Fibromyalgia.

Yes. Fibromyalgia is a recognized chronic pain disorder driven by altered central pain processing, classified by the International Association for the Study of Pain as nociplastic pain. Functional MRI shows objective differences in pain-processing networks compared with healthy controls. Major bodies including ACR, EULAR, and WHO recognize the diagnosis under ICD-10 code M79.7.

Most patients describe deep, aching, or burning pain in multiple body regions — neck, shoulders, low back, hips, arms, and legs — on both sides of the body. The pain fluctuates day to day and worsens with stress, weather changes, poor sleep, or overactivity. Light touch can feel painful, and pressure on otherwise normal soft tissue is uncomfortable.

Diagnosis is clinical, based on the 2016 American College of Rheumatology criteria: widespread pain across multiple body regions for at least three months, plus a Widespread Pain Index and Symptom Severity Scale score meeting threshold values. Blood tests and imaging are used to exclude conditions that mimic fibromyalgia, not to confirm it. The 1990 tender-point exam has been retired.

The core mechanism is amplified central pain processing — the nervous system perceives normal sensory input as painful and downplays its natural pain-dampening signals. Genetics, adverse childhood experiences, sleep disruption, mood disorders, and physical or emotional trauma all contribute. No single cause has been identified, and the condition is a final common pathway from many contributing factors.

Fibromyalgia is chronic and not curable, but it is treatable. Most patients achieve meaningful symptom control with a multimodal plan combining exercise, cognitive behavioral therapy, sleep optimization, and targeted medication. Roughly 25% of patients achieve substantial improvement within 2 years of starting comprehensive treatment, and lifespan is normal.

Fibro fog describes cognitive symptoms — difficulty with short-term memory, sustained attention, word-finding, and processing speed — reported by 50-80% of fibromyalgia patients. It worsens during flares and with poor sleep, fatigue, and stress. Treating sleep disorders, mood symptoms, and pain typically improves cognitive function, though some difficulty often persists.

Three medications carry US FDA approval: duloxetine 30-60 mg daily, milnacipran 50 mg twice daily, and pregabalin 150-450 mg per day divided. Amitriptyline 10-50 mg at bedtime and cyclobenzaprine at bedtime are widely used off-label with strong evidence. Low-dose naltrexone is an emerging option. Roughly half of patients achieve meaningful benefit on a given medication; combination therapy is common.

Yes. Aerobic, resistance, and aquatic exercise all show benefit in randomized trials and are recommended first-line by EULAR 2017. Start at low intensity (5-10 minutes) and increase gradually to avoid post-exertion flares. Tai chi performed equal to or better than aerobic exercise in the Wang NEJM 2018 trial. The key principle is starting low and progressing slowly.

Yes. Opioids are strongly discouraged. They worsen central sensitization and hyperalgesia, carry addiction and overdose risk, and have no evidence of long-term benefit in fibromyalgia. Tramadol is sometimes used cautiously when other options fail, but is not first-line. Patients on long-term opioids for fibromyalgia generally improve when guided through a structured taper.

Yes, though women are diagnosed 3-7 times more often than men. Male patients are likely under-diagnosed because the condition is culturally framed as a womens disease and men may report fewer symptoms. Mechanisms, treatment response, and prognosis are similar across sexes. The 2016 ACR criteria reduced the female-to-male diagnostic gap compared with the 1990 tender-point criteria.

There is a strong genetic component. First-degree relatives have an 8-fold higher risk, and twin studies estimate heritability at roughly 50%. Implicated genes affect serotonin transport, catecholamine metabolism, and pain processing. Genetics alone do not cause fibromyalgia; the condition develops when a predisposed person encounters triggering stressors such as trauma, infection, or sustained stress.

Fibromyalgia can qualify as a disability under US Social Security and ADA frameworks when symptoms significantly limit work or daily activities. Successful claims require documented chronicity, severity, and functional impact, ideally with objective records from a rheumatologist or pain specialist. Workplace accommodations such as ergonomic setup, paced work, flexible hours, and remote work substantially improve workforce participation.

Average time from first symptoms to diagnosis is 2-3 years in US and European cohorts. Delays are longer for women of color and patients in low-resource settings. Patients are commonly misdiagnosed with depression, hypothyroidism, or rheumatoid arthritis along the way. Awareness of the 2016 ACR criteria in primary care reduces diagnostic delay.

Yes. Fibromyalgia onset following SARS-CoV-2 infection has been reported in cohort studies, with new diagnoses appearing weeks to months after acute illness. Post-COVID fibromyalgia overlaps clinically with post-acute sequelae of SARS-CoV-2 (long COVID) and ME/CFS. Mechanisms likely involve central sensitization triggered by infection, immune activation, and sleep disruption during recovery.

Both involve central sensitization and overlap heavily. Fibromyalgia centers on widespread pain with fatigue secondary. Chronic fatigue syndrome (ME/CFS) centers on profound fatigue and post-exertional malaise — a sustained worsening 24-72 hours after even mild exertion. Graded aerobic exercise helps fibromyalgia but can worsen ME/CFS, so the distinction guides exercise prescription.

No. Routine blood tests and imaging are normal in fibromyalgia. Testing is done to exclude conditions that mimic the symptom cluster — thyroid disease, anemia, vitamin D deficiency, lupus, rheumatoid arthritis. Research-grade functional MRI and quantitative sensory testing show measurable differences in pain processing, but these are not routine clinical tests.

Generic duloxetine, amitriptyline, and cyclobenzaprine cost USD 5-25 per month in most countries. Pregabalin generic runs USD 10-40 per month; brand-name milnacipran is more expensive. Physical therapy and cognitive behavioral therapy are the larger cost drivers and benefit substantially from insurance coverage. In India and other emerging markets, generic medications and group therapy programs are widely affordable.

Yes. Juvenile fibromyalgia affects roughly 2-6% of adolescents, more often girls, with peak diagnosis ages 13-15. Symptoms mirror adult presentation: widespread pain, sleep disturbance, fatigue, and cognitive difficulty, with major impact on school attendance. Long-term follow-up shows persistence into adulthood in about 50% of cases. Treatment combines exercise, CBT, school accommodations, and selective medication.

Yes. Psychological stress, poor sleep, illness, weather changes, overactivity, and trauma all commonly precipitate flares. The underlying mechanism is amplification of central pain processing during physiological stress. Stress-management techniques — paced activity, mindfulness, cognitive behavioral therapy, and adequate sleep — reduce flare frequency.

See a rheumatologist when diagnosis is uncertain, when another rheumatic disease is suspected or coexists, when first-line medications fail, or when symptoms cause significant functional impairment. Many patients with established uncomplicated fibromyalgia are managed in primary care with periodic specialist input. A multidisciplinary team including physical therapy and pain psychology produces the best outcomes.

Mediterranean and DASH eating patterns show modest evidence for reducing pain and improving function. Specific elimination diets (gluten-free, low-FODMAP) help some patients with coexisting irritable bowel syndrome but are not generically recommended. Mega-dose supplements promoted as cures have no credible evidence. Modest weight loss in patients with BMI above 30 improves symptom scores.

Fibromyalgia is chronic and fluctuating rather than progressively worsening. With consistent multimodal treatment most patients stabilize or improve over years. Worsening typically reflects untreated comorbidities (sleep apnea, depression, deconditioning), inappropriate opioid use, or psychosocial stress. Targeted treatment of these factors restores trajectory.