Somatic Symptoms Associated with Fibromyalgia
Fibromyalgia is characterized by widespread pain accompanied by multiple somatic symptoms including fatigue, sleep disturbances, cognitive dysfunction, and various other systemic manifestations across multiple body systems.
Primary Somatic Symptoms
Pain-Related Symptoms
- Widespread musculoskeletal pain (the defining feature)
- Hyperalgesia (increased sensitivity to pain)
- Allodynia (pain from stimuli that normally don't cause pain)
- Muscle stiffness and tenderness
Neurological Symptoms
- Cognitive dysfunction ("fibro fog")
- Headaches and migraines
- Paresthesias (numbness and tingling sensations)
- Sensitivity to light, sound, and temperature changes
Sleep-Related Symptoms
- Non-restorative sleep
- Sleep disturbances
- Insomnia
- Morning stiffness upon waking
Fatigue-Related Symptoms
- Persistent fatigue
- Post-exertional malaise
- Reduced physical endurance
- General weakness
Overlapping Syndromes and Associated Symptoms
Gastrointestinal Symptoms
- Irritable bowel syndrome (IBS) symptoms (found in 50-70% of fibromyalgia patients) 1
- Abdominal pain and cramping
- Alternating constipation and diarrhea
- Bloating and distension
Urogenital Symptoms
- Urinary frequency and urgency
- Nocturia (frequent nighttime urination)
- Bladder pain
- Dyspareunia (painful intercourse) 1
Mood and Psychological Symptoms
- Anxiety
- Depression
- Mood disturbances
- Stress sensitivity
Other Common Somatic Symptoms
- Temporomandibular joint disorder (TMJ) 1, 2
- Chronic fatigue syndrome/myalgic encephalomyelitis overlap 1, 2
- Backache 1
- Dizziness and balance problems
- Dry eyes and mouth
- Chemical sensitivities
- Skin sensitivities and rashes
Pathophysiological Basis
The multiple somatic symptoms in fibromyalgia appear to be related to central sensitization, which involves:
- Altered central nervous system pain processing 2
- Amplified pain perception
- Hyperexcitability of pain pathways
- Reduced pain inhibition 3
Clinical Significance
The presence of multiple somatic symptoms beyond pain is clinically significant because:
- They contribute substantially to reduced quality of life
- They help differentiate fibromyalgia from other pain conditions
- They guide treatment approaches that must address multiple symptom domains
- They suggest shared pathophysiological mechanisms with other central sensitivity syndromes 2
Treatment Implications
Treatment should target both the widespread pain and associated somatic symptoms:
- SNRIs (duloxetine, milnacipran) for pain and depression 4
- Pregabalin for pain and sleep disturbances 1, 4
- Amitriptyline for pain and sleep issues 4
- Cognitive behavioral therapy for multiple symptom domains 1, 4
- Physical exercise programs tailored to individual capabilities 4
- Mindfulness-based therapies 1
Understanding the full spectrum of somatic symptoms in fibromyalgia is essential for accurate diagnosis and effective management of this complex condition.