What is fibromyalgia?
Fibromyalgia, also called fibromyalgia syndrome (FMS), is a long-term condition that causes pain all over the body. The pain usually comes with tiredness (fatigue), sleep that does not feel refreshing, stiffness and difficulty concentrating or remembering things, often called “fibro fog”. Symptoms change over time, and flare-ups, when symptoms suddenly get worse, are common.
The UK NICE guideline describes fibromyalgia as a form of chronic primary pain: chronic pain that lasts for more than three months and is not fully explained by an injury or another disease. Your pain is real, and seeking psychological support does not mean that it is “all in your head”.
Common symptoms of fibromyalgia
- Widespread pain, often aching, burning or stabbing
- Increased sensitivity to pain and touch
- Fatigue, from mild tiredness to exhaustion
- Waking up tired even after a full night (non-restorative sleep)
- Muscle stiffness, especially when you wake up
- Fibro fog: problems with memory, attention and concentration
- Headaches, irritable bowel syndrome (IBS), frustration, worry or low mood
Symptoms vary from person to person and can change with stress, physical activity or the weather.
How fibromyalgia is diagnosed
Fibromyalgia is diagnosed by a doctor, usually your GP and sometimes a rheumatologist. There is no single blood test or scan for it: the doctor asks how your symptoms affect your daily life, examines you and may order tests to rule out other conditions. Fibromyalgia can also exist alongside depression, anxiety or IBS. A therapist does not make the diagnosis, and neither can an online questionnaire.
Possible causes and contributing factors
The exact cause is not known. It is thought to involve changes in the way the central nervous system processes pain, inherited genes may play a part, and it is often triggered by an injury, an infection or emotional stress. Stress can also make symptoms worse or bring on flare-ups.
What fibromyalgia therapy can and cannot do
There is currently no cure for fibromyalgia, and psychological therapy does not cure it. Treatment aims to ease symptoms and improve quality of life, usually by combining physical activity, talking therapies and, when your doctor advises it, medication. Therapy works alongside your medical care, never instead of it, and the European EULAR recommendations describe the effect of most treatments as modest. A therapist can help you with:
- Coping with pain, flare-ups and the worry they bring
- Pacing: balancing activity and rest so that you do not overdo it on good days
- Sleep problems: sleep routines and relaxation
- Stress, low mood and anxiety
- Work, studies and relationships: explaining your condition, asking for adjustments and setting limits
Therapy approaches that can help
- Cognitive behavioural therapy (CBT) for pain: working on the thoughts, habits and emotions that make pain harder to live with
- Acceptance and commitment therapy (ACT): accepting what you cannot control and committing to what matters to you
- Mindfulness-based approaches, such as mindfulness-based stress reduction (MBSR)
- Relaxation and breathing techniques, as ways to reduce stress, at your own pace
- Pain management approaches, to reduce the impact of pain on your life
The NICE guideline lists CBT and ACT among the options for chronic primary pain, and EULAR suggests psychological therapies especially when low mood or unhelpful coping strategies are involved. Both also recommend exercise. Questions about medication belong to your doctor.
Looking for support with other kinds of long-term pain, or with living with a chronic illness? See our chronic pain support service or the page on adjusting to a chronic illness.
Fibromyalgia therapy for expats, online or in person
Living abroad, in Germany, France, Spain or elsewhere, can add to the load: finding a doctor who knows the condition, describing pain in a second language, a new health insurance system, family far away. Sessions can take place in person or online by video, from home, with no travel on days with more pain or fatigue. Our therapists work in several languages. The first session is a chance to describe what you live with and agree on goals.
Practical strategies for everyday life
- Break tasks into smaller steps and plan rest between them
- Keep up regular physical activity that you enjoy and can continue, ideally planned with a professional
- Get up at the same time every morning and take time to relax before bed
- Notice what tends to come before a flare-up, such as stress or overdoing it
- Talk to other people who live with fibromyalgia, for example in a support group
When to seek help
See a doctor if widespread pain, fatigue or poor sleep do not go away. Consider reaching out to a therapist if pain or flare-ups affect your mood, sleep, work or relationships, or if you feel you are no longer coping. If you constantly feel low or hopeless, talk to your doctor as well.
If you feel unsafe or at immediate risk of harm, contact local emergency services or a crisis hotline right away.
Medical disclaimer: This content is for general information only and does not replace diagnosis or treatment from a qualified professional.
