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Fibromyalgia: Causes, Symptoms & Treatment

SOS Tips: This helps with fibromyalgia

Since fibromyalgia manifests itself in different ways in those affected, there is also no generally binding recipe for symptom relief. The usual pain relievers are often not effective here. Pain therapy treatment should therefore be coordinated with the doctor.

The following measures bring relief to many patients:

  • Endurance training: two to three times a week. Not too intense, rather light to medium exertion. For example: cycling, aqua jogging (preferably in warm water), aqua aerobics (preferably in warm water), swimming, hiking, walking, dancing
  • Strength and coordination exercises: targeted training of joints and muscles to compensate for muscular imbalances. For example: gymnastics, functional training
  • Relaxation techniques: because stress often increases fibromyalgia pain. Possible options include: autogenic training, mindfulness meditation, progressive muscle relaxation according to Jacobson (PMR), yoga, qigong, tai chi
  • Physical therapy: warmth helps many patients, while cold helps others. It is best to try out what is good for you: heat treatment, whole-body cold therapy (a few minutes at sub-zero temperatures in the cold chamber), balneotherapy (medical baths)

What is fibromyalgia?

Fibromyalgia (fiber muscle pain) is a chronic pain disorder. The clinical picture is complex. Since there are often several symptoms, it is also referred to as fibromyalgia syndrome (FMS). It is characterized by deep muscle and joint pain in the right and left sides of the upper and lower body. Further symptoms are insomnia and tiredness during the day, concentration problems and exhaustion. Concomitant complaints, such as depression or anxiety, also often occur. Significantly more women than men are affected by the neurological disease of pain perception and processing. Experts also refer to fibromyalgia as a functional disorder. Because it is neither an inflammation nor a rheumatic disease (rheumatism) or a metabolic disease. The widespread assumption until a few years ago that fibromyalgia should be equated with soft tissue rheumatism is now outdated. Organs, muscles, ligaments or tendons are not damaged by fibromyalgia. The disease usually appears from the age of 35. The causes are still unclear. Pain-free episodes and times with very strong symptoms alternate. There is no cure for fibromyalgia.

In Germany, around 2 percent of the population suffer from fibromyalgia syndrome. It is the third most common disease in the musculoskeletal system after osteoarthritis and degenerative spinal disorders.

Causes of Fibromyalgia

The reasons for the development of fibromyalgia are still unknown to science. Both a genetic predisposition and psychological factors such as stress or trauma are suspected to be triggers. Fibromyalgia syndrome is not a rheumatic disease, nor is it inflammation or disease caused by wear and tear. According to the current state of knowledge, the central nervous pain perception is changed in those affected. Due to a lower perception of pain, the brain assigns a disproportionately greater importance to even slight pain. The increased pain sensitivity could also be inherited. This is supported by the fact that relatives have an eight-fold increased risk of the disease.

Scientists at the University of Würzburg are pursuing the thesis of a possible organic cause of fibromyalgia. They found out that the small nerve fibers in the muscle tissue of those affected appear changed. Since the studies on this are not yet completed, it is not known whether this is the case for all patients.

For a long time, fibromyalgia sufferers were viewed as hypochondriac because there was no evidence of their pain. Today this has been refuted, even if psychological factors play an essential role in the development of pain. Because stress, whether in a positive or negative form, can aggravate pain.

It is known that people who have experienced severe trauma in childhood or as adults are more likely to suffer from fibromyalgia.

Fibromyalgia can also develop with other medical conditions. One then speaks of secondary fibromyalgia. The following diseases favor the outbreak: rheumatism, infectious diseases (mostly viral infections with the Epstein-Barr virus, hepatitis viruses and HI viruses), some tumor diseases, hormonal disorders.

Symptoms of Fibromyalgia

Anyone with fibromyalgia suffers from chronic pain and muscle tension all over the body. Often there are also emotional complaints. The pain is usually focused on certain parts of the body and has existed for at least three months. The neck, back, arms, legs and chest are often affected. Those affected often react very sensitively to stimuli such as smells, cold, noise and bright light. Fibromyalgia patients are more sensitive to pain. A distinction is made between core symptoms, such as chronic muscle and limb pain, fatigue, difficulty falling asleep and staying asleep, and feelings of swelling, from other accompanying symptoms. Patients with these additional symptoms have a severe form of fybromyalgia syndrome. The intensity of the complaints is not the same every day. Pain-free times are also possible.

Physical fibromyalgia symptoms are:

  • Joint and muscle pain
  • Painful pressure points (so-called tender points)
  • Pain in the tendons
  • Stiffness
  • Burn
  • Headache migraine
  • Irritable bowel syndrome, often associated with abdominal pain, constipation, or diarrhea
  • Irritable bladder (constant need to urinate)
  • Trouble sleeping (difficulty falling or staying asleep)
  • Tiredness and exhaustion
  • Difficulty concentrating
  • Feelings of swelling in the hands and feet, sometimes in the face
  • Sensitive mucous membranes
  • Restless legs syndrome
  • increased reaction to pain stimuli (hyperalgesia)
  • low pain threshold: stimuli that others do not perceive as painful are perceived as painful (allodynia)

Mental fibromyalgia symptoms are:

  • depressions
  • Inner unrest
  • Listlessness
  • Anxiety disorders

Fibromyalgia: Therapy

Fibromyalgia has not yet been cured, but it also has no damaging effects on organs, muscles, ligaments or tendons. It is therefore important for those affected to learn to live with the disease. Depending on the severity of the fibromyalgia, doctors and therapists recommend multimodal therapy with different components. Since the severity of the symptoms varies from patient to patient, it is not possible to give general tips for therapy. Each fibromyalgia disease is individual and should be treated in the same way. Patients are therefore advised to pay close attention to what is personally good for them and what is not.

Sport and relaxation

In the treatment of the disease, individually adapted endurance training in combination with supportive psychotherapy have proven to be particularly effective. Through the training, patients should learn according to their possibilities to alleviate the symptoms through their own activity. We recommend:

  • Endurance training that is adapted to your own abilities. For example cycling, hiking, swimming, aqua jogging, walking, dancing.
  • Strength training (moderate)
  • Functional training (prescribes the attending physician)
  • Relaxation techniques for better coping with stress and pain. For example: meditation, qigong, tai chi, yoga, progressive muscle relaxation, autogenic training.

Since the athletic performance changes due to the fibromyalgia syndrome, everyone should find out for themselves where their own load limits are currently. Acceptance of physical limits is a prerequisite for moderate training. They should not be exceeded under any circumstances.

Cognitive behavioral therapy

In parallel to physical exercise, the sick benefit from psychotherapy. You can learn to perceive pain differently and also to face it differently. One of the goals of cognitive behavioral therapy is to reassess pain. The complaints do not go away as a result, but they no longer take up as much space in the consciousness. That can bring great relief. Together with the treating therapist, patterns of thought and perception that have a negative impact on the patient are examined. Based on this, new behavioral strategies can then be developed and learned that positively change the perception of pain in the long term.


Antidepressants for a reduced perception of pain

Suffering from pain on a regular basis is a huge burden. However, if you conclude that you have to take it easy in order to have fewer complaints, you are mistaken. Experience shows that regular and moderate training can have positive effects. However, if the pain is perceived as so severe that the person concerned excludes movement, certain antidepressants can help. They help to build an inner distance to the pain and to no longer feel it so intensely. The aim of taking an antidepressant is to break through avoidance behavior and reduce the level of suffering. Decreased pain perception can make it easier to take up sports activities. The medication can be taken during therapy.

Antidepressants for anxiety and depression

Fibromyalgia patients often suffer from comorbidities such as anxiety or depression. Antidepressants can also be helpful here - in addition to cognitive behavioral therapy. They act on the messenger substances in the brain and are thus able to reduce depressive symptoms and relieve pain. Usually, the doctor prescribes selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants. Primarily those with the host amitriptyline. Tricyclic antidepressants can reduce deep muscle pain in many people and even help them sleep better. The attending physician decides on the duration of the intake of antidepressants.


Anyone who suffers from pain will soon think of taking a pain reliever. For the main symptoms of fibromyalgia, common pain medication has proven to be little or no effective. Since fibromyalgia is not associated with inflammation, anti-inflammatory drugs such as ibuprofen, acetylsalicylic acid, or paracetamol are also not recommended. This also applies to cortisone. Medicines containing opioids are also usually not effective in treating the disease. The drug tramadol is an exception. Patients with very pronounced symptoms can benefit from this. It is also slightly antidepressant, anti-anxiety and calming.


Medicines from this group of active ingredients are actually used to treat or prevent epileptic seizures. In the context of fibromyalgia therapy, however, they also have their rightful place. Because they can both relieve pain and optimize sleep. For example, pregabalin blocks messenger substances that are responsible for transmitting pain. Especially patients with very severe pain can benefit from the drug. However, one should be aware of the possible side effects. In addition to dizziness and weight gain, this also includes edema on the arms and legs.

Multimodal treatment program

The coordinated therapy has proven its worth, especially in the case of severe disease. Medicinal, physiotherapeutic and psychological procedures complement each other sensibly.

Patient training

Many pain therapy centers and other medical practices offer patient training courses to better understand their illness and how to deal with it better. Those affected receive comprehensive information about the clinical picture of fibromyalgia, its course, diagnosis and forms of therapy.

Diagnosing fibromyalgia

Often times, patients have come a long way before being diagnosed with fibromyalgia. Identifying the disease is not easy due to the variety of complaints. Neither x-ray nor laboratory values ​​provide information. Ultimately, however, these examinations are important from a differential diagnostic point of view, because this way other diseases can be ruled out step by step. These include inflammatory and degenerative rheumatic diseases (rheumatoid arthritis or osteoarthritis), bacterial or viral infections, thyroid diseases and pain disorders limited to individual parts of the body (e.g. tennis elbow).

The first point of contact is usually the family doctor. He will first inquire about the exact medical and family history. If there is a suspicion of other illnesses such as rheumatism, orthopedic or psychological ailments, he will refer the patient to a specialist. Since there is no binding routine diagnosis for identifying the fibromyalgia syndrome, certain pain pressure points have been defined, which are intended to facilitate the diagnosis as uniform criteria. These pain pressure points are also known as tender points. They are usually found at muscle-tendon junctions and at tendon attachments. Even with light pressure, they cause disproportionately severe pain. Contrary to previous guidelines, a specific number of the total of 18 tender points no longer needs to be affected for a diagnosis to be made. Further indications of fibromyalgia are generalized pain in the arms and legs of both halves of the body and in the trunk. The pain must have persisted for at least three months.

Which Doctor Will Help With Fibromyalgia?

Fibromyalgia sufferers have different symptoms. As a result, most people go through many medical departments before they can be sure of a diagnosis. Starting with the family doctor through internal medicine, orthopedics, rheumatology, gynecology, ear, nose and throat specialist (ENT), ophthalmology to psychology and neurology. Few medical professionals have specialized in fibromyalgia so far. Nevertheless, there are rheumatologists, internists, orthopedists, psychologists and general practitioners who are well versed in the disease and pain therapy. - In order to find a well-versed doctor, you can ask in the initial contact with the practice whether fibromyalgia patients are being treated here. The exchange in fibromyalgia self-help groups is also helpful. If a doctor has been found who will take on constant care, he can refer to a pain therapist (anesthetist) or another specialist as required. In addition to many measures that a patient can implement himself, e.g. B. Endurance sports and gymnastics, supervision by a psychologist is recommended. In particular, cognitive behavioral therapy has proven to be effective here. Patients can learn to perceive pain differently and thus regain a great deal of quality of life.

Fibromyalgia sufferers should feel that their doctor has taken their comprehensive clinical picture seriously. Because the disease cannot be detected using imaging methods (e.g. X-ray, MRI or CT) or laboratory diagnostics, it is not uncommon for those affected to encounter a lack of understanding. Unfortunately, not every medical professional is familiar with fibromyalgia syndrome. It is important that you get appointments at short notice, even with severe complaints, and not be put off. A knowledgeable doctor takes the time to work out the best individual therapy approaches for the patient. Because the aim of treatment is to reduce the symptoms as much as possible.

Does Homeopathy Help With Fibromyalgia?

Since patients often experience the treatment of their illness with conventional drugs as inadequate, alternatives are also sought for homeopathic remedies. Depending on the specific symptoms, different homeopathic substances can be used. Many have had good experiences with relieving their pain with the remedy Rhus toxicodendron, among other things. It is used in particular for diseases of the tendons and ligaments, but also for psychological complaints and nervous disorders.

It is best to seek advice from an experienced homeopath according to the individual symptoms.

Does Acupuncture Help With Fibromyalgia?

Acupuncture can help relieve pain in fibromyalgia sufferers. Current studies assume that the insertion of a needle can lead to the release of pain relieving and mood-enhancing hormones such as serotonin and endorphins in the brain. In addition, patients with accompanying symptoms such as tiredness or depressive moods benefit from the application. The treatment is usually carried out lying down and with sterile disposable needles.

What are the consequences of fibromyalgia?

Fibromyalgia is a neurological disorder of pain perception and processing. The chronic generalized pain in muscles and joints does not cause permanent damage. However, there is no cure for the disease. Due to the complex symptoms, the course is different for everyone. Often phases with few or no symptoms alternate with such severe symptoms. The often long history of suffering often leads to emotional problems.

FAQ about fibromyalgia

What are the symptoms of fibromyalgia?

  • Persistent or recurring pain in muscles and tendons that has been around for at least three months
  • Painful pressure points at the so-called tender points
  • Accompanying symptoms such as sleep disorders, concentration problems, depressive moods, headaches, irritable bowel syndrome, feelings of swelling in the hands, feet or face, increased sensitivity to cold, noise and light.

Which drug helps with fibromyalgia?

Common anti-inflammatory painkillers such as ibuprofen, acetylsalicylic acid (ASA) or paracetamol are often ineffective against fibromyalgia pain. Antidepressants, for example with the active ingredient amitriptyline, can reduce the perception of pain. Selective serotonin reuptake inhibitors (SSRIs) can also help against depression and anxiety, which often accompany the disease. Anticonvulsants are more often used to reduce pain in fibromyalgia syndrome. However, one must reckon with pronounced side effects such as dizziness, weight gain and edema.

Is Fibromyalgia a Rheumatic Disease?

Fibromyalgia syndrome is neither an inflammation nor a metabolic disease or rheumatism. Until a few years ago, the disease was considered to be soft tissue rheumatism. This assumption is outdated today. Fibromyalgia is a neurological disorder of pain perception and processing.

What can you do about fibromyalgia pain?

Regular endurance training, functional training and relaxation procedures are recommended for those affected. Many patients also have good experiences with multimodal pain therapy. This is a combination of coordinated therapy methods. For example, cognitive behavioral therapy can be supplemented with relaxation exercises. But additional drug treatment is also possible. Multimodal therapies are often offered by pain clinics, psychosomatic clinics and also by rehabilitation clinics.

Is Fibromyalgia Curable?

Fibromyalgia is currently not curable. However, the disease is not life threatening either. The treatment of those suffering from FMS (fibromyalgia syndrome) aims to reduce pain and accompanying symptoms and also to change the individual way of dealing with the symptoms. The intensity of the perception of the complaints has a significant influence on the patient's level of suffering. A lot can be achieved here therapeutically and through your own sporting activity.

Can I influence fibromyalgia through my diet?

So far, there is no special dietary recommendation. Only testimonials from fibromyalgia sufferers. They point to an improvement in their symptoms with the following change in diet:

  • lots of vegetables and fruits (especially high in antioxidants)
  • Reducing meat consumption
  • Refraining from or consuming less alcohol, chocolate, coffee and nicotine.

Is Fibromyalgia Hereditary?

The disease occurs more frequently in a few families. However, there are still no final results on whether this has genetic causes or whether children adopt behaviors from their parents that then trigger fibromyalgia.

Where can I get more information about fibromyalgia?

There are now numerous self-help groups and associations for those affected. Amongst other things:

  • German Fibromyalgia Association (DFV)
  • Fibromyalgia League Germany (FLD)
  • German Rheuma-Liga Bundesverband e.V.