Conditions We Treat

Fibromyalgia Syndrome (FMS)

Fibromyalgia (often called “fibro”, or FMS) is a chronic condition characterized by widespread musculoskeletal pain, fatigue, and other systemic symptoms that can vary greatly in severity. It is a complex and often misunderstood disorder that can significantly impact on quality of life.

Fibromyalgia affects an estimated 2-8% of the population, predominantly women, and while it can affect people of all ages, it most commonly develops in middle age. It can be a controversial diagnosis (with some health professionals disagreeing that it is a “real” diagnosis), and is frequently undiagnosed or misdiagnosed, especially as symptoms are non-specific and can overlap with many other conditions.

What causes fibromyalgia?

The exact cause of fibromyalgia is not fully understood, but it is believed to involve a combination of genetic, environmental, and physiological factors, including:

Genetic Predisposition: A family history of fibromyalgia, or other related conditions may increase the risk of someone developing fibromyalgia
Illness or infections: Certain illnesses may trigger or exacerbate fibromyalgia symptoms
Stressful or traumatic events: Physical and psychological trauma such as car accidents, surgery, or significant psychological stress may precipitate fibromyalgia.
Autoimmune Disorders: Some autoimmune conditions are associated with a higher risk of fibromyalgia, like Sjogren’s disease, Hashimoto’s Disease, Lupus or Rhuematoid Arthritis

There’s no one clear answer for why fibromyalgia symptoms occur, but they are thought to result from changes to sensory processing and nervous system function as opposed to direct injury or structural problems in the muscles or joints themselves. This explains why people with fibromyalgia often have no obvious problems visible on scans. Some of the mechanisms suggested include:

Central Sensitization: An increased sensitivity to pain due to changes in how the body processes incoming sensory signals - think of it like the nervous system “turning up the pain dial”

Neurotransmitter Imbalance: It is thought that imbalances in certain neurotransmitters (molecules that are involved in nerve function) may contribute to fibromyalgia. Serotonin, norepinephrine and dopamine have all been suggested to play a role in abnormal pain perception and mood regulation.

Hormonal (Endocrine) Influences: Variations in hormone levels, particularly cortisol, which is involved in the body's stress response, may affect fibromyalgia symptoms. Women may also notice that their symptoms fluctuate with their menstrual cycle, or worsen around menopause.

Sympathetic Nervous System (SNS) Activation: People with fibromyalgia often have a heightened sympathetic nervous system response, otherwise known as the “fight or flight” system. The effects of chronic SNS activation on the body can increase sensitivity, and contribute to many symptoms including pain, fatigue, gut disturbances, and sleep issues.
Inflammation and immunity: increased systemic inflammation can play a sensitising role and contribute to widespread symptoms. More recently, it has been suggested there may be an auto-immune component to fibromyalgia, which is where the body’s immune system becomes reactive to itself. Fibromyalgia frequently overlaps with other autoimmune conditions like rhuematoid arthritis, Lupus, Hashimoto’s Disease and Sjogren’s syndrome.

What are the symptoms of Fibromyalgia?

Fibromyalgia symptoms can very greatly, and everyone with fibromyalgia will experience it differently.

Widespread pain that affects many areas of the body, which can be constant and severe.
Muscle stiffness/heaviness, feeling like lead
Fatigue: A feeling of severe tiredness that does not improve with rest or sleep.
Cognitive Difficulties: Often referred to as "fibro fog," this includes difficulty concentrating, memory problems, and mental cloudiness.
Sleep Disturbances: Trouble falling asleep, staying asleep, or waking up unrefreshed no matter how much you’ve slept
Headaches: Including tension headaches or migraines.
Digestive Issues: Irritable bowel syndrome (IBS) and other gastrointestinal problems.
Mood Disorders: Depression and anxiety are common in individuals with fibromyalgia.
Sensitivity to Stimuli: Increased sensitivity to light, noise, temperature, and touch.

People with fibromyalgia may notice different triggers for their symptoms, but things like too much physical activity, cold weather, stress, poor sleep, general illness, or food triggers are common. Everyone is unique and may notice different things affect them more than others.

Commonly Associated Conditions

Fibromyalgia is often seen alongside other medical conditions, including:

Chronic Fatigue Syndrome (ME/CFS)
Irritable Bowel Syndrome (IBS)
Autoimmune conditions (Sjogren’s, Hashimoto’s, rhuematoid arthritis)
Migraine and Tension Headaches
Temporomandibular Joint Disorders (TMJ)
Interstitial Cystitis or Painful Bladder Syndrome
Depression and Anxiety Disorders

Diagnosis can often be difficult as there may be many overlapping conditions that present with similar symptoms. While it used to be considered a diagnosis of exclusion (meaning that all other conditions needed to be ruled out), more recent research suggests it can co-occur with other conditions. Fibromyalgia as a diagnosis has been sometimes controversial, with some arguing it is not a “real” diagnosis because it is an invisible illness, with no specific test to differentiate it from other conditions. It’s made more complicated by the fact that many of the symptoms and suggested mechanisms are also seen in other diseases. However, awareness of fibromyalgia is growing, and it is clear that the symptoms and burden of the condition are very real, and need to be recognised and treated appropriately.

How is fibromyalgia treated?

There is no one-size-fits-all approach to fibromyalgia as everyone’s symptoms, triggers and response to treatment will be different. However, a combination of therapies and lifestyle changes can help to address the underlying mechanisms contributing to fibromyalgia symptoms and help to improve functional tolerance over time. Common treatment approaches include:

Medication: Options include analgesic medications (pain-relievers), antidepressants, and other medications that help to address pain, nervous system sensitivity, and secondary symptoms like poor sleep, depression or anxiety.
Physical Therapy: Tailored movement plans to pace and gradually increase activity can help build functional tolerance over time. This must be done carefully, and with flexibility to accommodate fluctuating symptoms and avoid flares of symptoms. Strengthening and mobility exercises may help to build fitness and functional capacity. Gentle options like hydrotherapy and yoga are often helpful when pain limits other types of exercise.
Lifestyle Modifications: Techniques such as implementing rest and self-care routines, stress management, improving sleep habits, and pacing activities can help manage symptoms.
Diet and Nutrition: Eating a varied and nutritious diet can help manage symptoms, as what we eat can have an influence on systemic inflammation. Evidence is still growing, but a Mediterranean style diet is often recommended to manage pain and for general health. Some people find relief with more specific dietary changes and elimination diets under supervision of a dietitian, particularly if they experience gastrointestinal issues or food sensitivities.
Stress Management & Nervous System Regulation: Techniques that help to reduce the “fight or flight” system can help to calm pain and other symptoms, and improve sleep quality. This can include specific mindfulness or relaxation exercises, breathing techniques, or other ways to generally help reduce stress.

Complementary Therapies: For some, other treatments like acupuncture, massage therapy, and use of TENS can be helpful for symptom relief. These should generally be used in conjunction with other management strategies, as evidence suggests that any benefits are only short-term.