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What is Fibromyalgia Syndrome?

From the Arthritis Foundation:

Fibromyalgia syndrome is a common form of generalized muscular pain and fatigue that is believed to affect approximately 2 percent of the U.S. population, or 5 million people.  The word fibromyalgia means pain in the muscles and in the tissues that connect bones, ligaments and tendons.  The cause of fibromyalgia is unknown.

Although people with fibromyalgia may ache like people with a joint disease, fibromyalgia does not cause inflammation, and so it is not a form of arthritis (which is characterized by joint inflammation). Instead, fibromyalgia is a form of soft tissue rheumatism.

Fibromyalgia syndrome cannot be diagnosed with laboratory tests.  The results of X-rays, blood tests and muscle biopsies look normal.  Therefore, the diagnosis is based on a clinical examination by a doctor of a person’s symptoms.

In 1990, the American College of Rheumatology (ACR), an association of approximately 5,000 rheumatologists (specialists in musculoskeletal diseases and immune disorders), developed guidelines to help doctors diagnose fibromyalgia.  According to the ACR criteria, a person has fibromyalgia if he or she has a history of widespread pain (of at least three months’ duration), and pain in 11 of the body’s 18 specific tender point sites.

Symptoms and Signs

Widespread musculoskeletal pain is the most prominent symptom of fibromyalgia. The pain generally occurs throughout the body, although it may start in one region, such as the neck and shoulders, and may spread over a period of time.

Fibromyalgia pain has been described in a variety of ways, such as burning, gnawing, aching, or as stiffness or soreness. It often varies according to time of the day, activity level, weather, sleep patterns and stress.  Most people with fibromyalgia say that some degree of pain always is present.  They feel the pain mainly in their muscles. For some people with fibromyalgia, the pain may be quite severe.

Although the results of a general physical examination usually are normal, and individuals may look healthy, a specific examination of the muscles of people with fibromyalgia reveals especially tender areas at locations known as tender points.  Tender points are areas of the body that are painful when pressed.  The presence and pattern of these characteristic tender points separate fibromyalgia from other conditions.  Not all physicians know how to check for tender points, but most rheumatologists can perform a tender point evaluation.

Fatigue and Sleep Disturbances

About 90 percent of people with fibromyalgia describe moderate or severe fatigue, decreased endurance, or the kind of exhaustion felt with the flu or lack of sleep.  Sometimes the fatigue is a greater problem than pain for people with fibromyalgia.

Most people with fibromyalgia experience sleeping problems.  Although they may be able to fall asleep without major difficulty, they may sleep lightly and wake up frequently during the night.  They often wake up feeling tired, even after sleeping through the night.  The resulting fatigue can range from listlessness and decreased endurance to exhaustion. The level of fatigue experienced may vary during the day and from one day to the next.

Nervous System Symptoms

Changes in mood are common symptoms of fibromyalgia.  Many individuals feel sad or down, although only about 25 percent are considered clinically depressed.  People with fibromyalgia also may feel anxious.  Some researchers think there is a link between fibromyalgia and certain forms of depression and chronic anxiety.  However, any person with a chronic illness – not just fibromyalgia – may feel depressed at times while struggling with their pain and fatigue.

People with fibromyalgia may report difficulty concentrating or performing simple mental tasks.  There is no evidence that these problems become more serious over time, and they tend to come and go.  Similar problems have been noted in many people with mood changes, sleep disturbances or other chronic illnesses.

Other Problems

Headaches, especially tension headaches and migraine headaches, are common symptoms of fibromyalgia, as are abdominal pain, bloating and alternating constipation and diarrhea (irritable bowel syndrome or spastic colon).  Bladder spasms and irritability may cause urinary urgency or frequency.

Some studies of people with fibromyalgia have reported other problems, such as cramps, dizziness and pain in the temporomandibular joint (TMJ), which attaches the lower jaw to the skull on each side of the face.

Contact the Arthritis Foundation for more information on Fibromyalgia at

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From the Fibromyalgia Network:


For the most part, routine laboratory testing reveals nothing about fibromylagia or chronic fatigue syndrome.  However, upon physical examination, the fibromyalgia patient will be sensitive to pressure in certain areas of the body called tender points.  To meet the diagnostic criteria, patients must have:

A. Widespread pain in all four quadrants of their body for a minimum of three months

B. At least 11 of the 18 specified tender points
(see diagram)

These 18 sites used for diagnosis cluster around the neck, shoulder, chest, hip, knee and elbow regions.  Over 75 other tender points have been found to exist, but are not used for diagnostic purposes.

*The 18 Tender Point Locations for FMS
on "The Three Graces" Masterpiece.

While many chronic pain syndromes display symptoms that overlap with fibromyalgia, the 1990 ACR multi-center criteria study (published in the February 1990 issue of Arthritis and Rheumatism) evaluated a total of 558 patients, of which 265 were classified as controls.  These control individuals weren't your typical healthy "normals."  They were age and sex matched patients with neck pain syndrome, low back pain, local tendinitis, trauma-related pain syndromes, rheumatoid arthritis, lupus, osteoarthritis of the knee or hand, and other painful disorders.  These patients all had some symptoms that mimic FMS, but the trained examiners were not foiled--they hand-picked the FMS patients out of the "chronically ill" melting pot with an accuracy of 88%.  FMS is not a wastebasket diagnosis!

Although the above criteria focuses on tender point count, a consensus of 35 FMS experts published a report in 1996 saying that a person does not need to have the required 11 tender points to be diagnosed and treated for FMS.  This criteria was created for research purposes and many people may still have FMS with less than 11 of the required tender points as long as they have widespread pain and many of the common symptoms associated with FMS.  Commonly associated symptoms include:

    irritable bowel (e.g., diarrhea, constipation, etc.)
    sleep disorder (or sleep that is unrefreshing)
    chronic headaches (tension-type or migraines)
    jaw pain (including TMJ dysfunction)
    cognitive or memory impairment
    post-exertional malaise and muscle pain
    morning stiffness (waking up stiff and achy)
    menstrual cramping
    numbness and tingling sensations
    dizziness or lightheadedness
    skin and chemical sensitivities

For more information, contact the Fibromyalgia Network at

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