Fibromyalgia Symptoms and Signs

Published: September 5, 2017
Last reviewed: October 23, 2017

Early Symptoms of Fibromyalgia

Symptoms of fibromyalgia can appear suddenly or gradually, range from mild to debilitating and have a waxing and waning course. Typical first symptoms include [1,2,3,4,8]:

1. Widespread body pain:

  • Appears in at least 4 of 5 body regions, mainly in the trunk
  • Arises from the muscle tendons and skin
  • Can be dull, aching, stabbing, throbbing, burning or prickling
  • Worsens with inactivity or heavy exercise but improves with regular light exercise

2. Abnormal sensations:

  • Allodynia – pain caused by stimuli that would not normally cause pain
  • Hyperalgesia – excessive pain caused by painful stimuli
  • Paresthesiae – numbness or tingling in the limbs or face
  • Hypersensitivity to heat and cold, loud noises, bright lights and strong odors
  • Ringing in the ears (tinnitus)

3. Fatigue:

  • Triggered by lack of sleep or depression
  • Lack of energy, difficulty start working

4. “Fibro fog” or “brain fog:”

  • Difficulty concentrating
  • Difficulty remembering things

5. Mood changes:

  • Depression, apathy, fear, hopelessness
  • Anxiety, irritability, anger

6. Insomnia:

  • Difficulty falling asleep
  • Frequent waking
  • Unrefreshing sleep and morning stiffness

Other Symptoms

Other common symptoms of fibromyalgia include [1,2,5,6,7,8,9,12,13,14]:

  • Abdominal pain, bloating, constipation or diarrhea (irritable bowel syndrome)
  • Difficulty swallowing (dysphagia), dry mouth, metallic taste in mouth
  • Chest tightness, rib pain, difficulty breathing
  • Chronic pelvic or low back pain, wrist, hand or foot pain
  • Cold hands and feet
  • Dizziness upon standing due to a drop in blood pressure (orthostatic hypotension)
  • Dry eyes, blurred vision
  • Dry mouth
  • Excessive sweating
  • Frequent urination
  • Headaches and migraines
  • Increased heart rate and palpitations upon standing or postural orthostatic tachycardia syndrome (POTS)
  • Jaw pain, teeth and sinus problems
  • Muscle cramps or twitching
  • Poor balance
  • Restless leg
  • In women: breast pain, burning pain in the vulva (vulvodynia), painful menstruation, decreased libido
  • In men: pain in the prostate or testicles, impotence


Tender Points

The only sign typical for fibromyalgia a doctor can identify during a physical examination are symmetrical tender points on both sides of the body and above and below the waist [2].

Tender point locations include the base of the skull at the back of the neck, the sides of the base of the neck, the upper (medial) angle of the scapula, the front of the neck above the clavicles, the joints between the 2nd ribs and the sternum, the outer (lateral) side of the elbows, the upper outer buttocks, the hips, and the inner (medial) sides of the knees (Picture 1[10,11].

Fibromyalgia Tender Points

Picture 1. Tender points in fibromyalgia

Tender points may be absent, especially at the onset of fibromyalgia, and their number can change considerably through time.

Symptoms and Signs NOT Typical for Fibromyalgia

The following symptoms and signs are not typical for fibromyalgia but may occur in conditions related to or similar to fibromyalgia [7,15]:

  • Fever, nausea, vomiting
  • Rash, hives, easy bruising, brittle nails, hair loss
  • Muscle weakness
  • Swollen joints
  • Cough, wheezing
  • Swollen lymph nodes
  • References

      1. Questions and answers about fibromyalgia  National Institute of Arthritis and Musculoskeletal and Skin Diseases
      2. Clauw DJ, 2014, Fibromyalgia clinical review  CiteSeerX
      3. Lucas CS et al, 2006, Fibromyalgia–new concepts of pathogenesis and treatment  PubMed
      4. Koroschec J et al, 2011, Fibromyalgia and neuropathic pain – differences and similarities. A comparison of 3057 patients with diabetic painful neuropathy and fibromyalgia  PubMed Central
      5. What are the symptoms of fibromyalgia?  Arthritis Research UK
      6. Bradley LA, 2009, Pathophysiology of fibromyalgia  PubMed Central
      7. Bennet RM et al 2007, An internet survey of 2,596 people with fibromyalgia  PubMed Central
      8. Bennet R, Clinical features of fibromyalgia
      9. Inacio P, Fibromyalgia Symptoms Can Include Breast  Fibromyalgia News Today
      10. Wolfe F et al, 2010, The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity  Wiley Online Library
      11. Konder C, 2015, Common Questions About the Diagnosis and Management of Fibromyalgia  American Family Physician
      12. Atarowska M et al, 2006, Difficulties with diagnosis of fibromyalgia: case report  PubMed
      13. Romeyke T et al, 2017, Severe forms of fibromyalgia with acute exacerbation of pain: costs, comorbidities, and length of stay in inpatient care  PubMed Central
      14. Pontari M et al, 2013, New developments in the diagnosis and treatment of chronic prostatitis/chronic pelvic pain syndrome  PubMed
      15. Wolfe F et al, 2009, Fibromyalgia, Systemic Lupus Erythematosus (SLE) and the Evaluation of SLE Activity  PubMed Central

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