Learn the signs and symptoms from an expert
March 2010
Fibromyalgia is a sneaky illness that can manifest in a number of different ways. But there is a core set of characteristic symptoms that lead doctors to suspect it.
There is always widespread pain that has existed over a period of months. There are no exceptions: fibromyalgia hurts, every day.
And there is always fatigue, almost always accompanied by sleep disturbances. We’re not talking about feeling tired after a couple long days at work. We’re talking about a continuing energy level so low that you feel your batteries have run down.
What makes fibromyalgia somewhat slippery to diagnose is that it doesn’t necessarily include or exclude any or all of many other symptoms or syndromes, with the exception of pain and fatigue. (A syndrome isn’t a formal disease per se, but rather a constellation of symptoms common to a group of patients.) Furthermore, no test, such as a blood test or x-ray, can definitively confirm a diagnosis.
Even more confusing, many fibromyalgia symptoms mirror those of other conditions, such as rheumatoid arthritis, chronic fatigue syndrome, depression and migraine headaches. These conditions, and others, often coexist with fibromyalgia. This is why it’s important for your doctor to look beyond the diagnosis of fibromyalgia to determine if you have other illnesses with overlapping or similar symptoms that also require treatment. Just because you have fibromyalgia doesn’t mean that you can’t have, for example, arthritis or lupus too.
Signs and Symptoms
Your doctor diagnoses fibromyalgia by recognizing a specific pattern of signs and symptoms. If you have all of the following, you almost certainly have fibromyalgia:
- Chronic, diffuse, aching pain at rest and, especially, stiffness and pain in the morning
- Disturbed sleep
- Chronic low energy
- Signs of stress such as worry, anxiety or depression
Some people with fibromyalgia complain that they feel sore all over—the kind of soreness you might expect if you worked out at the fitness center for six hours instead of your 30 minutes. Some say the pain is more like the all-over aching you get with the flu. Others describe muscle twitches or sensations such as burning, throbbing or hot, stabbing pains.
Fibromyalgia sufferers often present with still other symptoms. Topping the list: chronic, recurrent tension or migraine headaches, which bedevil about 70 percent of men and women who seek treatment for fibromyalgia. Another common feature is what we call central nervous system sensitization. I’ll explain: your central nervous system, consisting of the brain and the spinal cord, is connected to the rest of the body by the peripheral nervous system. Just as the threshold for pain is lower when you have fibromyalgia, so is the threshold for sensitivity. Consequently, the world may seem too loud, too bright, even too smelly to people with fibromyalgia.
Excerpted with permission from The Cleveland Clinic Guide to Fibromyalgia by William S. Wilke, MD. Published by Kaplan Publishing, © 2010 William S. Wilke. The author is a Staff member in the Department of Rheumatic and Immunologic Diseases within the Orthopaedic & Rheumatologic Institute at Cleveland Clinic.
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William S. Wilke, MD
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