Chronic Pain and Fibromyalgia: What's Normal, What's Not

What do your symptoms mean?

By Kate Rope

Everyone experiences pain occasionally, whether it’s a headache, muscle stiffness, or an upset stomach. Some people, such as migraine sufferers or those with irritable bowel syndrome, have to deal with pain and discomfort on a more frequent basis. And then there are people with fibromyalgia—a chronic pain disorder whose often debilitating symptoms overlap with many other diseases.

Now that three drugs (Lyrica, Cymbalta, Savella) have been approved to treat fibromyalgia, you may be hearing a lot about this condition. And if you’ve experienced unexplained pain recently, it’s easy to wonder whether you might even suffer from it. (Between 80% and 90% of those diagnosed with fibromyalgia are women.) Diagnosis can be tricky, but experts say that with the right information, it is possible to find the true cause of your pain—whether it’s fibro or something else—and get the treatment you need.

So where do your aches, pains, and everyday health woes fit in? Here’s our guide to what’s normal and what’s not, and when you should see your doctor.

Headaches

Headaches can be caused by any number of factors, and, rarely, they can be an indicator of a more serious health condition. More often, headaches are temporary and not dangerous, and can be treated with over-the-counter pain medication or by addressing an underlying issue—dehydration or sinus problems, for example.

People with fibromyalgia, however, can suffer from constant tension or migraine headaches. The key word is constant—meaning daily—headaches, combined with other fibromyalgia symptoms: Even having repetitive on-and-off headaches, say 10 a year, could just mean that you suffer from chronic headaches and should consult a neurologist to find effective treatment.

Memory problems

An inability to concentrate and difficulties with memory can be linked to sleep deprivation, attention disorders, Alzheimer’s disease and other forms of dementia, or just simply being overworked and overstressed.

People with fibromyalgia often experience these problems as well, known to doctors and patients as "fibro fog", in addition to chronic pain and discomfort. Research has shown that fibromyalgia is associated with a decrease in “gray matter” tissue in areas of the brain that are involved in memory and cognition.

All-over pain

The number-one symptom of fibromyalgia is persistent pain all over your body in your muscles and joints for an extended period of time. "[If a patient says,] 'I hurt all over,'" says rheumatologist Daniel Clauw, MD, director of the Chronic Pain and Fatigue Research Center at the University of Michigan, "that’s a big blinking neon light that it’s fibro." Rebecca, who has lived with fibromyalgia for more than three decades, says it feels like a bruise that covers your entire body.

Other conditions, such as lupus and rheumatoid arthritis, can initially cause a feeling of widespread pain. “If it’s just in the joints, that person really should see a rheumatologist or someone who specializes in rheumatic or musculoskeletal disorders to make sure they don’t have arthritis,” says Dr. Clauw. Chronic pain that is exclusively in the muscles, on the other hand, can sometimes be polymyalgia rheumatica. But any pain that persists for years in both the muscles and the joints, Clauw explains, is most likely fibro.

Upset stomach

Irritable Bowel Syndrome (IBS), which is characterized by stomach cramping, bloating, and diarrhea or constipation, is a common symptom of fibromyalgia. But many people have the condition on its own.

IBS can be triggered by stress, hormonal changes, certain foods, or even antibiotics, and it can be treated with diet and lifestyle changes and with medication. If you have chronic abdominal discomfort with diarrhea or constipation accompanied by the pain described in the previous slide, it’s worth asking your doctor if you might be suffering from fibromyalgia.

Bladder pain

Experts are increasingly recognizing the role that chronic bladder pain may play in fibromyalgia. “It’s a new focus [in pain research],” says Dr. Clauw. “It’s basically the irritable bowel syndrome of the bladder.” Symptoms include pain in the bladder or pelvic region accompanied by feeling the need to urinate frequently.

If these symptoms are short-lived, the most likely culprit is an easily treated bladder or urinary tract infection. Or, if the only symptom is the urge to urinate, the condition is called overactive bladder syndrome.

When combined with all-over chronic pain, bladder pain may be a component of fibromyalgia. Though currently called interstitial cystitis, Dr. Clauw says the name is rapidly changing to “painful bladder syndrome,” which more accurately describes it.

Insomnia

More than 40 million Americans have difficulty sleeping, but only an estimated 5 million people live with fibromyalgia—which means there are plenty of reasons why you may not be getting a good night’s sleep. Learn about some of the more common sleep disorders in Health.com’s comprehensive sleep resource center.

If you suffer from serious fatigue that limits your daily activities, accompanied by difficulties with concentration and memory, and chronic pain, you have the three most significant symptoms of fibromyalgia. “These three group together,” says Dr. Clauw. “If you have all three, it’s likely you have fibro.” Still, he cautions that the type of pain you have is the single most important predictor of whether you have fibromyalgia.

Putting it all together

With so many symptoms to choose from, it can seem easy to assume that if you experience one, you may be suffering from fibromyalgia. But Dr. Clauw emphasizes that for each of these symptoms, the question to ask is: “What company does it keep?”

With the exception of chronic, multifocal pain, almost all the other symptoms listed here are not a sign of fibromyalgia on their own. It’s when you put them all together that it counts—and that's when your doctor may be able to make a diagnosis and recommend medication and treatment options. Clauw recommends seeking help when symptoms become bad enough that they are impairing you function; he warns that doctors may be dismissive of mild fatigue, pain, or memory problems, for instance.  And he says your primary care doctor is "the best place to go."

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