Fibromyalgia: What Causes It and How Is It Treated?

Author: Ifeoma Ikechukwu, Pharm.D

Medical Reviewer: Abdulsalam Yakubu, MBBS, MPH

Highlights 

• Fibromyalgia is a disorder of the nervous system marked by widespread pain, chronic fatigue, sleep problems, and mental difficulties.
• Fibromyalgia is not caused by damage to muscles or inflammation. 
• Its symptoms can resemble those of other conditions like rheumatoid arthritis, osteoarthritis, or hypothyroidism.
• To be diagnosed with fibromyalgia, your symptoms must be consistent for at least 3 months.
• Fibromyalgia cannot be cured but can be managed effectively with exercise, behavioural therapies, or medication.

Introduction

Sandra, a 40-year-old woman, runs a cosmetic business and dreams of expanding her small startup into a major beauty brand.  Lately, that dream was put on hold. This is because her once-boundless energy has been replaced by an agonising, unexplained pain all over her body. This experience worsened over the past year after she was involved in a motorcycle accident. Desperate for a solution, Sandra booked an appointment with a doctor. After a series of blood tests and scans, her doctor traced her history of widespread pain and chronic fatigue to her experience. He delivered a diagnosis that became Sandra‘s new reality: Fibromyalgia. 

According to her doctor, understanding and managing her condition effectively will help her reclaim her vitality and pursue her business dream.

What Is Fibromyalgia?
Fibromyalgia is a condition that is marked by generalised muscle pain. This pain is usually accompanied by extreme fatigue, sleep problems, and memory and focus challenges. It is a long-term condition that arises when your nervous system amplifies painful and non-painful feelings in your body. Fibromyalgia does not come from muscle damage or inflammation. Rather, it is a disorder of the central nervous system. Symptoms often begin after a physical or emotional traumatic experience, while some cases might not have a clear trigger.  People often describe the pains as aching, throbbing, burning, or hurting all over their body.It can be difficult to diagnose fibromyalgia because symptoms can vary from person to person. While some people can have mild symptoms and lead a normal life, others may experience severe pain that impacts their ability to work. Additionally, its common features like chronic pain, fatigue, and cognitive issues are shared by other medical conditions, which further complicates diagnosis. Hence, a comprehensive evaluation of an individual’s medical history and physical examination is needed for accurate medical diagnosis [1].In this article, you will learn all there is to fibromyalgia, the causes, its symptoms, and how it can be treated.

What Causes Fibromyalgia?

The cause of this disorder has not yet been uncovered. Nevertheless, studies show that people with this condition have a change in how their neurons process pain. This is as a result of changes in the brain and spinal cord that lead to an abnormal increase in chemicals that signal pain.  Some studies suggest genetics as one of the factors that contribute to this, in that a change in certain genes may be responsible for how your central nervous system processes pain [2,3]. This is because fibromyalgia has been observed to run in families. If someone in your family has this condition, you might be more likely to develop it.  

Other factors that trigger this condition include:

• Physical trauma: Injuries sustained from incidents like car accidents can trigger fibromyalgia
• Emotional trauma: High stress levels, anxiety, and Post-Traumatic Stress Disorder (PTSD) can also trigger this condition 
• Severe infections: Infections like Epstein-Barr virus, long COVID, and Lyme disease. 
• Major surgeries: This can cause physical stress to your nervous system.

What Are the Symptoms of Fibromyalgia?

The common primary symptoms you will experience when you have this condition include the following:

• Widespread, persistent pain: This is the major characteristic symptom of this disorder. This pain is continuous and lasts a long time, usually for at least 3 months [4]. You can experience this pain in different parts of your body. 
• Fatigue and sleep problems: Fibromyalgia can make you feel exhausted after your daily activities. Often, the pain can negatively affect your sleep. You can wake up feeling extremely tired, and your sleep quality can also be deeply affected due to the pain, which can worsen your symptoms. 
• Cognitive impairment: This is commonly known as fibro fog or brain fog. This refers to the buildup of mental difficulties that come with chronic pain. It can manifest as difficulty with concentration, forgetting events, or inability to focus effectively. 

Because the nervous system can be overly sensitive and responds too strongly, fibromyalgia can trigger other symptoms in your body, which can include:

• Digestive issues
• Headaches
• Numbness and Tingling sensations
• Mood disorders

Who Is More Likely to Develop Fibromyalgia?

Anyone can develop fibromyalgia, both adults and children. However, studies show increased risk in some populations.

• Adult female: Women above 40 present more with fibromyalgia. Although the reason for this is not known, studies suggest that the historically reported wide female-to-male ratio differences may be due to unfairness or assumptions during diagnosis which is attributed to the pressure pain test as men and women often feel pain differently. However, current diagnostic criteria do not require this test and therefore show a smaller sex difference [5]. 
• Older Adults: The chance of having fibromyalgia increases as you get older. You may start noticing symptoms between the ages of 30 and 50, with risk increasing as you age. 
• First-degree relatives: People with family relatives like parents,  siblings, or a child with fibromyalgia have an increased risk. A family-based study of fibromyalgia showed that relatives of people with fibromyalgia were 8.5 times more likely to develop this health condition than the relatives of people with rheumatoid arthritis [6]. This suggests the condition runs in families and that genes play a major role.
• Individuals with pre-existing illnesses: You have a higher risk of having fibromyalgia if you have diseases like rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, irritable bowel syndrome, and mood disorders like anxiety and depression. 

How Is Fibromyalgia Diagnosed?

No single blood test or imaging scan is used to diagnose fibromyalgia. Instead, doctors diagnose it by obtaining a thorough medical history, physical examination, and some tests to rule out symptoms that might be due to other illnesses.   

Medical History

Usually, doctors use the American College of Rheumatology diagnostic criteria to obtain your clinical history. These criteria look out for the following components:

• Generalised pain: You must feel pain in at least 4 of the 5 regions of your body. These include the left upper region (shoulder, arm, jaw), the right upper region (shoulder, arm, jaw), the left lower region (hip, buttocks, leg), the right lower region (hip, buttocks, leg), and the axial region (neck, back, chest or stomach).
• Widespread Pain Index (WPI) and  Symptom Severity Scale (SSS): The WPI checks for the areas of your body where you feel pain out of the 19 body areas while the SSS measures the severity of the other symptoms that come with fibromyalgia. A WPI greater than or equal to 7 and SSS greater than or equal to 5 OR WPI between 4-6 and SSS greater than or equal to 9 satisfies fibromyalgia diagnosis.
• Duration of symptoms: The symptoms above must be consistently present for at least three months.
•  A diagnosis of fibromyalgia is valid irrespective of the presence of other diseases.

Physical Examination 

Physical examinations are done to identify coexisting conditions like osteoarthritis and neuropathic pain. During this process, your doctor looks out for signs such as swollen joints, muscle weakness, or nerve numbness.

Tests

Your physician might run some tests to determine the presence of other health conditions.Common tests to dismiss other underlying conditions include: 

• Complete blood count: To check for anaemia, which can cause fatigue
• Erythrocyte sedimentation rate: This checks for inflammation and can point to ailments like rheumatoid arthritis.
• Thyroid function test: This looks out for hypothyroidism, as the symptoms mimic those of fibromyalgia.

How Is Fibromyalgia Treated?

The treatment of fibromyalgia involves a combination of lifestyle changes, physical exercise, behavioural therapies, and medications. The treatment aims to manage symptoms, improve daily productivity, and reduce how your central nervous system processes pain.

Physical and movement therapy

The European League Against Rheumatism (EULAR) strongly recommends exercise [7]. Regular exercise prevents the body from getting weaker, which can make fibromyalgia symptoms worse. Recommended exercises include walking, swimming, cycling, Tai Chi, yoga, or Qigong.

Behavioural Therapy

This focuses on reframing how you perceive the pain that comes from fibromyalgia. Your doctor can use cognitive behavioural therapy (CBT). CBT helps to manage your symptoms by reducing anxiety, which often worsens your pain. It also helps to improve your sleep and energy. 

Medications 

Medications are used to change how your nervous system reacts to pain. Commonly prescribed medications include:

• Anti-seizure medication: Drugs like Pregabalin and Gabapentin help ease fibromyalgia pain. 
• Antidepressants: Your healthcare provider can prescribe these drugs to help improve fatigue, sleep, and your mood. These include Duloxetine, milnacipran, and amitriptyline. 
• Analgesics: These can also help relieve pain. An example is acetaminophen. 

Can Fibromyalgia Be Prevented or Cured?

There is currently no cure for fibromyalgia. As the cause of the disorder is not yet known, medical science has not yet devised a means to stop it from developing. However, with treatment, many individuals experience a significant reduction in symptoms, which improves their quality of life.Since genes also contribute significantly to this condition, prevention strategies focus on lowering your risk and preventing symptoms from getting worse. This can be achieved by 

• maintaining healthy habits like stress management, 
• regular exercise,
• prioritising deep sleep. 

Conclusion

Fibromyalgia results from an overly sensitive nervous system, which amplifies pain in the body. It’s often triggered by a physical or emotional traumatic experience, though some cases may not have a definite root cause. While the cause is yet unknown, studies suggest genetics as a significant contributing factor. Therefore, if a family member has fibromyalgia, you may be at high risk of developing it. The symptoms of fibromyalgia can be overwhelming, but your quality of life can be improved with proper diagnosis and the right treatment strategies. You should seek medical advice early when you start noticing symptoms and follow your doctor’s recommendations for the best treatment outcome. 

Frequently Asked Questions (FAQs)

1. What causes fibromyalgia? 

The cause of fibromyalgia is not known. Studies suggest that when your nervous system becomes overly sensitive, it increases your body's response to pain.

2. Do fibromyalgia symptoms become worse with time? 

Sometimes, symptoms can become worse due to stress or poor sleep and can affect your daily activities. These periods are called flare-ups. You may also go through periods when your symptoms appear normal, and you can maintain your daily routine. 

3. Is there a test to diagnose fibromyalgia? 

There is no single definitive test for diagnosing fibromyalgia. Your healthcare provider would obtain your medical history and use the recommended diagnostic criteria to assess your symptoms. He can decide to run other tests to rule out other diseases whose symptoms mimic those of fibromyalgia. 

4. Why does my doctor think I need exercise? 

Exercise is highly promoted for the management of fibromyalgia. Your doctor will likely prescribe this to help you get active and improve your symptoms. Nevertheless, you should consider mild to moderate exercises, so you don't overwork your muscles, leaving you with more pain. 

5. Why do I wake up feeling exhausted?

Oftentimes, the pain that comes with fibromyalgia interferes with your sleep. It prevents your brain from entering deep, restful sleep. Even after sleeping for 8 hours, you may wake up feeling unrefreshed because your nervous system never had the chance to fully recovery,

References 

1. Varrassi G, Rekatsina M, Perrot S, Bouajina E, Paladini A, Coaccioli S, Narvaez Tamayo MA, Sarzi Puttini P. Is fibromyalgia a fashionable diagnosis or a medical mystery? Cureus. 2023;15(9):e44852. doi:10.7759/cureus.44852. Available from: https://pubmed.ncbi.nlm.nih.gov/37809234/
2. American Fibromyalgia Syndrome Association. Possible causes: what causes fibromyalgia? & why so many symptoms [Internet]. Tucson (AZ): American Fibromyalgia Syndrome Association; [cited 2026 Oct 11]. Available from: https://www.fibromyalgiafund.org/possible-symptom-causes/
3. Kerrebijn I, Bjornsdottir G, Arbabi K, et al. The genetic architecture of fibromyalgia across 2.5 million individuals. Nat Med. 2026;32:3060–3070. doi:10.1038/s41591-026-04492-6. Available from: https://pubmed.ncbi.nlm.nih.gov/42521817/
4. Berwick R, Barker C, Goebel A; Guideline Development Group. The diagnosis of fibromyalgia syndrome. Clin Med (Lond). 2022;22(6):570-574. doi:10.7861/clinmed.2022-0402. Available from: https://pubmed.ncbi.nlm.nih.gov/36427885/
5. Wolfe F, Walitt B, Perrot S, Rasker JJ, Häuser W. Fibromyalgia diagnosis and biased assessment: sex, prevalence and bias. PLoS One. 2018;13(9):e0203755. doi:10.1371/journal.pone.0203755. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0203755&utm
6. Arnold LM, Hudson JI, Hess EV, Ware AE, Fritz DA, Auchenbach MB, et al. Family study of fibromyalgia. Arthritis Rheum. 2004;50(3):944-952. doi:10.1002/art.20042. Available from: https://pubmed.ncbi.nlm.nih.gov/15022338/
7. Macfarlane GJ, Kronisch C, Dean LE, Atzeni F, Häuser W, Fluß E, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017 Feb;76(2):318-328. doi: 10.1136/annrheumdis-2016-209724. Available from: https://pubmed.ncbi.nlm.nih.gov/27377815/

Disclaimer:
The information provided on this website is for general educational and informational purposes only. It is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Published October 30, 2026