Fibromyalgia

Diagnosis

To diagnose fibromyalgia, a healthcare professional begins by discussing your symptoms and reviewing your medical history. A physical exam is performed to check for the main sign of fibromyalgia — widespread pain throughout the body lasting at least three months.

You must have pain in at least four of the following five areas:

• Left upper region, including the shoulder, arm, or jaw

• Right upper region, including the shoulder, arm, or jaw

• Left lower region, including the hip, buttock, or leg

• Right lower region, including the hip, buttock, or leg

• Axial region, which includes the neck, back, chest, or stomach area

Tests

Blood tests or imaging tests may be done to rule out other conditions that cause similar symptoms. These tests help ensure that your pain and fatigue are not due to another illness.

Conditions that can cause similar ongoing pain and tiredness include:

• Rheumatoid arthritis

• Lupus

• Myalgic encephalomyelitis or chronic fatigue syndrome

You may also need additional tests to check for conditions that can occur along with fibromyalgia. For example, if sleep apnea is suspected, your doctor may recommend an overnight sleep study.

Common tests may include a complete blood count (CBC) or an erythrocyte sedimentation rate (sed rate) test.

Treatment

Treatment for fibromyalgia often combines medication and non-drug approaches. The goal is to manage symptoms, reduce pain, improve sleep, and enhance overall quality of life. Because fibromyalgia affects people differently, a combination of treatments may be most effective.

Medicines

Medications can help relieve pain, improve sleep, and reduce fatigue.

• Pain relievers such as acetaminophen, ibuprofen, or naproxen sodium may ease pain and discomfort. Opioid pain medicines are not recommended because they can cause dependence and worsen pain over time.

• Antidepressants such as duloxetine and milnacipran may help reduce pain and fatigue, even in people without depression. Amitriptyline or the muscle relaxant cyclobenzaprine may be prescribed to improve sleep and ease pain.

• Anti-seizure medicines such as pregabalin and gabapentin can help reduce certain types of nerve-related pain and improve overall symptom control.

Other therapies

In addition to medication, other approaches can help reduce the effects of fibromyalgia and improve daily function.

• Physical therapy can help improve strength, flexibility, and stamina. Water-based exercises may be especially helpful for easing pain and stiffness.

• Occupational therapy focuses on modifying your workspace or daily activities to reduce physical strain and make tasks easier to manage.

• Counseling provides emotional support and coping strategies. Cognitive behavioral therapy, in particular, helps manage stress, improve sleep habits, and strengthen confidence in handling symptoms.