Does fibromyalgia cause paresthesias?

Does Fibromyalgia Cause Paresthesias?

Yes, paresthesias (numbness and tingling) are a common symptom of fibromyalgia, occurring in approximately 84% of patients, though they are not caused by actual nerve damage and objective neurologic testing is typically normal. 1

Clinical Presentation of Paresthesias in Fibromyalgia

Paresthesias in fibromyalgia present with specific patterns that help distinguish them from true neurologic disease:

• Bilateral upper and lower extremity paresthesias are the most common distribution, or bilateral upper extremity involvement alone 1
• The paresthesias are persistent, with 98% of patients (56 of 57) continuing to report symptoms at 25-month follow-up 1
• These symptoms occur alongside other fibromyalgia features including widespread pain, fatigue, sleep disturbance, and cognitive difficulties 2
• Additional neurologic-mimicking symptoms include headaches, ocular and vestibular complaints, and esophageal dysmotility 3

Key Diagnostic Distinction: No Objective Nerve Damage

The critical clinical point is that paresthesias in fibromyalgia are subjective symptoms without objective neurologic abnormalities:

• Electromyography (EMG) testing is normal in 89% of fibromyalgia patients with paresthesias (32 of 36 tested) 1
• Patients lack concurrent diseases commonly associated with peripheral neuropathy 1
• This distinguishes fibromyalgia from true neuropathic pain conditions, which show "cold burning pain" in glove-and-stocking distribution with allodynia and small nerve fiber pathology 4

Mechanism: Central Sensitization, Not Peripheral Nerve Injury

Fibromyalgia is recognized as a condition with abnormal pain processing and central sensitization rather than peripheral tissue damage 4, 5:

• The paresthesias arise from altered nociception despite no clear evidence of actual nerve damage 4
• This classifies fibromyalgia as a "nociplastic" pain condition, distinct from neuropathic or inflammatory pain 4
• Biochemical, hormonal, and neurotransmitter abnormalities have been identified, making fibromyalgia a clearly identifiable condition 3

Clinical Pitfall: Avoiding Unnecessary Neurologic Testing

The presence of paresthesias in fibromyalgia may mimic neurologic disorders and lead to excessive testing 1:

• Judicious use of neurodiagnostic tests is indicated—not routine extensive workup 1
• Consider EMG/nerve conduction studies only if: (1) paresthesias follow a dermatomal or peripheral nerve distribution, (2) objective weakness or reflex changes are present, or (3) risk factors for true neuropathy exist (diabetes, B12 deficiency, toxin exposure) 1
• Normal laboratory results and imaging support rather than exclude the diagnosis of fibromyalgia 5

Management Approach for Paresthesias in Fibromyalgia

Since paresthesias are part of the fibromyalgia symptom complex, they respond to standard fibromyalgia treatment rather than neuropathic pain medications:

First-line treatment focuses on non-pharmacological interventions 5, 6:

• Patient education about central sensitization and the non-damaging nature of symptoms 5
• Graduated aerobic exercise starting at low intensity (10-15 minutes of walking, swimming, or cycling 2-3 times weekly) 5
• Cognitive behavioral therapy, particularly for patients with anxiety or maladaptive coping strategies 5, 6

Second-line pharmacological options if symptoms persist after 4-6 weeks 5, 6:

• Amitriptyline 10-50 mg at bedtime (start 10 mg, increase by 10 mg weekly) addresses both pain and sleep disturbance 5, 6
• Duloxetine 30-60 mg daily or pregabalin 75-300 mg daily may reduce overall fibromyalgia symptoms including paresthesias 5, 6
• Tramadol can be considered for refractory pain 4, 6

Avoid medications that lack efficacy and cause harm 4, 5, 6:

• Corticosteroids are not recommended 4, 5, 6
• Strong opioids are not recommended 4, 5, 6