Man with head in hands"As a rheumatologist, I am increasingly impressed that FM is primarily a neurological disorder which presents as a musculoskeletal pain syndrome."

— Robert Bennett, MD
FM specialist

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What is Fibromyalgia (FM)?

Fibromyalgia means “soft tissue and muscle pain.” The soft tissues are the tendons or ligaments. FM is a chronic pain syndrome often associated with ME/CFS, and sometimes confused with it. The pain can be severe enough to interfere with routine daily activities. It migrates, can be achy, burning, throbbing, shooting, or stabbing, and is worse in areas used most, such as the neck or back. FM may be associated with “tender points” which are painful when pressure is applied to them. Individuals often say they awaken feeling as if they hadn’t slept. A sudden onset of profound fatigue can occur during or following exertion. Many other symptoms are common to fibromyalgia, including stiffness on waking, memory and concentration problems, excessive sensitivity of the senses, headaches, Temporomandibular Joint Syndrome (TMJ), irritable bowel, and bladder and muscle spasm.

Who gets FM?

Medical research indicates that over 6 million people in the US have FM, and that 80-90% of them are women. On the other hand, there is an estimate that about 1 million people in the U.S. suffer from ME/CFS. However, about 80% of those with ME/CFS also suffer from FM—or about 800,000. Thus most people with ME/CFS also have FM, but most people with FM don’t have ME/CFS.

How is FM diagnosed?

The 1990 American College of Rheumatologists diagnostic criteria are:

1) Widespread pain for at least 3 months.

2) Pain in all four quadrants of the body: right side, left side, above and below the waist.

3) Pain in at least 11 of 18 specified tender points when they are pressed. These 18 sites cluster around the neck, shoulder, chest, hip, knee, and elbow regions.

No exclusions are made for the presence of concomitant radiographic or laboratory abnormalities.

Please note: In May 2010, the American College of Rheumatology (ACR) released new criteria for the clinical diagnosis of Fibromyalgia (FM). However not all health care providers are using these new criteria, so it is good for patients to be familiar with both. The new criteria recommend that the tender point examination be replaced with a combination of a widespread pain index (WPI) and severity scale of symptoms (SS). 

Using these new criteria, a diagnosis of Fibromyalgia will be made on the following basis:

The values and ranges allowed for the WPI and the SS scales should meet one of the combinations: WPI >7 AND SS >5 or WPI 3–6 AND SS >9.
Symptoms have persisted at this level for the past 3 months.
Patient does not have any other disorder or cause to explain the pain.

Read more about the diagnosis of FM.

Are FM and ME/CFS the same illness?

Research authorities vary in viewpoint as to the relation of FM and ME/CFS, but the best research to date indicates that the two illnesses, while often associated, are different and separable—both in nature of causation and in their pathophysiologies (effects on processes in the body.)

Medically, FM is classified as a rheumatological illness, and FM is most commonly diagnosed and treated by rheumatologists. ME/CFS historically comes more under the rubric of internal medicine or infectious disease. This difference occurs because ME/CFS very often presents with viral-like or infectious symptoms, which do not occur as often in FM. The primary symptom complexes in FM are 1) pain; 2) sleep disturbance; 3) fatigue and exhaustion. Viral and other infectious-type symptoms aremuch less frequent.

However, because of the similarities of many of the ME/CFS and FM symptoms, including the fact that many patients can have both, differential diagnosis can be a problem. It is very important that the two illnesses be diagnosed correctly because treatments for each are somewhat different.

A person with ME/CFS who is diagnosed with FM and treated accordingly may run into severe problems; and a person with FM who is incorrectly diagnosed with ME/CFS may also be treated improperly and lose the benefits of helpful treatments.

The fact that the two illnesses are the province of separate specialties can also lead to diagnostic problems. As a rheumatologist is trained in rheumatological illnesses, there are occurrences of ME/CFS being diagnosed as FM when the physician is not well-versed in ME/CFS diagnosis. And an infectious disease specialist may be prone to misdiagnosing FM as ME/CFS.

Therefore, when there is doubt about which illness a patient has, she or he should become familiar with the differences between the two illnesses and seek a physician who knows how to diagnose both illnesses.

Who treats FM?

Medically, FM is classified as a rheumatological illness, and FM is most commonly diagnosed and treated by rheumatologists.

How is FM treated?

There is presently no cure for FM. Treatment is aimed at reducing pain and improving sleep.

Most often prescribed medications include anti-inflammatories, tricyclics, and pain medications.

Lifestyle measures to lessen stress, balance exercise and rest, and the avoidance of factors that aggravate symptoms are helpful.

Many individuals have also benefited from incorporating nutritional approaches, physical or occupational therapy, counseling, and peer support groups as part of their treatment.

Recently three medications, Cymbalta, Lyrica, and Savella, have been approved for use in the treatment of FM.

Read more about the treatment of FM. For information about Cymbala, Lyrica and Savella, read an article about a German study comparing them.

Where can I find out more about FM?

There is a great deal of excellent research and clinical information about fibromyalgia. Please refer to other sections of this website, as well as to other Fibromyalgia websites listed below.

Fibromyalgia, like ME/CFS, continues to remain a somewhat controversial illness, and a number of doctors continue to believe that it causally is linked with psychiatric illness. However, like ME/CFS, extensive research has been done that demonstrates clear physiological dysregulation and abnormalities in FM patients. Obviously, as with any other chronic illness, a person with FM can develop secondary depression or anxiety.

More resources

Social Security Ruling for Evaluation of Fibromyalgia (eff. July 2012)

A study of 1555 FM Patients provides valuable insight

Clinical Guides for Fibromyalgia

Chronic Pain Control

Complementary and Mainstream Treatment Approaches

Comprehensive Treatment of Fibromyalgia

Drugs that can cause fibromyalgia by Dr. Byron Hyde

Insights about FM and Chronic Pain

New Study Finds That Pain Levels in Patients With Fibromyalgia Are Linked to Resting Brain Connectivity

Pharmacological Therapies Approved for FM

Presentation on Fibromyalgia by Dr. Byron Hyde

Review of Nutritional Supplements Used for ME/CFS/FM