What is Fibromyalgia?
An explanation by Dr. med. Kathrin De Beer – Specialist in Internal Medicine and Fibromyalgia Expert
Dr. med. Kathrin De Beer · Specialist in Internal Medicine
Fibromyalgia — a chronic pain syndrome
Fibromyalgia (ICD-10: M79.7) is a chronic pain syndrome characterised by widespread pain in the muscles and connective tissue, pronounced fatigue and non-restorative sleep. The World Health Organization (WHO) has recognised fibromyalgia as an independent condition since 1992.
At its core, it is a disorder of central pain processing: the nervous system of those affected responds to stimuli more sensitively than in healthy individuals — a phenomenon known as central sensitisation. This means: the pain is real, but its cause lies not in a typical, detectable inflammation or tissue destruction, but in an altered perception within the central nervous system.
Fibromyalgia is not imagined, not a psychiatric disorder and not a simulation. It is a well-described, clinically defined condition with clear diagnostic criteria — and it is treatable.
How common is fibromyalgia?
Approximately 2–4% of the population — around 2 to 3 million people in Germany are affected by fibromyalgia. This makes it one of the most common chronic pain conditions overall. Women are more frequently affected than men, and the condition typically occurs between the ages of 35 and 60 — although younger people and children can also be affected. Particularly burdensome: on average, around 16 years pass between the onset of first symptoms and a confirmed diagnosis.
Typical symptoms of fibromyalgia
Fibromyalgia manifests in a broad spectrum of complaints that extends well beyond the muscle pain that gives the condition its name. The hallmark symptoms are:
Muscle and joint pain in multiple body regions simultaneously, often migratory and changing.
Persistent tiredness and exhaustion that is not sufficiently relieved by sleep.
Non-restorative sleep as well as difficulty falling and staying asleep.
Difficulty concentrating, memory gaps and slowed thinking — as if the brain is in a "fog".
A feeling of stiffness in muscles and joints upon waking that improves over the course of the day.
Heightened sensitivity to pressure, cold, heat, noise or light — a typical sign of central sensitisation.
Note: Accompanying symptoms may also include headaches, irritable bowel syndrome, bladder complaints and psychological distress (anxiety, depression). The symptom picture varies greatly between individuals. All of these symptoms can, however, have other causes — a confirmed diagnosis can only be made by a physician.
How is fibromyalgia diagnosed?
There is no blood test, no X-ray and no other technical test that can conclusively prove fibromyalgia. The diagnosis is made clinically — based on standardised criteria from the American College of Rheumatology (ACR), which were last revised in 2016.
The diagnosis requires two scales:
Widespread Pain Index (WPI)
Records the number of painful body regions (out of 19 possible regions). Each region where pain occurred in the past week is counted. A WPI ≥ 7 is an essential diagnostic criterion.
Symptom Severity Score (SSS)
Rates the severity of fatigue, non-restorative sleep, cognitive symptoms (0–3 per symptom) and the extent of somatic complaints (0–3). The total score ranges from 0 to 12. An SSS ≥ 5 is required.
Fibromyalgia is present when: (WPI ≥ 7 and SSS ≥ 5) or (WPI 4–6 and SSS ≥ 9) — and symptoms have been present for at least 3 months and in at least 4 of 5 body regions.
The diagnosis also requires ruling out other conditions that can cause similar complaints. These include thyroid disorders, inflammatory rheumatic diseases and neurological disorders. However, fibromyalgia can also occur simultaneously with these conditions.
Fibromyalgia and other conditions
Due to its non-specific symptoms, fibromyalgia is frequently confused with other conditions or overlooked when it occurs alongside them. The most important distinctions:
Fibromyalgia vs. Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune disease with often measurable inflammation (elevated ESR, CRP, frequently positive specific rheumatoid markers). It attacks joint structures and shows visible changes on X-ray after a longer disease course. Affected joints can visibly swell and become red. Fibromyalgia shows no signs of inflammation and no joint destruction. Both can, however, occur simultaneously.
Fibromyalgia vs. Chronic Fatigue Syndrome (ME/CFS)
ME/CFS is characterised by extreme exhaustion after exertion (Post-Exertional Malaise) and often restricts those affected more severely. In fibromyalgia, pain is in the foreground; in ME/CFS, it is fatigue. Overlaps exist — careful diagnosis is important.
Fibromyalgia vs. Thyroid Disorders
An underactive thyroid (hypothyroidism) can cause muscle pain and fatigue — similar to fibromyalgia. Therefore, possible thyroid disorders should be investigated before confirming the diagnosis. A combination of fibromyalgia and thyroid disorders (e.g. Hashimoto's thyroiditis) is also not uncommon.
Treatment options for fibromyalgia
There is no single medication that cures fibromyalgia. The most effective approach is multimodal therapy — a combination of various measures tailored to the individual. The current S3 guideline on fibromyalgia from the AWMF recommends:
Patient education
Understanding one's own condition is a central element of therapy. Patient education helps those affected to understand the mechanisms of fibromyalgia, recognise triggers and actively manage the condition.
Exercise therapy
Regular endurance training (swimming, walking, cycling, yoga) is considered first-line treatment. Activity should be increased slowly — overexertion must be avoided.
Cognitive Behavioural Therapy (CBT)
CBT helps develop pain-coping strategies, reduce catastrophising and improve day-to-day management of the condition.
Relaxation techniques
Progressive muscle relaxation, mindfulness-based stress reduction (MBSR) and biofeedback show positive effects on pain and sleep quality.
Medication as a supplement
Medication is not the primary pillar of fibromyalgia therapy. Some patients benefit from antidepressants such as amitriptyline (low dose) or duloxetine. Conventional pain medications have limited effectiveness and may carry risks. Medications are best used as a supplement.
Nutritional medicine
An anti-inflammatory diet and targeted micronutrient support can have a supportive effect. Information on nutritional and micronutrient medicine is an important component of the FibroCoach programme.
Psychosocial support
Support through self-help groups, online communities or structured specialist programmes strengthens self-efficacy and reduces isolation.
Questions about fibromyalgia
What is fibromyalgia?
Fibromyalgia (ICD-10: M79.7) is a chronic pain syndrome with widespread muscle and joint pain, pronounced fatigue and non-restorative sleep. It is a disorder of central pain processing — not inflammation in the conventional sense, not joint destruction.
Is fibromyalgia a recognised condition?
Yes. The WHO has recognised fibromyalgia as an independent condition since 1992 (ICD-10: M79.7). It is clinically defined and has concrete diagnostic criteria.
How is fibromyalgia diagnosed?
Diagnosis is made according to the ACR criteria 2010/2016: WPI ≥ 7 and SSS ≥ 5, or WPI 4–6 and SSS ≥ 9. Symptoms must have been present for at least 3 months and in 4 of 5 body regions. There are no specific laboratory values — the diagnosis is clinical.
How common is fibromyalgia?
Approximately 2–4% of the population — around 2 to 3 million people in Germany — are affected by fibromyalgia. Women are more frequently affected than men.
Is fibromyalgia different from rheumatism?
Yes, clearly. Rheumatoid arthritis causes joint inflammation and is detectable through specific blood markers. Fibromyalgia shows no signs of inflammation and no joint destruction. Both can, however, occur together.
Can fibromyalgia be cured?
A complete cure is not yet known. However, many patients achieve a significant improvement in their quality of life through multimodal therapy. Active self-management — exercise, stress reduction, targeted nutrition — is key.
What helps with fibromyalgia pain?
The most effective strategy is multimodal therapy: a combination of patient education, regular exercise, cognitive behavioural therapy and relaxation techniques. Well-informed patients can engage more actively with their condition. Conventional pain medications are often less effective for fibromyalgia than for other pain conditions.
Can you exercise with fibromyalgia?
Yes — and it is expressly recommended. Regular, moderate exercise is one of the most effective forms of treatment. Suitable activities include swimming, walking, cycling and yoga. It is important to start slowly to avoid overexertion.
Could you have fibromyalgia?
Our free self-test is based on the official ACR diagnostic criteria and gives you an initial assessment in just a few minutes.