Fibromyalgia (FMS): Symptoms, Diagnosis, and Treatment of Fibromyalgia Syndrome

The term “fibromyalgia” literally translates to “fiber-muscle pain.”

Fibromyalgia syndrome (FMS) describes a complex, non-inflammatory pain disorder that primarily affects muscles, tendons, and structures near the joints. The condition falls under the category of rheumatological disorders but differs significantly from inflammatory rheumatic diseases such as rheumatoid arthritis.

Persistent pain in multiple areas of the body is characteristic of the condition. Unlike many other diseases, the symptoms usually cannot be explained by structural changes or inflammation. For this reason, it is believed that changes in pain perception and central pain processing, in particular, play an important role.

In Western industrialized nations, approximately 3–4% of the population is affected. Fibromyalgia is particularly common among women between the ages of 40 and 60. However, people of any age can develop fibromyalgia.

The severity of symptoms varies greatly from person to person; while some individuals experience only minor limitations, others suffer from severe pain and significant impairment of their daily lives.

The development of fibromyalgia remains the subject of intensive research to this day. The exact causes have not yet been fully elucidated. Based on current knowledge, it is believed that there is no single cause, but rather that various biological, psychological, and social factors interact.

Among other factors, a family predisposition appears to play a role in the development of fibromyalgia. Since the condition occurs more frequently in some families, genetic influences are being discussed. Furthermore, there is evidence that certain medical conditions may contribute to the development of fibromyalgia.

These include, in particular, autoimmune diseases, other rheumatic conditions, cancers, and various infections. Injuries, surgeries, and severe physical strain are also discussed as possible triggers. Additional factors that contribute to fibromyalgia include smoking, obesity, lack of physical activity, and chronic stress.

Another important aspect concerns the nervous system. Many experts believe that pain signals are processed differently in people with fibromyalgia than in healthy individuals. As a result, even mild stimuli can be perceived as significantly more painful. This altered perception of pain is now considered a central component of the condition.

Some experts also distinguish between a primary form of fibromyalgia and a secondary form, which can occur in connection with other conditions.

The symptoms of fibromyalgia can be very diverse and often affect the entire body. The most common symptoms include persistent pain in the muscles, tendons, and joints.

Many people with the condition describe the pain as dull, aching, or burning. It often occurs simultaneously in several areas of the body and can spread throughout the entire body.

Typical symptoms of fibromyalgia include muscle stiffness, muscle pain, painful joints, and pain in the neck, shoulders, or back.

The symptoms usually persist over a long period and are considered chronic if they last longer than 3 months. In addition to the pain, numerous other symptoms occur; those affected particularly often report severe fatigue, a lack of rest after sleep, and physical and mental exhaustion.

Sleep disturbances are among the most common symptoms associated with the condition. Although many patients sleep for a sufficient amount of time, they do not feel refreshed in the morning. In addition, difficulty concentrating, memory problems, and reduced performance may occur. Physical symptoms such as irritable bowel syndrome, an overactive bladder, or increased sensitivity to light, sounds, and odors are also frequently observed.

The symptoms of fibromyalgia can significantly impair daily life. Many people with fibromyalgia suffer from chronic pain that limits their professional, social, and personal lives. The severity of the symptoms can fluctuate over time.

© Andrey Popov / Fotolia

In addition to the patient’s personal medical history (anamnesis), the physical examination is particularly important for diagnosing fibromyalgia. By applying pressure to specific points (trigger points or tender points), the doctor checks whether the muscles and tendon insertions are painful (tenderness). These tender points are located at

• the neck,
• the back,
• shoulders,
• arms,
• legs, and
• hips.

The video demonstrates the principle of trigger point treatment:

If at least 11 of the 18 trigger points are painful when pressed and have been for more than three months, fibromyalgia is likely. This is especially true if laboratory test results are normal. Imaging tests (such as X-rays) are generally not performed when fibromyalgia is suspected, except perhaps to rule out other conditions.

The primary point of contact for patients with symptoms suggestive of fibromyalgia is the family doctor. However, at the latest when there is suspicion of an

• internal (e.g., inflammatory rheumatic disease),
• orthopedic (e.g., osteoarthritis),
• neurological (e.g., muscle disorder), or
• psychological disorder

is responsible for the symptoms, the patient should consult a specialist for a more detailed evaluation. This could be, for example, a rheumatologist, neurologist, orthopedist, or internist.

There is currently no treatment available that addresses the underlying cause of fibromyalgia. However, this does not mean that those affected are helpless in the face of their symptoms.

Modern therapy aims to reduce pain, improve physical function, and maintain quality of life.

It is important to know that fibromyalgia is incurable. Nevertheless, symptoms can be significantly alleviated in many patients.

A central pillar of treatment is regular exercise. Endurance training, cycling, swimming, and walking are particularly recommended. Moderate strength training and stretching exercises can also be beneficial.

Regular physical activity helps improve resilience and reduce symptoms over the long term.

In addition, relaxation techniques such as yoga, tai chi, qigong, or autogenic training are used. These methods help many people with fibromyalgia cope better with pain and stress.

© elnariz / Fotolia

For more severe symptoms, medication may also be prescribed. Commonly used medications include certain antidepressants and antispasmodics.

A classic example is amitriptyline, which can be particularly effective in alleviating sleep disturbances and pain. Like any medication, these drugs can also cause side effects. For this reason, they are always prescribed on an individual basis and under medical supervision.

Conventional pain relievers often have only limited effects in FMS. The reason is that the pain is not caused by inflammation, but rather by changes in pain processing.

In addition to physical therapies, psychotherapy plays an important role. Cognitive behavioral therapy and other cognitively oriented approaches, in particular, can help improve pain management.

In addition, many patients benefit from sharing experiences in a support group.

If symptoms persist despite various interventions, multimodal therapy may be beneficial. This approach combines body-oriented psychotherapeutic methods with medication.

The course of the condition varies from person to person. Fibromyalgia often begins gradually and develops over months or years. Some patients report that fibromyalgia begins after particularly stressful situations, infections, or surgeries.

The condition can be long-term and is usually chronic. However, this does not necessarily mean a continuous worsening of symptoms. Over time, many people with fibromyalgia learn to better understand their symptoms and actively manage them.

Fibromyalgia may lead to limitations in one’s professional life or social interactions. However, the condition does not shorten life expectancy.

Fibromyalgia syndrome is a complex clinical condition. Several specialists are often involved in the diagnosis and treatment.

A rheumatologist is a good point of contact if fibromyalgia is suspected. Rheumatologists specialize in the diagnosis and treatment of conditions classified as rheumatic diseases. In addition to polyarthritis, this also includes fibromyalgia. A rheumatologist may be an internist with a subspecialty in rheumatology or an orthopedic surgeon with additional training in rheumatology.

Pain management specialists play a particularly important role in the treatment of fibromyalgia. For a long time, there was no official training program for pain management specialists in Germany. Since the late 1990s, however, doctors have been able to complete advanced training and then use the additional specialty designation “Specialized Pain Therapy.” Pain therapists are specially trained in the areas of pain history, pain analysis, and the application of pain therapy techniques.

Is fibromyalgia a rheumatic disease?

Fibromyalgia is classified as a rheumatological condition. Unlike many other rheumatic diseases, however, it is not caused by inflammation.

Can fibromyalgia be cured?

Currently, fibromyalgia is considered incurable. However, appropriate treatment can often significantly alleviate symptoms.

What symptoms are particularly common in fibromyalgia?

Typical symptoms include muscle pain, fatigue, exhaustion, sleep disturbances, and pain in multiple areas of the body.

What treatments help with fibromyalgia?

The most important measures include exercise, endurance training, relaxation techniques, psychotherapeutic support, and medication if needed.

Can fibromyalgia affect quality of life?

Yes, if left untreated, the symptoms can significantly limit quality of life. An early diagnosis and personalized treatment can help patients better manage their daily lives.