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Symptoms

By Mayo Clinic staff

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Illustration locating the 18 tender points associated with fibromyalgia 
Tender points

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The pain associated with fibromyalgia often is described as a constant dull ache, typically arising from muscles. To be considered widespread, the pain must occur on both sides of your body and above and below your waist.

Fibromyalgia is characterized by additional pain when firm pressure is applied to specific areas of your body, called tender points. Tender point locations include:

  • Back of the head
  • Between shoulder blades
  • Top of shoulders
  • Front sides of neck
  • Upper chest
  • Outer elbows
  • Upper hips
  • Sides of hips
  • Inner knees

Fatigue and sleep disturbances
People with fibromyalgia often awaken tired, even though they report sleeping for long periods of time. Sleep is frequently disrupted by pain, and many patients with fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea, that further worsen symptoms.

Coexisting conditions
Many people who have fibromyalgia also may have:

  • Fatigue
  • Anxiety
  • Depression
  • Endometriosis
  • Headaches
  • Irritable bowel syndrome
References
  1. Fibromyalgia. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Fibromyalgia/default.asp. Accessed Nov. 2, 2010.
  2. Bennett RM. Fibromyalgia and chronic fatigue syndrome. In: Goldman L, et al. Cecil Medicine. 23rd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/225054422-4/1077621679/1492/1050.html#4-u1.0-B978-1-4160-2805-5..50300-1_13277. Accessed Nov. 2, 2010.
  3. Clauw DJ. Fibromyalgia: An overview. American Journal of Medicine. 2009;122:S3.
  4. Bennett RM. Clinical manifestations of diagnosis of fibromyalgia. Rheumatic Disease Clinics of North America. 2009;35:215.
  5. Goldenberg DL. Clinical manifestations and diagnosis of fibromyalgia in adults. http://www.uptodate.com/home/index.html. Accessed Nov. 4, 2010.
  6. Muller D, et al. Fibromyalgia syndrome. In: Rakel D. Integrative Medicine. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/225324736-4/1078619948/1494/93.html#4-u1.0-B978-1-4160-2954-0..50050-8_2384. Accessed Nov. 4, 2010.
  7. Goldenberg DL. Treatment of fibromyalgia in adults. http://www.uptodate.com/home/index.html. Accessed Nov. 4, 2010.
  8. Wolfe F, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care and Research. 2010;62:600.
  9. Hassett AL, et al. Nonpharmacologic treatment for fibromyalgia: Patient education, cognitive-behavioral therapy, relaxation techniques and complementary and alternative medicine. Rheumatic Disease Clinics of North America. 2009;35:393.
  10. Fibromyalgia and CAM: At a glance. National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/health/pain/fibromyalgia.htm. Accessed Nov. 4, 2010.
  11. Carson JW, et al. A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia. Pain. 2010;151:530.
  12. Wang C, et al. A randomized trial of tai chi for fibromyalgia. New England Journal of Medicine. 2010;363:743.
  13. Vincent A (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 16, 2010.
DS00079 Jan. 22, 2011

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