Fibromyalgia: everything hurts, and I’m always tired

According to the Spanish Society for Rheumatology (SER), fibromyalgia is a disorder that affects between 2% and 4% of the Spanish population, the vast majority (90%) of women. 

Fibromyalgia is a change in the perception of pain, in such a way that they are perceived as painful stimuli that are usually not; which in some cases can greatly limit the day to day life of those who suffer from it.  

It is not known what the cause is, and there is no cure, although there are treatments that can control it.



As Dr. Benigno Casanueva, coordinator of the Group for the Study of Fibromyalgia of the SER and rheumatologist at Marqués de Valdecilla University Hospital, points out,   

pain is the most important symptom; Not only does it affect all patients, but it is also very often what makes them seek help  .

However, there is no pain.

Fibromyalgia is in most cases generalized and diffuse, without being associated with specific areas.  

The intensity can vary from day to day and be severe enough to interfere with daily tasks or just cause mild discomfort. In fact, phases of stability can alternate with others where it worsens. Fibromyalgia pain is widespread and diffuse

In addition, for fibromyalgia to be diagnosed, it is  necessary that the pain lasts for at least three months,  and that it is simultaneously on the left and right side of the body; above the waist and below, as well as in the axial skeleton (skull, ribs, sternum and spine).


Along with pain, the other major symptom of fibromyalgia is fatigue without a cause that justifies it and that does not improve with rest. It affects 75-96% (according to studies) of those who suffer from the disease, and they describe it as a feeling of being exhausted all the time and of permanent exhaustion that is exacerbated by physical activity.  Fatigue manifests itself especially in the morning, after waking up, and can improve later, although it is not surprising that it reappears prematurely at noon or all day.


Pain and fatigue are the most common symptoms, but not the only ones. Dr. Casanueva emphasizes that up to 79 other symptoms have been described. The most characteristic is the feeling of generalized stiffness and swelling and tingling in the extremities, as well as sleep disorders, mood disorders, headaches, anxiety and memory loss and difficulty concentrating.


It is unknown what causes the disease,   but as the Spanish basis of rheumatology points out, it is believed that there are many factors involved. Thus, while some people develop the disease without an apparent cause, fibromyalgia appears in others after identifiable processes as a bacterial infection or the presence of another disease that limits the patient’s quality of life. In any case, these events are not thought to cause the disease, but rather they arouse it in people who already have a hidden abnormality in their response to certain stimuli.


There are no specific analytical tests (blood tests, X-rays…) that allow the diagnosis of fibromyalgia. The diagnosis is made by excluding other diseases and based on the patient’s medical history and examination.

  • To determine that it is a case of fibromyalgia, in addition to the generalized pain we mentioned earlier,  other criteria are followed, such as that established by the American College of Rheumatology, which consists of palpation of 18 specific points; if pain is registered in at least 11 of them, one can talk about fibromyalgia.


Since the cause is not known, there is no definitive cure, and the treatments are not completely satisfactory, although they help control the disease, and above all  ,  they  help relieve pain and other symptoms,   thus improving the quality of life of patients. Many of the symptoms are improved with medication (painkillers or muscle relaxants to relieve pain, antidepressants to increase serotonin levels…), but they should always be prescribed by a doctor.


The psychological and emotional aspect plays a very important role here.  In fact, the first step for the person diagnosed with fibromyalgia is to feel better, to accept and assume that it is very likely that they will feel pain for life and that they will have to learn to live with it. From there, you should try to maintain a positive attitude  and   appreciate the good things you have in your day to day life.

In addition, it is necessary to follow good health habits   (control weight, do not smoke, do not overdose with caffeine or alcohol…). In this sense , it is important to exercise since the endorphins that are secreted with it, reduce pain,   promote sleep, improve the feeling of fatigue and relieve anxiety and depression. all the symptoms associated with fibromyalgia.

However, it is important to remember that although it is recommended to maintain an active life, one should at the same time avoid stress and not do too many tasks that can lead to fatigue.

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