Fibromyalgia is a chronic disorder characterized by pain and tenderness throughout the body, as well as fatigue.Although the condition is often grouped in the same category of disorders as arthritis, it doesn’t cause damage to joints or other tissue.
Instead of being caused by inflammation, fibromyalgia is widely understood to be a disorder of the central nervous system — meaning that the brain is oversensitive to pain signals.
Fibromyalgia symptoms may fluctuate in intensity, and they may also improve or worsen over time.
Factors such as stress, changes in weather, too much or too little exercise, and too much or too little rest can affect the severity of your symptoms.
Symptoms of fibromyalgia may include:
Widespread pain, occurring on both sides of the body, above and below your waist
Tenderness to touch
Fatigue, despite getting enough rest
Difficulty falling or staying sleep
Morning stiffness, or pain that’s more pronounced in the morning
Difficulty with memory or concentration (known as “fibro fog”)
Dizziness
Problems with balance or coordination
Numbness or tingling in your hands or feet
Sensitivity to temperature (hot or cold)
Sensitivity to bright lights or loud noises
Painful periods during menstruation
Pain in your face or jaw
Headaches, including migraine
Digestive issues, including abdominal pain, bloating, or constipation
Bladder difficulties
Skin sensitivity
Symptoms in Women
The majority of patients seeking treatment for fibromyalgia are women. One reason may be that women with fibromyalgia experience more severe symptoms, though researchers don’t yet have a clear understanding of why. These symptoms may include more widespread pain throughout the body, irritable bowel syndrome, and morning fatigue.
Fibromyalgia Tender Points
Fibromyalgia tender points — also known as trigger points — are areas of the body where pain frequently occurs.
People with fibromyalgia often say that these areas hurt when pressed on with a finger.
There are 18 identified tender points (nine pairs) that tend to be painful when pressed.
These spots are commonly found on both sides of the body around the elbows, shoulders, knees, neck, hips, sides of the breastbone, and back of the head.
While there’s no definitive test to diagnose fibromyalgia, the American College of Rheumatology (ACR) has established criteria for identifying the disorder.
In the past, doctors would check the 18 tender points on the body to determine a person’s level of pain. Current guidelines don’t call for this kind of exam.
Instead, ACR guidelines suggest that doctors consider the following factors:
How many areas of the body (out of 18) are painful
Whether symptoms like fatigue, waking up unrefreshed, and difficulty thinking are present
Whether these symptoms have lasted at least three months
Whether any other condition might be the cause of these symptoms
Challenges in Diagnosing Fibromyalgia
Fibromyalgia is sometimes difficult to diagnose because many of its symptoms are similar to those of other disorders.
A diagnosis often requires excluding other conditions, rather than finding definitive proof that fibromyalgia is what you have.
“There’s very little to see on a physical exam” when someone has fibromyalgia, other than reported pain and tenderness, according to Don L. Goldenberg, MD, a rheumatologist and professor emeritus at Tufts University School of Medicine.
In addition, “laboratory tests are unremarkable,” and often give doctors little help, Dr. Goldenberg says.
You may end up seeing several doctors before getting an accurate diagnosis. This process may last longer than it should because of mistakes made by both doctors and patients, according to Goldenberg.
“Many patients with this condition will shop from doctor to doctor,” he says. “They’re sure that they’ve been injured or damaged, or there’s something in their environment. And they keep searching and searching.”
A diagnosis of fibromyalgia, says Goldenberg, requires accepting that your pain has no cause beyond the nervous system itself — and that it may, as a result, be more difficult to treat.
At the same time, doctors may prolong the diagnostic process by being either too deferential to — or too dismissive of — patients, Goldenberg says.
“A lot of doctors will order a lot of unnecessary tests,” he notes, due to patients’ desire to rule out improbable causes of their pain.
But more commonly, “Doctors will say, ‘It’s all in your head, toughen up,’” Goldenberg laments. “And of course that’s the last thing a person wants to hear.”
While Goldenberg doesn’t excuse this kind of behavior in doctors, he understands why some of them react so poorly to fibromyalgia.
“For a certain type of physician who likes things black and white, this is a real gray area,” he says. “There’s no cause and effect. The symptoms can be murky. The treatment is very murky.”
Ruling Out Other Conditions
Even if your doctor suspects that you have fibromyalgia, it may be desirable to rule out other, more serious conditions.
For example, “Widespread arthritis can cause pain in multiple areas,” Goldenberg notes. But most doctors can clearly distinguish pain due to arthritis from pain due to fibromyalgia.
If your doctor isn’t ready to diagnose fibromyalgia based on your symptoms and a physical exam alone, the following tests may be helpful:
Complete Blood Count This test can help rule out a number of disorders, including anemia (inadequate red blood cells), infections, and leukemia.
Erythrocyte Sedimentation Rate (ESR, or Sed Rate) This test can help reveal inflammatory processes throughout your body.
Cyclic Citrullinated Peptide and Rheumatoid Factor These tests can help detect rheumatoid arthritis.
Thyroid Function In some cases, it may be helpful to rule out a thyroid problem as the cause of your symptoms.
Because living with fibromyalgia can reduce physical activity, it comes with an increased risk of developing metabolic syndrome (a group of conditions that can collectively increase the risk of developing diabetes, stroke, and other conditions).Research also shows that accidents and infections also potentially create an increased chance of death.Mental health can also be affected by fibromyalgia. One 2025 review of research estimated that roughly half of fibromyalgia patients experience anxiety and depression, with the prevalence of depression, specifically, increasing with age.
If you’re experiencing multiple symptoms that you believe could be due to fibromyalgia, talk with your doctor. It’s important to find a doctor who is familiar with fibromyalgia. Many rheumatologists, internists, and family doctors can properly diagnose the condition and begin treatment.
Before seeing your doctor, you may want to write a list that includes:
All past and present medical conditions
A detailed description of your symptoms
Medical conditions that run in your family
All medicines and supplements you take
Any questions you’d like to ask your doctor
Fibromyalgia is considered to be a central nervous system disorder in which the brain is oversensitive to pain signals.
There are many potential symptoms of fibromyalgia, including pain, dizziness, and sensitivity to light or sound.
Diagnosing fibromyalgia can be difficult, and doctors may take a variety of factors into consideration. Talk with your doctor if you are experiencing symptoms that you believe may be due to fibromyalgia.
