Fibromyalgia is a chronic condition marked by widespread pain in many areas of the body. The pain is often accompanied by fatigue, sleep problems, and difficulties with attention and memory. It affects two to six percent of the population. It occurs one and a half to two times more often in women than in men.
In fibromyalgia, the source of the pain is not in the tissues. In a healthy person, pain arises from tissue damage or inflammation. In people with fibromyalgia, the central nervous system becomes overly sensitive to both painful and non-painful stimuli. Even stimuli that would not normally bother someone, such as light, sound, and smell, can trigger a pronounced reaction in these patients. This is called nociplastic pain. In other words, the pain does not come from peripheral damage but from the way the central nervous system processes pain signals.
Brain imaging studies have revealed changes that support this. Loss of gray matter has been detected in the brains of patients with fibromyalgia, particularly in the anterior cingulate cortex and the prefrontal cortex. The connectivity pattern among the brain regions involved in pain processing has also been found to change. These findings show that the condition has a measurable biological basis.
Genetic predisposition also plays a role. The risk of developing fibromyalgia is roughly thirteen times higher among first-degree relatives of a person with the condition than in the general population. No single causative gene has been identified yet, but several gene regions related to pain perception have emerged in research.
The core symptom of fibromyalgia is widespread pain lasting at least three months. Patients often describe this pain as "I hurt all over" or "I feel like I constantly have the flu." Fatigue accompanies the pain; even light activity can worsen the fatigue, and staying inactive for a long time can have the same effect. Sleep is usually light and unrefreshing. Difficulty concentrating and struggling with tasks that require quick thinking are common. Between a third and half of patients also have depression or anxiety. Other complaints, such as tension-type headache, irritable bowel syndrome, and heartburn, are also frequently seen alongside it.
The diagnosis is made clinically. No specific blood test or imaging method demonstrates fibromyalgia directly. The tests that are performed serve to rule out other conditions with similar symptoms. In the past, the diagnosis was made by checking for tenderness in at least eleven of eighteen tender points on the body. This method is no longer necessary today; the diagnosis is now based on the widespread pain the patient describes and the accompanying symptoms.
The first step of treatment is non-drug approaches. Educating the patient is very important; they need to be told that the pain is real and that it can be treated. Regular physical activity is the method with the strongest evidence, and low-intensity aerobic exercises such as walking, swimming, and cycling are especially recommended. Exercise should be started slowly, because sudden, intense activity can worsen symptoms. Cognitive behavioral therapy has a positive effect on pain, sleep, and mood. Maintaining a regular sleep schedule, limiting caffeine and alcohol, and reducing screen use before bedtime are also recommended.
Drug treatment is considered for moderate to severe symptoms. Antidepressants and gabapentinoids can be used. The effect of these drugs is limited, and they do not eliminate the condition. If a single drug is not enough, low doses from different drug classes can be tried together.
Fibromyalgia is a lifelong condition, but it is not life-threatening. Symptoms fluctuate over time, easing in some periods and worsening in others. In managing the condition, the physician, physiotherapist, and mental health professional working together is decisive for helping the patient maintain daily life.
