Fibromyalgia in 2025: Causes, Symptoms, Diagnosis & Latest Treatments
Find out how fibromyalgia affects the body and brain — and what you can do to feel better.
Fibromyalgia is often misunderstood. Once dismissed as a vague or “catch-all” diagnosis, it’s now increasingly recognized as a complex chronic pain syndrome that can deeply disrupt daily life. In this blog, we will explore the possible causes, common symptoms, and available treatment options for fibromyalgia.
At Stanford Pain Management Center, our specialists take a comprehensive, multidisciplinary approach to diagnosing and treating fibromyalgia, combining the latest research with personalized care strategies.
What Causes Fibromyalgia?
There is no single known cause of fibromyalgia, but researchers believe it involves multiple factors — both biological and environmental — that affect the way the nervous system processes pain.
Fibromyalgia can be triggered by:
Physical trauma, such as a car accident or injury
Emotional stress or post-traumatic stress
Infections like Epstein-Barr virus or Lyme disease
Sleep disturbances, particularly in deep (slow-wave) sleep
Coexisting autoimmune conditions like rheumatoid arthritis or lupus
There’s also growing evidence that fibromyalgia may involve central sensitization — a heightened sensitivity in the brain and spinal cord’s pain pathways. People with fibromyalgia may process pain differently, feeling more intense pain from the same stimulus than others.
This dysregulation can show up as:
Impaired conditioned pain modulation (CPM) — the brain’s ability to dial down pain
Alpha wave intrusion during deep sleep, contributing to poor rest
Possible small fiber neuropathy — damage to tiny nerve fibers that help regulate pain and temperature
Brain imaging studies showing changes in how pain signals are processed
Research at Stanford and other leading institutions has identified measurable differences in how pain signals are processed in the brains of people with fibromyalgia. Using advanced neuroimaging techniques, scientists can now visualize these altered pain pathways.
Fibromyalgia often runs in families, indicating a genetic component. But many people with fibromyalgia have no clear trigger — making it a complex and individualized condition.
Common Symptoms of Fibromyalgia
The most common symptom of fibromyalgia is widespread pain above and below the waist. This pain can feel like aching, shooting, or burning and may vary in intensity. While the pain is not typically in the joints, it can feel as if it is. Fibromyalgia is a syndrome — meaning it’s defined by a cluster of symptoms, not a single known cause. Other symptoms include:
Morning stiffness: Many people with fibromyalgia wake up with body aches and muscle stiffness, which may improve during the day but worsen at night.
Fatigue: Nearly everyone with fibromyalgia experiences tiredness, even after a full night’s sleep.
Sleep problems: People with fibromyalgia often have difficulty falling or staying asleep, which contributes to the overall feeling of fatigue.
Increased pain with stress or weather changes: Cold or damp weather, as well as emotional stress, can make the pain worse.
Gastrointestinal complaints: Bloating or IBS-like symptoms.
Cognitive issues: Many people with fibromyalgia report feeling mentally foggy or forgetful. This is sometimes referred to as "fibro fog."
The condition affects approximately 4 million adults in the United States (about 2% of the adult population). While historically diagnosed predominantly in women (80-90% of cases under older criteria), newer diagnostic approaches are identifying more men with the condition, suggesting previous gender disparities may have partly reflected diagnostic bias.
How is fibromyalgia diagnosed?
Fibromyalgia is diagnosed based on clinical criteria rather than lab tests or imaging. Historically, doctors used a “tender point” exam—checking for pain in at least 11 of 18 specific spots on the body. But that method is now outdated.
Today, doctors rely on updated criteria that include:
Widespread pain in multiple areas of the body
A symptom severity score, which takes into account fatigue, unrefreshing sleep, cognitive issues ("fibro fog"), and other somatic symptoms
These updated criteria reflect a broader understanding of fibromyalgia as a condition involving the central nervous system, rather than just localized muscle tenderness.
Because fibromyalgia symptoms can overlap with other conditions, diagnosis typically involves ruling out other potential causes through blood tests and appropriate imaging. This careful differential diagnosis is important for developing an effective treatment plan.
Treatment Options for Fibromyalgia
Although fibromyalgia has no cure, treatment can help manage symptoms and improve quality of life. A combination of therapies is often the most effective approach.
Non-Invasive Treatments
Physical therapy and exercise: Gentle movement and physical therapy can help improve flexibility, reduce pain, and prevent muscle loss.
Relaxation techniques: Practices like light massage, meditation, or acupuncture may help reduce pain and ease stress.
Medications: Several medications can help manage fibromyalgia symptoms, including pain relievers and antidepressants. Some drugs, like duloxetine (Cymbalta) and pregabalin (Lyrica), are specifically approved for fibromyalgia treatment. Medication selection is highly individualized, as responses vary significantly between patients. At Stanford, we take a measured approach to medication, starting with the lowest effective doses and carefully monitoring benefits and side effects.
Psychological Support
Cognitive-behavioral therapy (CBT) can help patients cope with the mental and emotional challenges of fibromyalgia. It teaches people how to manage stress, change negative thinking patterns, and adopt healthier behaviors.
Lifestyle Adjustments
A healthy lifestyle can also play a role in managing fibromyalgia. Eating a balanced diet, avoiding caffeine, and following a regular sleep routine are important steps in improving overall health. Getting enough rest can help manage fatigue, and maintaining an active lifestyle may reduce pain.
Integrative Approaches
Some patients find benefit from integrative medicine approaches such as mindfulness-based stress reduction (MBSR), tai chi, yoga, and acupuncture. While research on these methods continues to evolve, they may offer additional options as part of a comprehensive treatment plan.
Healthy habits can support fibromyalgia management. A balanced diet like this—featuring lean protein, whole grains, and fresh vegetables—paired with regular sleep and physical activity, can help reduce fatigue and improve overall well-being.
Ongoing Research and Hope for the Future
While fibromyalgia remains a challenging condition, researchers are continually working to understand it better and find more effective treatments. Ongoing studies aim to explore new therapies and investigate the role of medications like low-dose naltrexone, which has shown promise in treating fibromyalgia symptoms.
Stanford researchers are at the forefront of investigating how neuroinflammation and glial cell activation may contribute to fibromyalgia symptoms, potentially opening new avenues for more targeted treatments.
If you or a loved one is struggling with fibromyalgia, know that you are not alone. Many people with fibromyalgia lead active, fulfilling lives with the right combination of treatments and lifestyle changes. While there is no cure yet, there are many ways to manage symptoms and improve your quality of life.
To learn more about our approach to fibromyalgia, visit our Patient Resources page for downloadable guides, symptom tracking tools, and information about our support groups.
If you're looking for more information or treatment options, reach out to Stanford’s Pain Management Center. Together, we can find a plan that works for you.