What is fibromyalgia?
Fibromyalgia syndrome (FMS) is a chronic condition characterised by widespread pain in the muscles and connective tissue. Estimates suggest that around 2–4% of the population in Austria are affected, with women more frequently than men. Despite sometimes severe symptoms, no inflammatory or structural changes can be detected in the muscles or joints – fibromyalgia is now regarded as a disorder of central pain processing in the nervous system.
Typical features include not only persistent chronic pain at the muscle and tendon attachments, but also a range of other symptoms that shape the clinical picture.
Common symptoms
- Persistent pain in several regions of the body, often bilateral
- Pronounced fatigue and rapid exhaustion
- Non-restorative sleep, difficulty falling and staying asleep
- Concentration and memory problems ("fibro fog")
- Stiffness, especially in the morning
- Sensitivity to cold, noise or touch
- Accompanying complaints such as irritable bowel, headaches or depressive moods
Causes and development
The exact causes of fibromyalgia have not yet been fully clarified. Research suggests an interaction of several factors:
- Altered pain processing: The central nervous system reacts hypersensitively to stimuli, a phenomenon known as "central sensitisation".
- Genetic predisposition: FMS occurs more frequently in some families.
- Psychosocial factors: Stressful life events, chronic stress or trauma can favour its development.
- Concomitant conditions: Rheumatic diseases, thyroid disorders or infections may in some cases precede the onset.
Diagnosis: how is fibromyalgia identified?
As there is no single laboratory or imaging finding that confirms the diagnosis, assessment is carried out step by step. The aim is to rule out other conditions with similar symptoms and to identify the typical symptom pattern.
History and physical examination
During the medical consultation, the location and duration of pain, accompanying symptoms and the impact on daily life are recorded. Physical examination serves to rule out other causes, such as inflammatory rheumatic diseases.
Current diagnostic criteria
The criteria commonly used today (according to ACR 2016) take into account:
- the Widespread Pain Index (WPI): number of painful body regions
- the Symptom Severity Scale (SSS): severity of fatigue, sleep quality and cognitive complaints
- a duration of symptoms of at least three months
- the exclusion of other conditions that could explain the symptoms
Additional assessment
For differential diagnosis, laboratory tests (e.g. blood count, inflammation markers, thyroid values, vitamin D, muscle enzymes) and, if necessary, imaging procedures are often used. This helps to distinguish conditions such as polymyalgia rheumatica, rheumatoid arthritis or thyroid dysfunction.
Holistic treatment of fibromyalgia
As the causes are multifaceted, a multimodal treatment approach has proven effective. This takes physical, psychological and social aspects into account together. Drug treatment alone is generally not sufficient.
Exercise and physical activity
Regular, moderate exercise is considered one of the most important components of fibromyalgia therapy. Studies show that tailored endurance and strength training can alleviate pain and improve quality of life.
- Endurance sports such as walking, cycling or swimming
- Gentle strength training to stabilise the muscles
- Forms of movement such as yoga, tai chi or qigong
- Aquatic exercise, especially in warm water
A gentle start is important to avoid overexertion.
Physical therapy
In addition, the following measures may help to alleviate symptoms:
- Heat applications (e.g. mud, fango, warm baths)
- Manual therapy and targeted physiotherapy
- Lymphatic drainage in the case of accompanying sensations of swelling
- Relaxation-oriented massages
Psychological support
As chronic pain places a strain on both the musculoskeletal system and the psyche, accompanying psychotherapeutic support is often helpful. Approaches that have proven effective include:
- Cognitive behavioural therapy
- Pain management training
- Mindfulness-based methods (e.g. MBSR)
- Relaxation techniques such as progressive muscle relaxation or autogenic training
Pharmacological approaches
Medication is used selectively and usually for a limited period of time, mainly to relieve pain, sleep disorders and accompanying depressive symptoms. These include low-dose antidepressants (e.g. amitriptyline, duloxetine) or certain anticonvulsants (e.g. pregabalin). Classic painkillers such as non-steroidal anti-inflammatory drugs or opioids often show only limited efficacy in fibromyalgia and are used cautiously. The choice is made individually by the treating physician.
Nutrition and lifestyle
Lifestyle also plays a role. Recommended measures include:
- A balanced, anti-inflammatory diet with plenty of vegetables, fruit, wholegrain products and omega-3 fatty acids
- Reducing alcohol and highly processed foods
- Sufficient sleep and a regular daily routine
- Stress management in everyday life
- Avoidance of nicotine
Some studies suggest that a vitamin D deficiency can intensify symptoms. A targeted laboratory check-up is advisable.
Complementary methods
Some patients additionally benefit from approaches such as acupuncture, TENS (transcutaneous electrical nerve stimulation) or spa treatments. The evidence base varies, but individual experiences can be positive.
Living with fibromyalgia
Fibromyalgia is a chronic condition that currently cannot be cured – however, symptoms can often be significantly alleviated. Realistic expectations are key: the goal is not necessarily to be pain-free, but to achieve a better quality of life, greater resilience and a self-determined way of coping with the condition.
Self-help groups and patient organisations can provide valuable support. Relatives, too, often benefit from learning more about the condition in order to better support those affected.
When medical assessment makes sense
Anyone suffering from widespread muscle and joint pain, persistent fatigue and sleep disorders for several months should have their symptoms assessed by a doctor. An early diagnosis makes it possible to begin targeted multimodal therapy and to reduce secondary burdens such as social withdrawal or the development of depression.
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This article does not replace medical advice.