Diagram of Fibromyalgia patient

Fibromyalgia is a widely mis-understood and sometimes mis-diagnosed chronic disease, commonly characterized by widespread muscle pain, fatigue, concentration problems and sleep problems.

The severity of fibromyalgia symptoms can vary from person to person. Because it is a chronic illness, in most cases the symptoms of fibromyalgia never disappear completely. The good news is that fibromyalgia is not progressive or life-threatening, and treatments can help alleviate many symptoms.

Fibromyalgia is a clinical condition in which people describe symptoms that include widespread pain and tenderness in the body, often accompanied by fatigue, cognitive impairment and emotional distress.

Fibromyalgia affects two to five percent of the population, mostly women, but men and teenagers can also develop the disease. It tends to develop during middle adulthood.

The causes of fibromyalgia

The cause or causes of fibromyalgia are unknown. It is more common in people with:
  • Lupus or rheumatoid arthritis
  • An illness as a virus (or a recent illness or infection)
  • Pain from an injury or trauma
  • Family history
  • Previous pain syndromes
  • Emotional stress and depression
  • Mood disorder
  • Substance abuse.
  • There is no cure for fibromyalgia, but with medications and self care strategies we can control its symptoms.

    Triggers for symptoms of fibromyalgia

    Fibromyalgia symptoms can be caused or aggravated by several factors including:

  • Weather changes
  • Hard physical work
  • Allergies
  • Mental stress
  • Infections
  • Overexertion
  • Other musculoskeletal disorders such as rheumatoid arthritis or osteoarthritis.
  • Graph showing causes of fibromyalgia

    Symptoms of fibromyalgia

    Diagram showing Symptoms of fibromyalgia

    The symptoms of fibromyalgia can vary from mild to severe.

    The most common symptoms will be:
  • Sensitivity of pain increased due to a decreased threshold of pain
  • More responsive to sensory stimuli like cold, heat, light and numbness or tingling
  • Extreme fatigue (tiredness)
  • Problems with cognition (impact on memory and concentration)
  • Sleep disturbances
  • It is important to remember that each person with fibromyalgia will have its own unique set of symptoms.

    The symptoms of fibromyalgia are variables. They can be mild, moderate or severe. Symptoms can disappear for long periods of time, perhaps even years. Other people have pain every day, or variations of experience between these two extremes.

    Some people with fibromyalgia have other symptoms, such as, irritable or overactive bladder, irritable bowel syndrome, headaches, and swelling and numbness or tingling in the arms and legs. Living with chronic pain and fatigue often leads to secondary problems such as anxiety and depression.

    The diagnosis of fibromyalgia

    Fibromyalgia can be very difficult to diagnose because it does not cause inflammation or damage. There are no blood tests, X-rays or CT scans that can help diagnose for fibromyalgia, but these tests can be used to rule out other conditions.

    Signs that suggest a diagnosis of fibromyalgia are:
  • Widespread pain for three months or more
  • Tenderness at certain points around the neck, shoulder, chest, hip, knee and elbow
  • The patterns of sleep disturbance
  • A multimodal assessment and diagnosis is required
  • Treatment of fibromyalgia

    While there is no cure for fibromyalgia, medications and self care strategies can help control its symptoms. A management program must be designed to meet the needs of each person.

    In general, the management of fibromyalgia includes:


    people with fibromyalgia need to understand the condition in order to decide which management approach will help them.


    In combination with other strategies, medications can be used to control pain, reduce stress and promote sleep.


    A program of gentle aerobic exercise, such as walking, tai chi or water-based exercise can help control symptoms such as pain, fatigue and sleep disorders.

    Stress management and relaxation:

    Stress can aggravate symptoms. Skills that can help manage stress include planning, relaxation, assertiveness and emotional management.

    Balance rest and activity:

    Plan their activities to make the most of their energy by alternating periods of activity with rest. Break big jobs into small achievable tasks so you do not overdo things.


    This can help muscle relaxation and stress management.


    Eating a balanced diet can help provide better energy levels; it helps to maintain your weight, and gives you a greater sense of wellbeing.

    Physiotherapy Options for Fibromyalgia Relief

    The increased flexibility and strengthen of muscles through an exercise routine are two important ways by which physiotherapy can help reduce fibromyalgia pain and make life more manageable.

    Options include:

    Stretching exercises:

    By increasing flexibility through stretching, tight, stiff muscles loosen up, providing relief. Your physiotherapist can instruct you on the proper way to stretch muscles, tendons, and ligaments.

    Number of repetitions should be 5 to 10. Holding a stretch for 30 to 60 seconds is good for large muscle groups, with possibly only one or two repetitions necessary.

    Diagram showing Stretching exercises

    Aerobic exercises:

    Low-speed and low-impact activities are best, stationary bicycles and elliptical machines are usually less stressful on the joints.

    Diagram of Aerobic exercises

    Aquatic exercises:

    Swimming and other water exercises are excellent for patients with fibromyalgia. "The buoyancy of water can decrease the strain on muscles and joints and improve flexibility." A heated pool can be especially beneficial because heat can soothe aching muscles.

    Diagram of pool exercises

    Joint mobilization:

    Can improve muscle tightness, tenderness and joint stiffness

    More Ways to Relieve Fibromyalgia Pain

    TENS (Trans-cutaneous electrical nerve stimulation): TENS stimulates nerve fibers and can decrease fibromyalgia pain.

    TENS helps:
  • Block pain signals to the spinal cord
  • Release the body’s own natural pain-killing chemicals
  • Improve blood circulation and gently contract muscles for healing and relaxation
  • Diagram showing Trans-cutaneous electrical nerve stimulation

    Soft tissue manipulation:

    It is helpful in relieving muscle spasms or soreness, but is best used in combination with strengthening, stretching, lifestyle modification, and conditioning exercises.


    Your physiotherapist might use biofeedback device that may help control muscle tension and reduce pain, and provide information about the amount of stress on your muscles.

    The therapist places electrodes on the skin with a soft gel. This helps in recording the muscular tension. Your therapist can then explain how you can relieve that tension.


    Fibromyalgia is a general, debilitating disorder with widespread and fluctuating symptoms. It is important to recognize diagnosis, so that the patient has access to an appropriate therapeutic strategy.

    Management of fibromyalgia is best carried out by using a multimodal and holistic approach with involvement of patient’s local doctor.

    The patient themselves need to be encouraged to take an active role in their own treatment which augments any other therapeutic benefits.