Stiffness is a Core Symptom of Fibromyalgia
Yes, stiffness is one of the primary signs and symptoms of fibromyalgia syndrome. 1 Fibromyalgia is characterized by chronic widespread musculoskeletal pain that may be associated with muscle or joint stiffness, along with other symptoms including fatigue, sleep disturbances, anxiety, and depression.
Key Symptoms of Fibromyalgia
Fibromyalgia presents with a constellation of symptoms that significantly impact quality of life:
- Widespread pain: Affects all four body quadrants 2
- Stiffness: Particularly morning stiffness 1, 3
- Fatigue: Often severe and persistent 2
- Non-refreshed sleep/sleep disturbances 2, 4
- Cognitive impairment: Often called "fibro fog" 2
- Mood disturbances: Including anxiety and depression 2, 1
Clinical Presentation and Diagnosis
Fibromyalgia is diagnosed clinically based on the pattern of symptoms. The diagnostic approach has evolved from requiring tender points to focusing on:
- Chronic widespread pain affecting all four body quadrants
- Multiple somatic symptoms
- Absence of other conditions that would explain the symptoms 2
The condition can present with different predominant symptoms:
- Pain-predominant
- Fatigue-predominant
- Cognitive-predominant
- Mood-predominant 2
Pathophysiological Mechanisms Related to Stiffness
Stiffness in fibromyalgia appears to be related to several underlying mechanisms:
- Central sensitization: Hyperexcitability at spinal/brainstem level 2, 1
- Peripheral sensitization: Alterations in peripheral nociceptor signaling 1
- Inflammatory and immune mechanisms: Developing concurrently with sensitization 1
Management Strategies for Stiffness and Other Symptoms
Patients with fibromyalgia often develop strategies to cope with stiffness and other symptoms:
- Pacing/planning: Managing activities to avoid symptom exacerbation 5
- Physical exercise: Both land-based and water-based exercises can help reduce stiffness 1
- Medications: Several medication classes have shown efficacy 3, 4
Important Clinical Considerations
- Stiffness in fibromyalgia is often worse in the morning 3
- The diagnosis of fibromyalgia is often delayed, taking more than 2 years with an average of 3.7 consultations with different physicians 2
- Stiffness and other symptoms significantly impact physical functioning, social relationships, work productivity, and overall quality of life 2
Common Pitfalls in Recognition and Management
- Misattribution: Stiffness may be incorrectly attributed to other rheumatological conditions
- Incomplete assessment: Focusing only on pain without addressing associated stiffness
- Inadequate treatment: Not addressing the multidimensional nature of fibromyalgia symptoms
- Overlooking non-pharmacological approaches: Physical therapy, exercise, and other non-pharmacological interventions are essential components of care 1
In conclusion, stiffness is indeed a significant and recognized symptom of fibromyalgia syndrome, often manifesting as morning stiffness, and should be addressed as part of the comprehensive management approach to this condition.