Fibromyalgia is a chronic condition characterised by widespread musculoskeletal pain, extreme fatigue, cognitive difficulties (“fibro fog”), and sleep disturbances. It affects approximately 1–5% of the UK population — around 1–2 million people — and is more common in women, who are diagnosed 7 times more often than men. Despite being one of the most common chronic pain conditions, fibromyalgia remains poorly understood and is frequently misdiagnosed or dismissed.
What Is Fibromyalgia?
Fibromyalgia is now understood to be a condition of central sensitisation — a problem with how the brain and nervous system process pain signals. In people with fibromyalgia, the pain “volume” is turned up too high: the central nervous system amplifies pain signals, making ordinary sensations feel painful and genuinely painful stimuli feel excruciating. This is a real neurological phenomenon, not “all in the mind.”
Research shows differences in brain activity, neurotransmitter levels (particularly serotonin and substance P), and spinal cord processing in people with fibromyalgia. It is not an inflammatory condition — joint and muscle tissue appear normal on tests.
Fibromyalgia Symptoms
Core Symptoms
- Widespread pain — pain felt all over the body, typically described as a deep aching, burning, or stabbing. Pain is often worse in the morning and after periods of inactivity
- Extreme fatigue — not just tiredness, but a profound exhaustion that doesn’t improve with rest; described as “like running on empty”
- Sleep disturbance — difficulty falling asleep, frequent waking, unrefreshing sleep (even after 8+ hours). Sleep studies show interruption of deep (slow-wave) sleep
- Fibro fog (cognitive dysfunction) — difficulty concentrating, memory lapses, difficulty finding words, mental sluggishness
Associated Symptoms
- Headaches and migraines
- Heightened sensitivity to light, sound, smell, and temperature
- Restless legs syndrome
- Irritable bowel syndrome (IBS) — affects up to 70% of fibromyalgia patients
- Bladder problems — urgency, interstitial cystitis
- Anxiety and depression — very common co-existing conditions
- Painful periods (dysmenorrhoea)
- Temporomandibular joint (jaw) pain
- Numbness or tingling in hands and feet
- Raynaud’s phenomenon
Flares
Fibromyalgia symptoms typically fluctuate in flares — periods when symptoms worsen significantly. Common flare triggers include: stress, overexertion (“boom and bust”), poor sleep, illness, hormonal changes, weather changes, and changes in routine.
Causes and Risk Factors
The exact cause is not fully understood, but fibromyalgia often develops after a triggering event:
- Physical trauma (injury, surgery, illness)
- Significant psychological trauma or stress
- Viral infections (some cases developed after COVID-19; fibromyalgia-like symptoms overlap with Long COVID)
- Other rheumatic conditions — fibromyalgia commonly co-exists with rheumatoid arthritis, lupus, and osteoarthritis
Genetics play a role — first-degree relatives of people with fibromyalgia are 8 times more likely to develop it. Female sex is a significant risk factor. Anxiety and depression can both precede and follow fibromyalgia.
Diagnosis
There is no blood test or scan that diagnoses fibromyalgia. Diagnosis is clinical, based on symptoms and the exclusion of other conditions. The older “tender points” examination is now largely replaced by the 2016 ACR Criteria, which focus on:
- Widespread pain index (WPI) — count of painful areas out of 19 defined regions
- Symptom severity score — fatigue, sleep, and cognitive symptoms rated
- Symptoms present for at least 3 months
- No other disorder that would explain the pain
Your GP will typically arrange blood tests (FBC, ESR/CRP, thyroid function, ANA) to rule out inflammatory arthritis, lupus, and hypothyroidism before confirming a fibromyalgia diagnosis.
NHS Treatment for Fibromyalgia
There is no cure for fibromyalgia, but a combination of approaches can significantly improve quality of life. NICE guidelines recommend a holistic, self-management focused approach.
Exercise (Most Important Treatment)
Regular, graduated aerobic exercise is the most evidence-based treatment for fibromyalgia — more effective than any medication. It reduces central sensitisation over time. Start very low (even 5 minutes of gentle walking) and increase very gradually to avoid triggering a flare. Swimming, hydrotherapy, cycling, and yoga are well-tolerated options.
Psychological Therapies
- CBT (Cognitive Behavioural Therapy) — addresses the fear-avoidance cycle and negative thought patterns that worsen pain; strong evidence in fibromyalgia
- Acceptance and Commitment Therapy (ACT) — helps people live meaningful lives despite chronic pain
- Pain management programmes — multidisciplinary programmes available in many NHS trusts; combine exercise, CBT, and education
Medications
| Medication | Evidence | Notes |
|---|---|---|
| Amitriptyline (low dose) | Good | 10–50mg at night; improves sleep and reduces pain; first-line in UK |
| Duloxetine | Good | SNRI; approved for fibromyalgia in some countries; off-label in UK but commonly used |
| Pregabalin (Lyrica) | Moderate | Licensed for fibromyalgia; can help pain and sleep; controlled drug; weight gain common |
| Gabapentin | Moderate | Off-label; similar to pregabalin; now a controlled drug in UK |
| Tramadol | Limited | Low-dose; short-term use only; high dependency risk |
| NSAIDs/paracetamol | Limited | Generally not very effective for fibromyalgia pain alone but may help co-existing musculoskeletal pain |
Note: Opioids (codeine, morphine) are NOT recommended for fibromyalgia. They are ineffective for central sensitisation pain and carry significant risks of dependence and increased pain sensitivity (opioid-induced hyperalgesia).
Sleep Management
Improving sleep quality significantly reduces fibromyalgia pain. Strategies include: consistent wake times, avoiding caffeine after midday, CBT for insomnia (CBT-I), and low-dose amitriptyline or melatonin (available on prescription).
Self-Management Strategies
- Pacing — the most important self-management strategy; avoid the “boom and bust” cycle; spread activity throughout the day
- Heat therapy — warm baths, heat pads; widely reported to help with pain and muscle stiffness
- Relaxation techniques — mindfulness, breathing exercises, gentle yoga
- Dietary choices — no specific diet is proven, but some people find reducing processed foods, caffeine, and alcohol helpful
- Keeping a symptom diary — helps identify flare triggers and patterns
- Disability support — fibromyalgia may qualify for PIP and Access to Work support; speak to Citizens Advice if struggling financially
Support Organisations
- Fibromyalgia Action UK (fmauk.org) — helpline, local support groups, benefit guidance
- UK Fibromyalgia (ukfibromyalgia.com) — online community and resources
- Pain UK (painuk.org) — chronic pain charity with signposting to services
This article is for informational purposes only and does not constitute medical advice. If you think you may have fibromyalgia, speak to your GP. Keep a symptom diary to bring to your appointment — this is very helpful for diagnosis.
Related Health Guides on YourHealthXpert
Explore these related NHS-aligned health guides:
- Anxiety and Depression — depression and anxiety are common in fibromyalgia; the conditions share neurobiological mechanisms
- Insomnia — poor sleep significantly worsens fibromyalgia pain and fatigue
- Back Pain — back pain is a common feature of fibromyalgia
- IBS — IBS and fibromyalgia frequently coexist; both involve central sensitisation
- Vitamin D Deficiency — low vitamin D causes widespread musculoskeletal pain similar to fibromyalgia
- Rheumatoid Arthritis — fibromyalgia can coexist with inflammatory arthritis and complicate its management