The following symptoms and complaints may indicate fibromyalgia:
Leading symptoms
- Burning or gnawing pain that is aggravated by specific stimuli, such as cold or damp weather, stress, physical exertion, anxiety, or lack of sleep
- Tender points (pressure painful points), especially on the muscle attachments at the back of the head, elbow, and inside of the knee
The following core symptoms are required for the diagnosis of FMS – symptom triad of:
- Chronic pain in multiple regions of the body
- Fatigue or tendency to exhaustion (physical and/or mental).
- Insomnia or non-restorative sleep
Associated symptoms
- Anxiety (anxiety disorders)
- Depression or depressed mood
- Dysmenorrhea (period pain)
- Cognitive disorders such as concentration disorders or short-term memory disorders.
- Sensitivity to light (photophobia)
- Morning stiffness in the region of the trunk, hips and shoulder girdle.
- Paresthesias (sensory disturbances) in the hands and feet.
- Irritable bowel Note: A subset of fibromyalgia patients may have subclinical celiac disease (gluten-induced enteropathy) or a non-celiac gluten sensitivity
- Sleep disturbances (insomnia) resulting in non-restorative sleep (→ fatigue).
- Swelling sensation on the hands
- Tension headache
- Vertigo (dizziness)
- Vegetative disorders: cold acra, hyperhidrosis (profuse sweating), xerostomia (dry mouth).
Criteria for the clinical diagnosis of FMS (AWMF guideline FMS).
| Symptom | Criteria |
| Obligatory main symptom | Definition of chronic pain according to ACR |
| Obligatory other symptoms | Fatigue (physical and/or mental) and sleep disturbance and/or non-restorative sleep and feeling of swelling and/or stiffness of the hands and/or feet and/or face |
| Diagnosis of exclusion | Exclusion of a physical disease that does not adequately explain the typical symptom pattern |
Overlap between FMS-typical symptoms and gynecologic or endocrinologic clinical pictures:
- Chronic lower abdominal pain (“chronic pelvic pain“) in women; affects approximately 15% of all women.
- Dysmenorrhea (period pain); prevalence (disease frequency) is up to 80% of women in Germany.
- Dyspareunia (pain during sexual intercourse); prevalence is about 10% of all women in Germany.
- Climacteric syndrome
- Libido disorders; prevalence of reduced libido in premenopausal women aged 20 to 49 years is estimated at 22-43%
- Vaginismus (vaginal cramping); prevalence data vary from 4 to 42% of all women
- Vulvodynia – insensations and pain of the external primary sex organs that last longer than three months without identifiable cause; complaints are localized or generalized over the entire perineal area (tissue area between the anus and the external sex organs); possibly also present as a mixed form; prevalence (disease frequency) of essential vulvodynia: 1-3 %.
- Nonspecific symptoms: Drive disorders, depressive episode, drop in performance, mood swings.
The above overlaps present a challenge for the gynecologist! If necessary, see also under differential diagnoses of the symptoms or diseases mentioned.
Further notes
- A retrospective survey of 1,111 fibromyalgia patients showed:
- 89% chronic joint pain, in addition to muscular symptomatology.
- 75 % depression
- 62 % Migraine