What are the symptoms and signs of fibromyalgia?

Fibromyalgia Symptoms and Signs

Fibromyalgia is characterized by chronic widespread pain, fatigue, sleep disturbances, cognitive problems, and mood disorders, significantly impacting patients' quality of life. 1 These core symptoms form the foundation of the clinical presentation that physicians should recognize when evaluating potential fibromyalgia cases.

Primary Clinical Manifestations

Pain Characteristics

• Widespread musculoskeletal pain: Affects all four quadrants of the body for at least 3 months 2
• Pain does not cause true muscle weakness 1
• May be accompanied by muscle or joint stiffness 3
• Normal inflammatory markers (ESR, CRP) and creatine kinase levels 1

Associated Symptoms

• Fatigue: Persistent, often debilitating
• Sleep disturbances: Non-restorative sleep, insomnia
• Cognitive dysfunction: Often called "fibro fog" - includes memory problems, difficulty concentrating
• Mood disorders: Primarily anxiety and depression (present in 50-55% of cases) 1

Diagnostic Considerations

Common Comorbidities

• Chronic fatigue syndrome (55-60% of cases) 1
• Anxiety and depression (50-55% of cases) 1
• Other somatic functional syndromes 1

Laboratory Findings

• Normal inflammatory markers (ESR, CRP) - helps distinguish from inflammatory conditions 1
• Normal creatine kinase (CK) - helps distinguish from myositis 1

Diagnostic Challenges

• Diagnosis requires an average of 3.7 consultations with different doctors 1
• No specific diagnostic biomarkers exist 3
• Diagnosis is primarily clinical, based on symptom patterns

Pathophysiological Basis

The symptoms of fibromyalgia stem from several underlying mechanisms:

• Central sensitization: Altered pain processing in the central nervous system 3
• Peripheral sensitization: Changes in peripheral nociceptor signaling 3
• Inflammatory and immune mechanisms that develop alongside sensitization processes 3
• Genetic predisposition in 40-50% of cases 1

Clinical Pearls and Pitfalls

• Fibromyalgia is more prevalent in women than men 3
• Most common between ages 30-35 but can occur at any age 3
• It's the third most common musculoskeletal disorder after lower back pain and osteoarthritis 3
• Key pitfall: Mistaking fibromyalgia for conditions requiring different treatment approaches, such as inflammatory arthritis, myositis, or polymyalgia rheumatica 1
• Important distinction: Fibromyalgia causes pain but not true muscle weakness 1

Differential Diagnosis Considerations

When evaluating localized shoulder pain, consider:

• Rotator cuff tendinitis/injury
• Inflammatory myositis
• Polymyalgia rheumatica
• Immune checkpoint inhibitor-related arthritis 1

Other central pain disorders that may overlap with fibromyalgia:

• Irritable bowel syndrome
• Chronic fatigue syndrome
• Migraine 4

Understanding the constellation of symptoms that characterize fibromyalgia is essential for accurate diagnosis and effective management, as complete symptom remission is rare and requires a multimodal treatment approach 1.