Fibromyalgia | Guide to Symptoms, Diagnosis, Treatment

Joon Nah BScPT
Registered Physiotherapist
updated Feb 27, 2025

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What is Fibromyalgia?

Fibromyalgia is a chronic syndrome that presents with pain in multiple areas of the body (especially joints and muscles) with the addition of fatigue, cognitive issues, difficulty sleeping and emotional changes. Though causes of fibromyalgia are still under research, it appears to result from a multi-system issue involving genetic changes, psychological influences and environmental factors. These combine to change how the brain processes pain signals, magnifying symptoms and reducing the ability to disconnect from pain.

 

What are the symptoms of Fibromyalgia?

Fibromyalgia symptoms are different from person to person. Some patients can have milder discomfort with fewer areas affected while others can be severe with widespread symptoms throughout. The most common symptoms include:

1. Multiple areas of pain

• A constant, aching pain that is present for more than 3 months.
• The pain is both in the upper body and lower body and on both the left and right sides.

What does fibromyalgia feel like?
It is often described as a deep ache with occasional burning or shooting sensations. Affected people often mention being hypersensitive to pain (hyperalgesia).

2. Chronic fatigue

• Persistent low energy and tiredness, even after a good night’s sleep.
• It’s common to have difficulty getting to sleep and/or staying asleep.
• Patients often also report conditions such as sleep apnea or restless leg syndrome

3. Cognitive impairments

• Symptoms include issues with memory, multi-tasking and concentration.
• Brain fog or “Fibro fog” is commonly reported.

4. Secondary Symptoms

These can include:

• gastrointestinal issues such as irritable bowel syndrome
• headaches
• anxiety and depression
• parasthesias (numbness and/or tingling) in the hand, arms, legs, feet.

 

What are the causes of Fibromyalgia?

The causes of fibromyalgia are still unclear, however there is growing evidence that it is a result of several factors working together. These include:

Family History (Genetics)

There are studies that show mutations in your genes can increase your sensitivity to pain and how that pain is interpreted by your brain. These defective genes can get passed down and children of those with fibromyalgia have a higher chance of having a similar condition.

Infections

Bacterial and viral infections can possibly trigger fibromyalgia and certainly can make an existing condition feel worse. It is thought that if your body’s immune response to an infection is prolonged, this can hypersensitize your brain’s link to pain and have pain sensations continually linger. These infections can include Hepatitis C, Epstein-Barr, and Lyme disease.

Emotional Trauma

Significant stress or trauma can alter your brain’s production of hormones (such as the stress hormone cortisol) in addition to changes in the chemicals that send signals to and from nerves (neurotransmitters). These neurological changes can affect how sensitive your body and brain are to pain and through a process called “central sensitization”, can make it difficult for you to stop pain signals from getting triggered.

 

How is Fibromyalgia diagnosed?

Like most conditions, there is no single test that accurately diagnoses fibromyalgia. Rather, medical professionals use a combination of tests to rule out other conditions and rule in fibromyalgia. Here are common diagnostic methods:

Detailed Patient History

• look for widespread body pain that is present for at least 3 months
• secondary symptoms such as fatigue, cognitive issues (like brain fog and memory lapses), sleep problems, anxiety, depression
• activities of daily living that are impacted, such as your ability to work, go to school, be a partner, parent, care-giver.

Physical Exam

Some clinicians will use a body map with 18 specific tender points identified. 11 of more that are painful on a pressure test is considered a positive test for fibromyalgia. However as we’ve learned more about fibromyalgia, there is a reducing emphasis on this specific test and more on other methods.

The Widespread Pain Index (WPI) is now more commonly used in conjunction with the above pressure tests, and in some cases replacing it. The WPI focuses more on a patient’s reports of their areas of pain, rather than manual pressure on their body by the clinician.

Other Testing Scales

In combination to the WPI above, the Symptom Severity Scale (SSS) is also used which measures the severity of factors besides pain, such as fatigue, cognitive issues, and sleep disturbances. Higher scores on the WPI combined with the SSS then allow a health care professional to be more likely to assign a diagnosis of fibromyalgia.

Lab Testing and Imaging

Laboratory tests are mainly used to “rule out” fibromyalgia from other conditions.
Lab tests can help dismiss other diagnoses with similar symptoms such as:

• rheumatoid arthritis or other autoimmune joint conditions
• lupus erythematosus
• hypothyroidism
• orthopaedic issues

X-rays, ultrasounds, CT scans and MRIs will not show if a patient has fibromyalgia, rather helps to “rule out” other diagnoses

 

Who does Fibromyalgia affect? What are the risk factors?

Fibromyalgia can affect anyone, men, women and children. However the most common risk factors are:

Gender:   Women are more likely than men to develop fibromyalgia
Age:   Fibromyalgia is most common between the ages of 30 and 50.
Family History:   There’s a higher risk when other family members have fibromyalgia
Stress and Trauma:   Physical and/or emotional trauma can increase the risk for developing fibromyalgia
Other Pathologies:   An existing condition such as arthritis (rheumatoid/osteoarthritis) or lupus can increase the risk of fibromyalgia

 

What are the triggers of Fibromyalgia? What causes a flare-up?

Common triggers for fibromyalgia include:

• Over-exerting your self:  Excessive exercise or pushing too hard with physical activity
• Sedentary lifestyle: On the other hand, too little activity can make muscles and joints more susceptible to flare-ups
• Anxiety and Stress:  Particularly if unmanaged
• Poor Sleep Hygiene:  Lack of sleep or poor sleep quality
• Poor Food Choices:  Such as processed food, sugar, alcohol, and too much caffeine
• Hormonal Changes:  Particularly in women due to pregnancy, menopause and menstrual cycles.
• Infections:  Viral and bacterial infections
• Weather Changes:  Especially sudden changes in temperature and humidity, or in colder climates.

 

How do you treat Fibromyalgia?

Treatment for fibromyalgia is achieved through use of a group of strategies rather than one single approach. The aim of treatment is to manage or reduce symptoms, to improve the ability to perform functions or specific activities and to generally improve quality of life. The following are common treatments for fibromyalgia:

Physiotherapy

Fibromyalgia rehabilitation focuses on pain reduction, improved mobility and improved function. Physiotherapy aims to improve joint and soft tissue flexibility, increase muscle strength and core strength, optimize movement patterns to reduce stress on the body. Physio can also reduce pain through manual therapy and modalities such as acupuncture/dry-needling and heat. Physiotherapists will also provide patients with education on posture, activity and how to interact with your environment safely and effectively.
They will also be a great resource to have in your back pocket to help you manage the inevitable fibromyalgia flare-ups.

Medication

Common medications to help with fibromyalgia include:

• Acetaminophen, ibuprofen and naproxen to help with pain and inflammation
• SSRIs, SNRIs, Benzodiazepines (e.g. Zoloft, Effexor, Ativan) to address mood disorders
• Gabapentin to help with nerve-related pain

Psychotherapy

The significant effects that anxiety and depression has on fibromyalgia must be managed in order to promote lasting improvement in symptoms. Cognitive Behavioral Therapy (CBT) is the most common type of therapy that can help manage emotional stress and improve coping strategies.

Lifestyle Modifications

Small changes to a variety of lifestyle factors can add up to significant improvements in overall fibromyalgia symptoms.

Improve your diet:  avoid processed foods, high sugar and saturated fat; rather increase your intake of whole foods, high-fiber and lean proteins.
Better sleep hygiene:  stay consistent with your sleep and wake times, have a wind-down night-time routine, avoid food late at night, use meditation
Exercise:  It could be as simple as walking every day, to regular sessions of prescribed resistance exercise and zone 2 cardio. These could have major benefits for reducing fibromyalgia symptoms.

 

How do you treat a fibromyalgia flare-up?

Flare-ups are common to every fibromyalgia sufferer and they can be debilitating. When you experience a “fibro-attack”, you should be looking to gradually reduce pain and manage symptoms while identifying and avoiding aggravating factors.
Here are some tips:

• Reflect on why you are experiencing a flare-up and commit to distancing yourself from it (if possible).
• Back off on any higher-paced physical activities. Reduce the stress/strain on your muscles and joints BUT periodic low level activity (like short walks) are better than no activity.
• Gentle stretching can help. Your physiotherapist can provide you with stretches that are safe and beneficial for when your fibromyalgia flares up.
• Hot and cold packs can help with pain reduction, but some find one works better than the other. Experiment with both to see what your body prefers.
• Follow your doctor’s advice for medications that you should have on hand for your flare-ups.
• Many pain symptoms can be significantly modified by your mood and levels of anxiety. Learn deep breathing and meditation techniques and practice them often. These can usually be more effective and longer lasting than pain medications, without the risks of side-effects.
• Make an appointment with your physiotherapist or massage therapist. They can help with advice on how to reduce your symptoms more quickly and apply techniques for reducing pain ASAP.

 

When should you get physiotherapy for fibromyalgia?

Here’s when it makes sense to see a physiotherapist:

• when your symptoms are interfering with any of the activities of daily life (working, going to school, participating in physical activities, socializing with friends and family, cooking/cleaning, maintaining your role as a partner, parent etc).
• when you start to notice any changes in the mobility of your arms, legs, neck or back
• when you’re unable to manage flare-ups on your own
• if you don’t want to use medication as the primary tool for symptom management;  want to reduce meds usage;  or want to limit increasing medication dosage.
• if you’re interested in preventative management of your condition before it gets more difficult to treat. Physiotherapy is helpful at any stage of fibromyalgia but earlier management works more effectively than later.

 

Can you prevent fibromyalgia?

As mentioned earlier, fibromyalgia can be hereditary in some cases. If a family member has been diagnosed, there may be some concern that others related to them could be similarly affected. Unfortunately, there is no way to prevent fibromyalgia.

However having a genetic link to an individual with fibromyalgia can allow others to try to minimize the risk factors for this condition. Additionally, earlier diagnosis of fibromyalgia is more likely with an increase in awareness, which means positive action can be taken sooner.

 

What is your prognosis if you have fibromyalgia? Can it be cured?

Fibromyalgia is considered a chronic condition that has no cure at this time. However in many cases it can be so effectively managed that it can potentially have minimal to no impact on a person’s quality of life. Though these results certainly vary from person to person.

It is important to note that fibromyalgia is not a physically progressive condition, which means that it does not cause significant tissue damage to muscles and joints over time. Additionally patients have a considerable amount of control over the negative effects of fibromyalgia. Being mindful of preventative strategies, handling flare-ups and adjusting your lifestyle can make a world of difference.

 

Cornerstone Physiotherapy has experienced and highly-skilled physiotherapists throughout the Greater Toronto Area. If you’d like some assistance improving your fibromyalgia symptoms, we’d love to help. Contact us today and get us on your team!