Fibromyalgia and Physiotherapy

Fibromyalgia is a common clinical syndrome with considerable disability. Early diagnosis and intervention can help.

Fibromyalgia affects 2% of the population with a peak incidence in middle-aged women. Despite a poor understanding of its cause, there is increasing evidence for mechanism-based management approaches.Active rehabilitative approaches are the most useful but drugs can help to control symptoms. Avoid Opioids.

Timely accurate diagnosis is important. People with fibromyalgia often have other chronic conditions. Effective approaches include careful clinical evaluation and management of aggravating factors.

Fibromyalgia overlaps with other functional somatic syndromes:

  1. Irritable bowel syndrome
  2. Chronic fatigue syndrome
  3. Temporomandibular joint dysfunction.
  4. Co-occurrence with mood and anxiety disorders

A co-ordinated, patient-centred, multidisciplinary approach to management can help more than bits of treatment such as intermittent massage.

Physiotherapy includes:

  • Education on pain
  • Pain mechanisms
  • Explaining the influence of faulty thought viruses
  • Strategies for self-management
  • Tailored to the individual

What do you feel with Fibromyalgia?

Most people with Fibromyalgia report widespread aches and pains and deep tissue tenderness. The current theory is that these relate to sensitisation of neural pain pathways.

Symptoms of Fibromyalgia:

  • Fatigue
  • Sleep disturbance
  • Cognitive dysfunction (poor memory etc)
  • Psychological distress (anxiety, depression).

** Few physical abnormalities are found during clinical assessment

How does Fibromyalgia develop?

Fibromyalgia can start spontaneously or infection may trigger the disorder.  It probably represents a maladaptive, biological response of the body to the cumulative effects of physical or psychological stress (with a genetical predisposition).

The condition is thought to derive from pathophysiology within the central nervous system, particularly, disordered sensory processing. With a new understanding of brain plasticity, we can treat “thought viruses” with accurately researched information.

Diagnosis of Fibromyalgia

Fibromyalgia presents in a multidimensional nature, including its association with other chronic medical disorders. There may be persistent, significant musculoskeletal pain, fatigue or sleep disturbance. Particularly when such symptoms seem out of proportion to the severity of any background chronic illness.

Referral to a rheumatologist or pain medicine specialist may assist.

Fibromyalgia survey questionnaire

I. Using the following scale, indicate for each item the level of severity over the past week by checking the appropriate box.
0: No problem
1:  Slight or mild problems; generally mild or intermittent
2: Moderate; considerable problems; often present and/or at a moderate level
3: Severe; continuous, life-disturbing problems
Fatigue 0  1  2  3
Trouble thinking or remembering 0  1  2  3
Waking up tired (unrefreshed) 0  1  2  3
II. During the past 6 months have you had any of the following symptoms?
Pain or cramps in lower abdomen       Yes    No
Depression        Yes    No
A headache         Yes    No
III. Joint/body pain
Please indicate below if you have had pain or tenderness over the past 7 days in each of the areas listed below. Please make an X in the box if you have had pain or tenderness. Be sure to mark boxes.
Shoulder left Upper leg left Lower back
Shoulder right Upper leg right Upper back
Hip left Lower leg left Neck
Hip right Lower leg right
Upper arm left Jaw left No pain in any areas
Upper arm right Jaw right
Lower arm left Chest
Lower arm right Abdomen
IV. Overall, were the symptoms listed in I–III above generally present for at least 3 months?              Yes    No

Management of Fibromyalgia

Spontaneous recovery is unusual. Our aims for individually-tailored management are to improve symptoms, function and the quality of life. Treatment is multimodal, multidisciplinary and combines non-pharmacological and pharmacological approaches.

Some patients will have significant benefits from particular therapeutic approaches. There have been some positive results, emphasising the potential utility of a multimodal approach.

Physiotherapy Treatment of Fibromyalgia

The pain sensitisation experienced by patients with fibromyalgia is thought to result from disturbed nerve related inhibitory influences. This occurs at multiple levels in the central nervous system. Careful clinical evaluation is essential. As a Physiotherapists, I assist with diagnosis, education and treatment and management advice.

Factors that aggravate pain in fibromyalgia

  • Spinal and/or peripheral arthritis, tendinopathies myofascial trigger points
  • Sleep disorders (obstructive sleep apnoea, restless legs and periodic limb movement disorder)
  • Obesity (with consequent pain-sensitising effects of meta-inflammation)
  • Smoking
  • Opioid-induced hyperalgesia
  • Statin myopathy
  • Depression
  • Catastrophising cognitive style
  • Psychosocial stressors

The burden of living with fibromyalgia is higher than with other rheumatic disorders and higher than with most other chronic illnesses. The medical management of fibromyalgia is often only partially successful. Physiotherapists are able to give patients sustained support clients to become their own expert active self-managers.

Interventions aim to enable successful living. Best results come from a self-management skills training within a supportive small group setting. This approach explores education, coping skills training, and cognitive behavioural approaches. Exercise and psycho-educational approaches have the greatest evidence of efficacy. We need to tailor them to you as an individual.

As a Physiotherapist, I promote and monitor your daily physical activity. I may suggest referral to a psychologist, particularly if you are psychologically distressed.

Pharmacological approaches

Pain, sleep disturbance and psychological distress are the most factors amenable to medication therapy. Stop the tablets if no benefit is achieved.Some patients either do not tolerate or benefit from drugs. These have a supportive role in symptom management. Start medication at low doses and increase slowly.


  • Profound, multidimensional disability can accompany Fibromyalgia. Multidisciplinary management can be helpful.
  • A patient-centred approach yields clinically meaningful improvements in symptom control, function and quality of life.
  • Non-pharmacological treatments have an important role.
  • Medication can complement an active rehabilitation program.
  • See your doctor.


Häuser W, Jung E, Erbslöh-Möller B, Gesmann M, Kühn Becker H, Petermann F, et al. Validation of the Fibromyalgia Survey Questionnaire within a cross-sectional survey. PLoS One 2012;7:e37504.

Modified by Helen Potter FACP February 16th 2018

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