage?
Fibromyalgia does not normally damage joints or muscles, even though the pain can be severe. However, someone can have fibromyalgia and a separate condition that does cause physical damage or inflammation.
Can fibromyalgia be seen on an MRI scan?
There is no routine MRI finding that confirms fibromyalgia. Scans may be requested if symptoms suggest another problem, but a normal scan does not disprove fibromyalgia or mean that the pain is not real.
Can a blood test diagnose fibromyalgia?
No. Blood tests may help rule out or identify other causes of pain and fatigue, such as thyroid disease, anaemia, inflammation or vitamin deficiencies. Diagnosis is based mainly on symptoms and clinical assessment.
Is fibromyalgia the same as ME/CFS?
No, but the conditions overlap. Both can involve fatigue, poor sleep, cognitive difficulty and pain. Widespread pain and tenderness are particularly associated with fibromyalgia, while post-exertional malaise is central to ME/CFS. Some people meet the diagnostic criteria for both conditions.
Does fibromyalgia ever go away?
Fibromyalgia is usually described as a long-term condition. Symptoms can nevertheless improve, and some people experience lengthy periods when they are mild. Treatment aims to reduce symptoms, improve function and make flare-ups less disruptive.
What is the best medicine for fibromyalgia?
There is no best medicine for everyone. Some people benefit from an antidepressant used for chronic pain, while others experience little benefit or troublesome side effects. Medication should form part of an individual plan rather than being the only treatment.
Is exercise safe with fibromyalgia?
Exercise is generally recommended and can improve pain and quality of life, but it should begin at a suitable level and build gradually. A physiotherapist or supervised programme may be useful if activity repeatedly causes severe flares or you are unsure how to start.
Can stress cause fibromyalgia?
Fibromyalgia sometimes develops after significant physical or emotional stress, and stress can make existing symptoms worse. It is not accurate to say that stress is the sole cause. The condition is thought to involve a complex mixture of nervous-system, biological and environmental factors.
Where can I find support?
Your GP can help with assessment, treatment and referral to local pain, physiotherapy or psychological services. Fibromyalgia Action UK also provides information, support groups and a helpline for people affected by the condition.
