Fibromyalgia (fibromyalgia syndrome, FMS) is a chronic pain condition in which those affected suffer from widespread pain in several body regions - often accompanied by pronounced fatigue, sleep disturbances and cognitive impairments. It is not an inflammatory or degenerative disease of the joints or muscles.¹
According to current knowledge, fibromyalgia is understood as a disorder of central pain processing: the nervous system reacts oversensitively to pain stimuli (central sensitization). The disease is real, measurable and not imaginary - even if it was often not taken seriously in the past.¹˒²
Not curable - but treatable well
The disease is not curable, but treatable well. The S3 guideline recommends a multimodal therapy approach with movement as the core building block.¹
2. Symptoms
Core symptoms
Chronic pain in several body regions - often changing in intensity and location; those affected often describe the pain as deep, burning, boring or pulling
Fatigue and exhaustion - often the most burdensome symptom; sleep often brings no recovery
The exact cause of fibromyalgia is, according to current knowledge, not fully clarified. An interplay of several factors is assumed.¹
Central sensitization: The nervous system processes pain stimuli more strongly - the pain threshold is lowered. According to current knowledge, this is the central mechanism.
Genetics: A familial clustering is known. Genetic factors influence pain processing.
Stress and trauma: Chronic stress, psychological burdens and traumatic experiences can favor the development.
Sleep disturbances: Non-restorative sleep can be both a cause and a consequence - a vicious circle.
Lack of exercise: Physical inactivity can increase pain sensitivity.
Not the cause
Fibromyalgia is not an inflammatory disease, not an autoimmune disease and not a psychiatric disorder - even if psychological comorbidities are common.
4. Diagnosis
The diagnosis of fibromyalgia is a clinical diagnosis - there is no laboratory value and no imaging that can prove or rule out fibromyalgia.¹
Symptom-based diagnosis: Chronic pain in several body regions over at least three months, accompanied by fatigue and/or sleep disturbances and/or cognitive impairments.
Standardized criteria: The current ACR criteria (2010/2011) use the Widespread Pain Index (WPI) and the Symptom Severity Score (SSS) - the former tender points are no longer mandatory.
Exclusion diagnostics: Other diseases with similar symptoms must be ruled out: inflammatory rheumatic diseases, thyroid diseases, vitamin D deficiency, iron deficiency and others. Basic laboratory tests (blood count, CRP, ESR, TSH, vitamin D) are generally recommended.
Capture comorbidities: Depression, anxiety disorders, sleep disturbances, irritable bowel syndrome - must be treated as well.
When the symptoms fit, the diagnosis should be made
The diagnosis of fibromyalgia often takes years. Many of those affected feel that they are not taken seriously. When the symptoms fit and other causes have been ruled out, the diagnosis should be made and a targeted therapy initiated - even if the laboratory values are unremarkable.
5. Therapy: what helps
The S3 guideline recommends a multimodal therapy approach. Movement is the core building block.¹
Core building blockMovement
Endurance training
Regular moderate endurance training (walking, swimming, cycling, aqua aerobics) is the best-studied and most effective single measure for fibromyalgia. Recommendation: at least two to three times per week. Start slowly, increase gradually.¹
Strength training
Moderate strength training can improve pain and functional capacity.
RecommendedPsychological therapy
CBT (cognitive behavioral therapy)
Can improve pain coping, functional capacity and quality of life. Is recommended by the guideline.¹
With a severe courseMultimodal pain therapy
An interdisciplinary setting
A combination of movement, psychotherapy, relaxation and, if needed, medications in an interdisciplinary setting. Is recommended with a severe course.
SupplementaryRelaxation techniques
Progressive muscle relaxation, yoga, tai chi, qi gong
Can improve pain and well-being.
SupplementaryMedications
There is no medication that is specifically approved for fibromyalgia.
Amitriptyline (low-dosed), duloxetine
Can be considered with strong pain and/or accompanying depression. NSAIDs and opioids are generally NOT recommended with fibromyalgia.¹
FoundationPatient education
Information about the disease
Information about the disease, its mechanisms and the treatment options is an important building block.
6. Therapy: what is NOT recommended
The guideline expressly lists therapies that are not recommended with fibromyalgia.¹
Opioids - not effective with fibromyalgia and associated with considerable risks
NSAIDs (e.g. ibuprofen) as a long-term medication - not effective with fibromyalgia
Cortisone - not effective, since there is no inflammation
Surgical procedures on the spine or on joints because of fibromyalgia pain
Purely passive therapies as a sole measure (massage, acupuncture, magnetic field therapy)
7. Living with fibromyalgia
Movement: The most important building block. Regular, moderate, suitable for everyday life. It does not have to be perfect - every bit of movement counts.
Pacing: Consciously plan activities and rest phases. Do not overdo it on good days, do not give up on bad days. Consistency is more important than maximum performance.
Self-help: The German Fibromyalgia Association (DFV) e. V. and the German Rheumatism League offer advice and self-help groups.
Mental health: Anxiety, depression and frustration are common with fibromyalgia. Psychotherapy or psychological counseling can help - this does not mean that the pain is imaginary.
How brite helps you with fibromyalgia
Pain that wanders. Days when everything works, days when nothing works. Amitriptyline in the evening, duloxetine in the morning, plus maybe a sleep aid and accompanying medication. Fibromyalgia demands patience and an overview - brite helps you keep both.
Intake reminder - amitriptyline in the evening, duloxetine in the morning, plus accompanying medications: brite reminds you punctually. Especially with fibro fog, a reliable reminder is worth its weight in gold. Set up a reminder
Interaction check - duloxetine plus a triptan? Plus tramadol? Amitriptyline plus other antidepressants? With fibromyalgia, several active ingredients often come together - brite shows what fits together and what does not. Check now
Health history - document pain intensity, sleep quality, exercise volume and mood over time. At the next appointment, show what really happened - instead of having to reconstruct it from memory, which is difficult anyway with fibro fog. Track your history
Digital medication plan - all medications clearly organized for pain medicine, rheumatology, GP and psychotherapy. Helpful because, with fibromyalgia, several disciplines are often involved in care. Go to medication plan
Yes. Fibromyalgia is a recognized disease with its own ICD-10 diagnosis M79.7. The central pain processing is demonstrably altered in those affected. Fibromyalgia is not imaginary and not a purely psychological problem.¹
Not according to current knowledge. Fibromyalgia is a chronic disease. With multimodal therapy (movement, CBT, if needed medications), the symptoms can, however, be improved considerably in many of those affected.¹
NSAIDs (e.g. ibuprofen) and opioids are generally not effective with fibromyalgia, because the pain does not arise through an inflammation or tissue damage, but through an altered central pain processing. Amitriptyline or duloxetine can help in certain people affected, but work through other mechanisms.¹
Moderate endurance training (walking, swimming, aqua aerobics, cycling) is the best-studied single measure. Important: start slowly and increase gradually. The best sport is the one you do regularly and enjoy.¹
Generally rheumatology, pain medicine, general medicine or psychosomatic medicine. With a severe course, a multimodal pain therapy in a specialized center is recommended.
A colloquial term for the cognitive impairments with fibromyalgia: difficulties concentrating, memory problems, mental slowness. Fibro fog can considerably impair everyday life and the ability to work.
The former ACR criteria (1990) used specific pressure points (tender points) as a diagnostic criterion. The current criteria (2010/2011) use the Widespread Pain Index and the Symptom Severity Score instead - the tender-point examination is no longer mandatory.
No. Fibromyalgia is a disorder of central pain processing - not a psychiatric disorder. Psychological comorbidities (depression, anxiety) are common and can intensify the symptoms, but are not the cause. Psychotherapy can nevertheless help to improve pain coping.
This article is for general information and does not replace medical advice, diagnosis or therapy. Fibromyalgia medications should not be stopped or dosed on one's own. The treatment planning is always determined individually by the treating practice.
