Fibromyalgia and Joint Pain: Understanding the Connection

Key Takeaways

Fibromyalgia causes widespread pain that often feels like it’s in the joints
Unlike arthritis, fibromyalgia doesn’t cause joint damage or inflammation
The pain is real—it results from how the nervous system processes pain signals
Fibromyalgia and arthritis can occur together, complicating diagnosis and treatment
Treatment focuses on medications, exercise, sleep, and stress management
Many people improve significantly with comprehensive treatment approaches

If you have widespread pain that seems to affect your joints, you might assume you have arthritis. But if your X-rays and blood tests come back normal, and yet you still hurt, fibromyalgia might be the culprit.

Fibromyalgia is a chronic pain condition that’s often misunderstood—by patients, family members, and sometimes even healthcare providers. Understanding what it is (and isn’t) can help you get appropriate treatment and find relief.

What Is Fibromyalgia?

Definition

Fibromyalgia is a chronic condition characterized by:

Widespread musculoskeletal pain
Fatigue
Sleep disturbances
Cognitive difficulties (“fibro fog”)
Heightened sensitivity to pain

The Central Sensitization Model

Fibromyalgia is now understood as a disorder of central sensitization—the central nervous system becomes sensitized and amplifies pain signals.

How it works:

Normal pain signals from the body are received by the brain
The brain’s “volume control” for pain is turned up too high
Signals that should feel mild are perceived as intense
Pain persists even without ongoing tissue damage

Think of it as: A thermostat set too sensitive. Instead of responding to actual temperature changes, it overreacts to minor fluctuations.

Not “Just in Your Head”

This is real pain, not imagined. Brain imaging studies show:

Increased pain-related brain activity in fibromyalgia patients
Altered levels of pain-modulating neurotransmitters
Changes in how the brain processes sensory information

The pain is being genuinely experienced—it’s the pain processing system that’s dysregulated.

Fibromyalgia Pain vs. Arthritis Pain

Key Differences

Feature	Fibromyalgia	Arthritis
Location	Widespread, diffuse	Localized to specific joints
Joint damage	None	Present (can see on X-ray)
Inflammation	Not primary feature	Common in inflammatory types
Blood tests	Normal	May show inflammation markers
Pain character	Aching, burning, diffuse	Localized, may be sharp
Morning stiffness	Brief (under 30 min) or variable	Often prolonged (over 30 min in RA)

How Fibromyalgia Pain Feels

People with fibromyalgia describe their pain as:

Widespread: Affecting many body areas simultaneously
Constant: A baseline of pain that’s always present
Variable: Intensity fluctuates but doesn’t fully resolve
Multi-character: Aching, burning, stabbing, or throbbing
Migratory: Moves around the body
Out of proportion: Minor stimuli cause significant pain

The Tender Points (Historical)

Traditionally, fibromyalgia was diagnosed based on tender points—18 specific spots where gentle pressure causes pain. While no longer required for diagnosis, people with fibromyalgia still tend to have widespread tenderness.

Symptoms Beyond Pain

Fibromyalgia is more than just pain. Most people experience a cluster of symptoms:

Fatigue

Profound, unrefreshing tiredness
Not relieved by sleep
Can be as disabling as the pain
Often described as “bone-tired” or “exhausted even after sleeping”

Sleep Disturbances

Difficulty falling asleep
Waking frequently
Non-restorative sleep (wake up tired)
Sleep studies may show abnormalities

Cognitive Difficulties (“Fibro Fog”)

Difficulty concentrating
Memory problems
Trouble finding words
Feeling mentally “cloudy”
Impaired decision-making

Other Common Symptoms

Headaches (tension and migraine)
IBS-like digestive symptoms
Numbness and tingling
Sensitivity to cold, heat, light, or sound
Anxiety and depression
Restless legs syndrome

Can You Have Both?

Fibromyalgia Plus Arthritis

Yes, fibromyalgia commonly coexists with arthritis:

20-30% of people with rheumatoid arthritis also have fibromyalgia
10-15% of people with osteoarthritis have fibromyalgia
Fibromyalgia can complicate assessment of arthritis activity
Pain may persist even when arthritis is well-controlled

Why This Happens

Several explanations:

Chronic pain from arthritis may “sensitize” the nervous system
Shared risk factors (stress, poor sleep, inflammation)
Both conditions more common with certain genetic backgrounds
Fibromyalgia may be triggered by physical stressors like surgery or injury

Diagnosis Challenges

When both are present:

It can be hard to know which condition is causing pain
Arthritis medications may not fully relieve symptoms
Fibromyalgia needs separate treatment
Doctors must assess both conditions independently

Diagnosis

Current Diagnostic Criteria

Fibromyalgia is diagnosed clinically based on:

Widespread pain (both sides of body, above and below waist, plus spine)
Symptoms lasting at least 3 months
Associated symptoms: fatigue, sleep problems, cognitive symptoms
No other condition fully explaining the symptoms

What Tests Are Done

Blood tests (to rule out other conditions):

Complete blood count
Inflammatory markers (ESR, CRP)
Thyroid function
Vitamin D level
Rheumatoid factor, anti-CCP (if RA suspected)

These should be normal in fibromyalgia alone.

Imaging:

Usually not needed for fibromyalgia diagnosis
May be done to evaluate for arthritis if suspected
X-rays normal in fibromyalgia

Who Can Diagnose

Primary care physicians
Rheumatologists (often involved)
Pain specialists
Some neurologists

Treatment Approaches

Medication

FDA-approved for fibromyalgia:

Duloxetine (Cymbalta): Antidepressant that also reduces pain
Milnacipran (Savella): Similar mechanism to duloxetine
Pregabalin (Lyrica): Reduces nerve-related pain signaling

Other medications used:

Low-dose tricyclic antidepressants: Amitriptyline for sleep and pain
Gabapentin: Similar to pregabalin
Tramadol: Limited role, concerns about dependence
Muscle relaxants: For muscle spasm component
NSAIDs: Often not very effective (not inflammatory pain)
Strong opioids: Generally not recommended

Exercise

Critical for fibromyalgia management:

Reduces pain sensitivity over time
Improves sleep quality
Combats fatigue (paradoxically)
Improves mood and cognitive function

How to approach exercise:

Start very slowly (less than you think you can do)
Gradually increase
Expect temporary pain increases initially
Consistency matters more than intensity
Low-impact activities: walking, swimming, cycling

Sleep Improvement

Since poor sleep worsens fibromyalgia:

Maintain regular sleep schedule
Create optimal sleep environment
Treat sleep disorders (sleep apnea, restless legs)
Sleep medications sometimes helpful
Avoid caffeine and alcohol near bedtime

Stress Management

Stress amplifies pain:

Mindfulness-based stress reduction (strong evidence)
Cognitive behavioral therapy
Relaxation techniques
Setting realistic expectations
Accepting limitations while pushing gently

Complementary Approaches

Some evidence for:

Acupuncture
Massage (gentle)
Tai chi and qi gong
Yoga (gentle forms)
Warm water therapy

Living with Fibromyalgia

Pacing

One of the most important management strategies:

Don’t overdo on good days
Take breaks before exhaustion
Spread activities throughout the day
Plan for recovery time

Flare Management

Flares are common. When they happen:

Reduce activities temporarily
Focus on sleep and rest
Use heat or other comfort measures
Don’t catastrophize—flares pass
Contact your doctor if significantly worse

Work and Disability

Many people with fibromyalgia continue working:

Workplace accommodations may help
Flexible scheduling when possible
Breaking up sedentary time
Communication with employers about limitations
Some people do require disability

Building Your Team

Primary care doctor who understands fibromyalgia
Rheumatologist if arthritis is also present
Physical therapist experienced with chronic pain
Mental health provider (CBT can be very helpful)
Support groups (online or in-person)

Frequently Asked Questions

Is fibromyalgia an autoimmune disease?

No. While fibromyalgia often coexists with autoimmune diseases, it is not itself autoimmune. There are no antibodies attacking the body. It’s a disorder of pain processing in the central nervous system.

Does fibromyalgia get progressively worse?

Not necessarily. Fibromyalgia is not degenerative—it doesn’t cause progressive damage. Symptoms may fluctuate over time, and many people improve with proper treatment. Some find symptoms ease over years.

Can fibromyalgia cause joint damage?

No. Fibromyalgia does not cause joint damage, inflammation, or deformity. If you have visible joint changes, that’s from a coexisting condition like arthritis, not fibromyalgia.

Why is fibromyalgia so hard to diagnose?

There’s no blood test or imaging study that can confirm fibromyalgia. Diagnosis is based on symptom patterns after ruling out other conditions. The subjective nature of pain and overlap with other conditions makes diagnosis challenging.

Can men get fibromyalgia?

Yes. While fibromyalgia is more common in women (about 80-90% of cases), men can and do develop it. Men may be underdiagnosed because of assumptions that it’s a “women’s condition.”

Fibromyalgia and depression commonly coexist, but one doesn’t cause the other. Both may share underlying mechanisms (neurotransmitter imbalances). Treating depression can help pain, and treating pain can help mood—they’re interconnected.

Want to learn more about chronic pain conditions? Explore our guides on joint hypermobility syndrome or read about stress management for chronic pain.

Last medically reviewed: February 2025

Medical Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. If you have symptoms suggesting fibromyalgia, please consult a healthcare provider for proper evaluation.