Fibromyalgia 4.31/5 (78)

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Fibromyalgia with rheumatic pain most often among women

Fibromyalgia causes pain and usually attacks women

Definition of fibromyalgia

Fibromyalgia is a common cause of chronic, widespread (generalized) pain in muscles, tendons and joints, mostly among adult women. The pain affects nighttime sleep, concentration and can contribute to fatigue (fatigue) and depression. The pain threshold is reduced so that small loads cause great pain. A number of symptoms from different parts of the body are common (Reference: Wolfe F, 2015). Rheumatic inflammation is not present and the disease is not a systemic connective tissue disease or a vasculitis. Fibromyalgia is included among disease without medically explained physical causes (MUPS). Fibromyalgia reduces quality of life, but usually does not shorten life.

Disease Cause

The cause of the disease is unknown, but the pain is aggravated by general tension and stress. Some results may indicate that the brain is affected (Reference: Albrecht DS, 2018), while others emphasize stresses and psychological aspects (Reference: Furness PJ, 2018).


About 2-3% of the population has the disease defined by Wolfe 1990 criteria (see below).

  • Most are women in the age group of 20-49 years, with about 8-10% having fibromyalgia (Reference: Forseth KO, 1992)


Chronic pain in muscles, joints and tendon parties.

  • Symptoms develop gradually, most often over several years
  • Neck- and headache
  • Stiffness, especially after physical activity
  • Frost, feeling of fever
  • Varying numbness in the hands and feet
  • Sensation of swelling
  • Eye irritation
  • Discomfort by bright light and high sounds
  • Sensation of foreign body in the throat
  • Alternating stools, diarrhea
  • Reduced sleep
  • Exhaustion
  • Difficulty concentrating

Medical examination for fibromyalgia

Usually it is the general practitioner / GP who does the medical examinations and makes the diagnosis. With the newer (2016) criteria (see below) the diagnosis can be made using a questionnaire. It is recommended that the patient reviews the form with the GP. Some patients are referred to a rheumatologist to rule out the presence of other rheumatic diseases.

  • Medical examinations show normal blood samples, X-rays, MRIs etc. The disease progression shows no evidence of organ damage

Criteria for diagnosis

Newer criteria (updated 2016)

Based on questionnaire: Fibromyalgia Criteria Patient Version (2019) NEL.pdf - intended for printing. One must be aware that these criteria do not necessarily identify the same patients as in previous criteria (Perrot S, 2017). Among other things, it has been found that the gender distribution woman: man is 2: 1 with the new criteria against 9: 1 previously.

Literature: 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. (Wolfe F, 2016; Fors EA, 2020).

Fibromyalgia - 2016 Criteria


I. Use the following scale to indicate the severity of each problem during the last week. 0: No problem. 1: Mild or moderately problematic; mostly gentle who can come and go. 2: Moderate; significant problem; often present and / or at a moderate level. 3: Severe: Continuous, the problems greatly disrupt the unfolding of life.

Exhaustion 0 1 2 3  
Problems thinking and remembering 0 1 2 3  
Waking up tired (not rested) 0 1 2 3  
II. Have you had any of the following symptoms in the last 6 months?  
Pain / cramp in the lower abdomen Ja in      
Depression Ja in      
Headache Ja in      
III. Please indicate if you have had pain or tenderness in each area listed below during the last 7 days. Tick ​​the box if you have had pain or tenderness. Be sure to mark the right side and the left side separately.  
Shoulder left Shoulder right Upper arm left Upper arm right Forearm left Forearm right
Jaw left Jaw right Chest Belly / stomach    
Neck / neck Upper back Lumbar spine      
Hip left Hip right Thighs left Thighs right Lay left Lay right
No pain in any of these areas


The diagnosis is made on the basis of the number of points and prevalence:

The form consists of two main parts:

1) Pain: Point III above: "Widespread pain index" (WPI): 19 body regions are scored on whether there is pain there or not. Pain in a body region = 1 point, so that there is a maximum = 19 points on WPI.


2) Other symptoms: "Symptom Severity Score" (SSS): Three main symptoms of fatigue, cognitive dysfunction and poor sleep) are scored on a 0-3 scale and can give a maximum of 9 points in total. In addition, 3 other symptoms (abdominal pain / cramps; depression; headache) that are scored separately depending on whether they exist (= 1) or not (= 0), and can therefore give up to a further 3 points. SSS can thus be scored in total from 0-12 (9 + 3) points.

To get the diagnosis, the following applies: 

1) The pain score (WPI, point III above) must be at least 7 or higher while the symptom score (SSS) is 5 or higher; alternatively, the WPI must be 4-6 while SSS is 9 or higher

2) The pain must be widespread in at least 4 of 5 body regions (it is sufficient to have 1 pain location in each region, while pain in the jaw, chest and abdomen / abdomen does not
included here). These are the regions:
Region 1 = «Upper left». Upper arm left, forearm left and / or shoulder left.
Region 2 = «Upper, right»: Upper arm right, forearm right and / or shoulder right
Region 3 = «Lower left»: Hip left, thigh / knee left and / or calf / foot left
Region 4 = «Lower right»: Hip right, thigh / knee right and / or leg / foot rightRegion 5 = «Central region»: Neck / neck, lower back and / or upper back

3) The symptoms must have been present and stable for at least 3 months.

4) One can have a fibromyalgia diagnosis at the same time as other diagnoses. It therefore does not exclude other diagnoses to have a fibromyalgia diagnosis, or fibromyalgia if one has
another diagnosis, e.g. RA or osteoarthritis Fibromyalgia form


ACR 1990 criteria

It is still common to diagnose fibromyalgia (Reference: Wolfe F, 1990) on the basis of

  1. Daily, significant pain in both arms, both legs and neck or back, provided that these have occurred for more than 3 months (chronic generalized rheumatic pain)
  2. In addition, examination requires clear pain in at least 11 of 18 defined points at a certain pressure ("tenderpoints")

It is assumed that no other causes of the pain are detected (Differential diagnosis)

Tender points fibromyalgia

"Tender points" are especially sore points veed fibromyalgia. Sav vas, Jmarchn [CC0], from Wikimedia Commons

Incorrect Diagnosis (similar conditions / differential diagnoses)

Treatment of fibromyalgia


Unfortunately, no drugs are particularly effective

  • Side effects often exceed potential effects
  • Several types of drugs have been tested
  • Sarotex (aminotryptiline) 10-25 mg taken an hour before bedtime can improve sleep and pain in some (but many initially experience "hang-over" with increased fatigue the next morning)
  • More about medications here: Forseth KO, 2006


  • Good information is important for managing the disease in the best possible way

Physical Activity

  • Physical activity or careful training that is individually adapted helps in the long run. Mastering techniques against pain and measures to improve night's sleep are also important
  • Some benefit from exercises in hot water and relaxation exercises

Heat and varm climate

  • Most people with fibromyalgia feel less pain and stiffness in warm climates. Research supports the fact that rehabilitation in warm climate helps (reference: Clarke-Jenssen AC, 2014)

Fibromyalgia and diet

No diet has been shown to affect the pain or the course of the disease. Nevertheless, dietary changes can be helpful for many who are struggling with stomach symptoms or difficulty sleeping. About 40% have symptoms of "Irritable bowel"(Bloating, fluctuating fluid and hard stools, normal intestine when examined). Raw onion, broccoli, beans and broccoli are good sources of nutrition, but can contribute to gastrointestinal gas and bloating. Lightly cooked vegetables may be preferred. Some have as well lactose intolerance and experiencing intestinal symptomes (loose, frequent stools, stomach cramps, bloating) of milk products. If one avoids milk products, calcium should be taken via chewable tablets (eg Calcigran Forte).

Guten Sensitivity is quite common in the population and the symptoms overlap with fibromyalgia. Try with Gluten free diet can be done for a limited time (reference: Rossi A, 2015)

Reduced sleep and affected sleep quality are common. Coffee, tea and chocolate can enhance sleep problems, especially when taken in the evening. Alcohol is unfavorable for sleep quality. In general, it is important to find a diet that works well for the individual.

Pain often results in reduced physical activity. Some gain weight. A disparity between nutrition intake and physical activity easily occurs. The diet should consist of much more unsaturated fat via fish, vegetables, fruit and grain products. If a lack of vitamins, iron and salts is suspected, a medical examination should be performed and relevant tests carried out.

Medical prognosis

Most people will have pain for many years

  • Intensity varies
  • After 16's disease progression, two out of three with fibromyalgia report improvement compared with the time of diagnosis
  • There is no evidence that fibromyalgia develops and damage joints, muscles or internal organs
  • No increased mortality has been demonstrated (Reference: Wolfe F, 2011)

Key words for medical examinations, referral to a specialist and journal writing for fibromyalgia

Your rights


EULAR: Macfarlane GJ, 2016 (management)

Others: Kia S, 2017


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