Fibromyalgia Symptoms

Fibromyalgia is a syndrome, meaning it is a collection of symptoms that together characterize an illness.

Some symptoms are essential for the diagnosis while others, although less predominant, are hallmarks of fibromyalgia. Each individual diagnosed with fibromyalgia will encounter a different assortment of problems.

The American College of Rheumatology published a paper that categorized the varying features of fibromyalgia by defining them as "core features,” "characteristic features,” or "common features."

  1. Core Features of Fibromyalgia
  2. Characteristic Features of Fibromyalgia
  3. Common Features of Fibromyalgia
  4. Depression: An Associated Symptom
  5. Sleep Disorders
  6. Aggravating Factors
  7. Symptoms Variable, Unique

1. Core Features of Fibromyalgia

Generalized pain and widespread tenderness are considered "core features" of fibromyalgia because they are necessary for the diagnosis. People with fibromyalgia describe the pain, which may be concentrated in different places in the body, in various ways, using adjectives such as "aching," "boring," "burning," "nagging," "gnawing," and "radiating." In general, fibromyalgia patients suffer with pain most commonly in the central regions of the neck, shoulders, back and pelvis; almost all experience pain in the neck or lower back. Although little is written about where the pain of fibromyalgia typically develops first, one researcher notes in the Scandinavian Journal of Rheumatology that 55% of fibromyalgia patients report back pain prior to onset of other symptoms.

2. Characteristic Features of Fibromyalgia

The characteristic features of fibromyalgia are those that occur in more than 75 percent of fibromyalgia sufferers. The characteristic features are not required for diagnosis. According to the 1990 American College of Rheumatology fibromyalgia definition the following features are found in fibromyalgia patients:

  • fatigue in 78.2% to 85.2%;
  • sleep disturbance in 73.3% to 75.6%; and
  • morning stiffness in 76.2% to 78%.

3. Common Features of Fibromyalgia

Common features of fibromyalgia are less predominant problems than the core features or characteristic features, but are closely associated with the syndrome. They arise in more than 25% of individuals with fibromyalgia.

The 1990 American College of Rheumatology definition of the criteria for fibromyalgia diagnosis cites the following as common features:

  • paresthesias, a numbness or tingling in the extremities in 57.9% to 67.1% of fibromyalgia patients;
  • headache in 44.3% to 51.1%;
  • irritable bowel (intermittent episodes of abdominal pain, bloating and constipation followed by loose stools) in 22.4% to 35.7%; and
  • anxiety in 44.9% to 51.1%.

Other common features include the sensation of swelling around the joints or through the fingers and Raynaud's phenomenon. Swelling is experienced by 32% of fibromyalgia patients, according to a 1991 Seminars in Arthritis and Rheumatism study.5 And a 1989 report found that Raynaud's phenomenon, characterized by pain and color changes in the extremities in response to cold, occurs in 9% to 38% of fibromyalgia patients.

Each of these problems can impact an individual with fibromyalgia in a variety of ways. For instance, irritable bowel syndrome ranges from being a mild nuisance to causing severe pain and disruption of each day. Some fibromyalgia patients discover their headaches respond to over-the-counter remedies; others find relief only with more potent prescription medications. Each problem should be treated on an individual basis. If severe or debilitating, a problem requires the focused attention of a physician and a specific fibromyalgia treatment.

4. Depression: An Associated Symptom

Depression is common among fibromyalgia patients. Psychologists classify depression as either being current or lifetime. The diagnosis of current depression is made at the time of diagnosis of fibromyalgia, when the patient is currently depressed. The diagnosis of lifetime depression is made when a patient is not depressed at the time of fibromyalgia diagnosis, but gives a history of past depression. The prevalence of current depression among fibromyalgia patients in 20 to 25 percent. The prevalence in the normal population is about 12%. 8The prevalence of lifetime depression among fibromyalgia patients is about 50%.9 These findings suggest that there is a genetic link between depression and fibromyalgia, but depression is not the cause of fibromyalgia.

A 1996 Rheumatic Disease Clinics of North America review of seven showed that depression is significantly more frequent among people with fibromyalgia than among the general population. The chance that someone with fibromyalgia is also suffering from major depression ranged from 6% to 35%. The chance that a fibromyalgia patient will be diagnosed with major depression was reported in the review to range from 20% to 83%. Of the seven studies, five reported the lifetime risk of depression to be greater than 50%.

Depression can be profoundly detrimental to any individual's quality of life, and the resulting inertia can adversely impact efforts to follow through with treatment recommendations. The effort to determine whether the depression is the result of having chronic pain or from some other cause should not keep anyone with fibromyalgia from seeking proper counseling. Even if a person does not meet the criteria for severe depression, the mild aspects of depression can worsen the problems associated with fibromyalgia, and coping with the illness can become more difficult. Depression can make the pain seem more debilitating, restful sleep less likely, and headaches and irritable bowel symptoms more frequent. When a fibromyalgia patient is depressed, it is unlikely that he or she can initiate and maintain measures used to control fibromyalgia, such as exercise, stretching, or socializing. For these reasons, depression should be aggressively managed with early, focused treatment.

5. Sleep Disorders

There is an increased prevalence of sleep disorders in fibromyalgia: Sleep Apnea and Restless Leg Syndrome.

A 1993 American Journal of Medicine study shows that while only 2.2% of women with fibromyalgia have accompanying sleep apnea, which is the cessation of normal breathing during sleep, 44% of men with fibromyalgia have this problem.13 Sleep apnea worsens nighttime sleep patterns and adds to day-time fatigue. Given the high prevalence of apnea among men, men with fibromyalgia are often tested for this problem.

Restless leg syndrome refers to poorly defined sensations, such as tingling and a need to continually move the legs, which is worse in the evening. Patients with those symptoms usually unconsciously twitch their legs during the night, which impairs their ability to attain deep, refreshing sleep.

6. Aggravating Factors

Many fibromyalgia patients report worsening of symptoms with changes in environment or lifestyle. This "modulation" was found in 60 to 79% of fibromyalgia patients, according to the 1990 American College of Rheumatology study defining fibromyalgia criteria.14 In a 1991 study, 92% of fibromyalgia patients reported worsening of symptoms with cold or humid weather. Other aggravating factors included poor sleep, alcohol use, exposure to air-conditioned areas, menstrual periods, and weather change before rain. 32% of patients reported improved symptoms during the summer. 92% of those studied cited hot showers as helpful in alleviating symptoms, while gentle physical activity helped 82% and massage provided worthwhile but transient improvement for 64%.

7. Symptoms Variable, Unique to Individual

Each person with fibromyalgia encounters a unique assortment of symptoms. Fatigue and headaches may bother one person most, while another battles muscle stiffness and bowel problems, but each suffers from the same syndrome. Even within the individual, major symptoms can vary with time. One day, it is headaches that cause difficulty, the next day muscle stiffness. Similarly, fibromyalgia patients may discover that after two or three years, the prominent symptom changes, for instance from Raynauds’ phenomenon to headaches. The loose association of symptoms and their evolution with time frustrates many people with fibromyalgia and often confuses their physicians.

Because fibromyalgia causes such a wide variety of problems from headaches to tingling, a Patient Care article refers to it as "irritable everything" syndrome.16 It is important to remember that although the location of the pain may move and problems may transform with time, one illness, fibromyalgia, is to blame. Managing the syndrome's subset of problems can require additional therapies, but treatment with medications or nonpharmacological therapies must remain focused on managing the primary culprit -- fibromyalgia.


"Fibromyalgia: The clinical syndrome," by F. Wolfe, Rheumatic Disease Clinics of North America, The Fibromyalgia Syndrome, Vol. 15, No. 1, February 1989, pages 1-18.

"Primary fibromyalgia," by A. Bengtsson et al, Scandinavian Journal of Rheumatology, Vol. 15, 1986, pages 340-347, as cited in "Fibromyalgia: The Clinical Syndrome," see 3 below.

"The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: Report of the multicenter criteria committee," by F. Wolfe et al, Arthritis and Rheumatism, Vol. 33, No. 2, Feb. 1990, pages 160-172.

"The American College of Rheumatology 1990 criteria for the classification of fibromyalgia," cited above.

"Primary fibromyalgia (fibrositis): Clinical study of 50 patients with matched normal controls," by M. Yunus, A. Masi et al, Seminars in Arthritis and Rheumatism, Vol. 11, No. 1, August, 1991, pages 151-171.

"Fibromyalgia: The clinical syndrome," cited above. “Confounding features of the fibromyalgia syndrome: A current perspective of differential diagnosis,” R.M. Bennett, Journal of Rheumatology, 16 suppl., vol. 19, 1989, pages 58-61

“Psychiatric and psychological aspects of fibromyalgia syndrome,” D.L. Goldenberg, Rheumatic Disease Clinics of North America, vol. 15, 1989, pages 105-114.

“Fibromyalgia and major affective disorder: a controlled phenomenology and family history study,” J. Hudson, et. al., American Journal of Psychiatry, vol. 142, 1985, pages 441-46.

“Relationship of clinical features with psychological status in primary fibromyalgia,” M. B. Yunus, et. al., Arthritis and Rheumatism, vol. 34, 1991, pages 15-21.

“Psychiatric diagnoses in patients with fibromyalgia are related to health care-seeking behavior rather than illness,” L. Aaron, et. al., Arthritis and Rheumatism, vol. 39, 1996, pages 436-445.

"The relationship between fibromyalgia and major depressive disorder," by J. Hudson and H.G. Pope, Rheumatic Disease Clinics of North America, Controversies in Fibromyalgia and Related Conditions, Vol. 22, No. 2, May 1996, pages 285-303.

"Sleep apnea in male patients with the fibromyalgia syndrome," by K.P. May, The American Journal of Medicine, May 1993, Vol. 94, pages 505-508.

"The American College of Rheumatology 1990 criteria for the classification of fibromyalgia," cited above.

"Primary fibromyalgia (fibrositis): Clinical study of 50 patients with matched normal controls," cited above.

"Recognizing fibromyalgia," by R. Bennett, H. Smythe, F. Wolfe, Patient Care, March 15, 1992, pages 211-228.

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Last updated: 5/13/2022