Signs and Symptoms of Fibromyalgia
Fibromyalgia is characterized by chronic widespread pain as the dominant symptom, along with fatigue, non-refreshed sleep, mood disturbance, and cognitive impairment, which significantly impact quality of life and reflect the heterogeneous and complex nature of this condition. 1
Primary Symptoms
Pain Characteristics
- Widespread pain: Affects all four quadrants of the body for at least 3 months
- Hyperalgesia: Increased sensitivity to pain
- Allodynia: Pain from stimuli that normally don't cause pain
Associated Core Symptoms
- Fatigue: Persistent, often severe
- Sleep disturbances: Non-refreshed sleep, insomnia
- Cognitive dysfunction ("fibro fog"):
- Memory problems
- Difficulty concentrating
- Mental clarity issues
Secondary Symptoms
Mood Disturbances
- Depression
- Anxiety
- Mood fluctuations
Neurological Symptoms
- Headaches/migraines
- Paresthesias (tingling/numbness)
Gastrointestinal Issues
- Variable bowel habits
- Diffuse abdominal pain
- Symptoms resembling irritable bowel syndrome
Urological Symptoms
- Urinary frequency
- Symptoms resembling interstitial cystitis
Other Common Symptoms
- Morning stiffness
- Temporomandibular joint dysfunction
- Sensitivity to environmental factors (temperature, noise, light)
Diagnostic Considerations
The diagnosis of fibromyalgia has evolved from the traditional tender point examination (11 of 18 specific tender points) to a more comprehensive assessment of symptom severity and distribution 1, 2. Current diagnostic approaches focus on:
- Chronic widespread pain affecting all four body quadrants
- Multiple somatic symptoms
- Absence of other conditions that would explain the symptoms
Symptom Patterns and Subgroups
Fibromyalgia presents differently among patients, with varying predominant symptoms:
- Pain-predominant: Focus on widespread musculoskeletal pain
- Fatigue-predominant: Overwhelming exhaustion as primary complaint
- Cognitive-predominant: "Fibro fog" as most disabling feature
- Mood-predominant: Depression/anxiety as leading symptoms
Impact on Quality of Life
The constellation of fibromyalgia symptoms significantly impacts:
- Physical functioning
- Social relationships
- Work productivity
- Psychological wellbeing
- Overall quality of life
Pathophysiological Mechanisms
Current understanding suggests fibromyalgia involves:
- Central sensitization with hyperexcitability at spinal/brainstem level
- Altered pain perception
- Dysfunction in pain-inhibitory systems
- Potential genetic predisposition
- Biopsychosocial factors including stress response 3, 4
Clinical Significance
Early recognition of this symptom pattern is crucial as diagnosis often takes >2 years with an average of 3.7 consultations with different physicians 1. Proper identification of these symptoms can reduce unnecessary healthcare utilization and lead to appropriate management strategies.
Understanding this comprehensive symptom profile is essential for proper diagnosis and developing targeted treatment approaches that address the multiple dimensions of this complex condition.