What are the signs and symptoms of fibromyalgia?

Signs and Symptoms of Fibromyalgia

Fibromyalgia is characterized primarily by chronic widespread musculoskeletal pain, along with fatigue, non-refreshed sleep, mood disturbance, and cognitive impairment, which significantly impact quality of life and emphasize its heterogeneous and complex nature. 1

Core Symptoms

• Chronic widespread pain: The dominant symptom, affecting multiple body regions with hyperalgesia (increased pain sensitivity) and allodynia (pain from normally non-painful stimuli) 1, 2
• Fatigue: Persistent tiredness that is not relieved by rest, often described as overwhelming 1, 3
• Sleep disturbances: Non-refreshed sleep and poor sleep quality, contributing to daytime fatigue 1, 4
• Cognitive dysfunction: Often called "fibro fog," includes problems with memory, concentration, and mental clarity 2, 4
• Mood disorders: Depression and anxiety commonly co-occur with fibromyalgia 2, 5

Associated Symptoms

• Headaches and migraines: Frequently reported by patients with fibromyalgia 2, 6
• Gastrointestinal symptoms: Variable bowel habits, diffuse abdominal pain, and symptoms resembling irritable bowel syndrome 1, 3
• Urinary symptoms: Increased frequency and urgency 1, 7
• Morning stiffness: Muscle and joint stiffness, particularly upon waking 3, 4
• Paresthesias: Numbness and tingling sensations in extremities 4, 7
• Sensitivity to environmental factors: Heightened sensitivity to temperature, noise, bright lights, and odors 8, 4

Diagnostic Considerations

• Symptoms typically persist for years and can be debilitating for many patients 5, 7
• Diagnosis is often delayed, taking more than 2 years with an average of 3.7 consultations with different physicians 1
• No specific laboratory or imaging findings confirm the diagnosis; it remains primarily clinical 6, 8
• The American College of Rheumatology criteria focus on widespread pain and associated symptoms 2, 6

Clinical Presentation Patterns

• Symptom severity fluctuates over time, with periods of exacerbation and relative improvement 8, 3
• Symptoms are often exacerbated by stress, weather changes, physical activity, or poor sleep 3, 4
• The combination and severity of symptoms vary significantly between individuals, highlighting the heterogeneous nature of the condition 1, 8

Impact on Function and Quality of Life

• Significant impact on daily activities and quality of life 2, 7
• Reduced physical functioning and increased disability 5, 4
• Social and occupational impairment due to persistent symptoms 8, 3
• High healthcare utilization, averaging over $2000 per patient per year 1, 7

Common Pitfalls in Symptom Recognition

• Symptoms overlap with many other conditions, leading to diagnostic challenges 6, 4
• The absence of objective findings on standard laboratory tests or imaging can lead to dismissal of symptoms 8, 5
• The fluctuating nature of symptoms may cause inconsistent clinical presentations 3, 4
• The presence of comorbid conditions can complicate symptom attribution and management 2, 7