What Is Fibromyalgia?

If you suffer from widespread pain coupled with fatigue and cognitive issues, you could be suffering from fibromyalgia.

But, what does that even mean?

The term fibromyalgia comes from the Latin word “fibro” meaning fibrous tissue, and the Greek words “myo” meaning muscle and “algos” meaning pain. The term literally means “muscle and connective tissue pain.” Core fibromyalgia symptoms include:

  • Chronic pain
  • Fatigue
  • Mood disorders
  • Sleep disturbances
  • Cognitive dysfunction, or “fibro fog”

This condition also shares many symptoms with chronic fatigue syndrome and lupus. The origins of fibromyalgia pain are unknown.

Fibromyalgia is a syndrome, as opposed to a disease. There is no one single primary cause. Fibromyalgia pain has been called by many other names such as:

  • Fibromyositis
  • Muscular rheumatism
  • Nonarticular rheumatism
  • Periarticular fibrositis
  • Rheumatoid myositis
  • Fibrositis
  • Tension myalgia
  • Musculoskeletal pain syndrome

Some scientists believe fibromyalgia occurs from hypersensitivity of pain transmissions toward and away from the central nervous system. If you suffer from this condition, a coordinated approach is best. Your doctor will help you find both medications and non-medication therapies that work.

Must-watch fibromyalgia video 

The Impact Of Fibromyalgia

Fibromyalgia is diagnosed in 2-4% of the U.S. population. According to the National Fibromyalgia Association, as many as ten million people in the U.S. suffer from this disorder. This number was calculated using the 1990 American College of Rheumatology (ACR) guidelines. However, some scientists argue that that estimate is too low and fails to capture almost 50% of people with this disorder.

Fibromyalgia disorder is more prevalent in women, with a nine to one ratio in favor of women. The majority of women diagnosed generally range in age from 20 to 50 years. In the past, researchers have found that prevalence also increases with age. However, the disorder has been diagnosed in all genders, races, and ethnicities.

The economic impact of fibromyalgia is burdensome. It may cost over $10,000 per patient a year. This expense is more than three times the average when compared to those with chronic conditions like high blood pressure, diabetes, and elevated cholesterol. On top of that, patients miss almost 17 days of work per annum. Overall, these healthcare expenditures represent upwards of $14 billion per year in the U.S.

Fibromyalgia Statistics | PainDoctor.com

Fibromyalgia Causes

The cause of fibromyalgia has never been clearly defined. Currently scientists think that this condition is a complex interplay between sociological, biological, and psychological agents. Infections, trauma, and repetitive injury may contribute as well. Those with hepatitis C infections and other rheumatic disorders, such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and osteoarthritis (OA), are also at greater risk. The common characteristic of all these disorders is systemic, chronic inflammation.

Fibromyalgia also overlaps with many other diseases such as:

Lifestyle and environmental factors also have roles in the development of fibromyalgia pain. Smoking, obesity, and a sedentary lifestyle are other elements that may influence the development of this condition.

Mental health issues

Those with fibromyalgia also often suffer from mental health conditions such as substance abuse, mood, anxiety, and eating disorders. They may also suffer from:

  • Depression
  • Bipolar disorder
  • Generalized anxiety disorder (GAD)
  • Anorexia
  • Bulimia
  • Panic disorder
  • Social phobia
  • Obsessive-compulsive disorder (OCD)
  • Addictions (heroin, cocaine, alcoholism, or prescription pain medications)
  • Stress related conditions, such as IBS, PTSD, and chronic fatigue syndrome

Chemical brain imbalances may play a role in those with fibromyalgia. Neurotransmitters are chemical agents responsible for transmitting electrical signals in the central nervous system.

Researchers have linked decreased levels of serotonin, dopamine, cortisol, and norepinephrine to the development of this chronic pain condition. In contrast, elevated levels of the neuropeptide substance P have also been linked to fibromyalgia. Substance P is thought to be responsible for the perception of pain and is found in the spinal cord. In addition to pain perception, serotonin is involved in digestion, mood, appetite, and sleep. Likewise, dopamine is involved in memory, attention span, behavior, mood, and sleep. Low serotonin levels have been shown to be a hallmark of this condition.

Pain amplification

Transmission of amplified pain signals are also thought to have a role in fibromyalgia. This means that those with fibromyalgia experience more pain.

Imaging techniques can help us gain insight into exactly how pain signals move through the brain and spinal cord.

Functional MRI has illuminated an increase in blood flow to the area of the brain responsible for processing pain stimuli in people with fibromyalgia. Research has also revealed dysfunction in descending pain fibers. A combination of these two defects may result in an elevated perception of pain. This would amplify pain signals going to and from the central nervous system.


Researchers have also linked genetics, or heredity, to the development of this condition. In studies, more people with first-degree relatives with fibromyalgia were diagnosed themselves.

Researchers have also found defects in the genes responsible for producing dopamine and serotonin. More emerging research is needed to uncover the full influence of genetics on the development of fibromyalgia.

Fibromyalgia Symptoms

Fibromyalgia is a syndrome with many symptoms. According to the 2010 revision of the American College of Rheumatology’s diagnostic criteria, fibromyalgia consists of chronic, widespread pain and tenderness. Chronic pain is defined as symptoms that present longer than 12 weeks, or three months.

For fibromyalgia, pain is typically on both sides of the body, below and above the waistline, and include the vertebral column. In addition, diagnostic criteria also require:

  • Chronic fatigue
  • Sleep cycle disturbances
  • Cognitive issues

Other fibromyalgia symptoms may include:

  • Cold or heat intolerance
  • Decreased attention
  • Anxiety
  • Headaches
  • Depression
  • Tingling sensations in the hands and feet
  • Stiffness
  • Anger
  • Muscle spasms
  • Bladder or bowel incontinence
  • Dizziness
  • Poor balance
  • Restless leg syndrome


Fibromyalgia | PainDoctor.com


Fibromyalgia Risk Factors

Possible risk factors for fibromyalgia include:

  • Heredity
  • Gender
  • Age
  • Trauma
  • Poor physical conditioning

Despite these risk factors, many patients have none of these.


Female gender may play a role in fibromyalgia.

Researchers believe the pain pathways in women are augmented by their hormonal levels. This may contribute to the overall amplification of painful stimuli and fibromyalgia.


Age is another possible risk factor in the development of fibromyalgia. Most people diagnosed with this condition report pain beginning in their 20s to 50s. Prevalence peaks from 60 to 79 years of age.


Trauma, whether physical or psychological, is a probable risk factor for fibromyalgia. Research from the American Journal of Medicine examined trauma due to physical stressors. Researchers looked into categories such as heavy lifting, repetitive movements, and squatting or sitting for extended periods. They found that trauma as a result of these physical stressors could lead to fibromyalgia.

Researchers also looked at trauma due to psychological stressors by looking at disagreements among coworkers and levels of disillusionment with work. Trauma due to psychological stressors was found to directly contribute not only to fibromyalgia, but also increased pain scores.

Physical condition and sleep 

Finally, poor physical conditioning is another risk factor for fibromyalgia.

Researchers correlate this risk factor with common sleep disturbances. Fibromyalgia wreaks havoc on the fourth phase of sleep–the most restorative and restful phase of sleep. Disruption of the fourth phase of sleep leads to unrefreshed sleep.

Conditions Related To Fibromyalgia

There are many common conditions associated with fibromyalgia. These disorders can occur together or singly.

The following conditions may be related to fibromyalgia:

  • Irritable bowel syndrome (IBS), or spastic colon, which is a chronic disorder of the colon (large intestine) characterized by abdominal pain and cramping, bloating, gas, and changes in bowel patterns (diarrhea or constipation)
  • Osteoarthritis, which is inflammation of bones and joints that leads to deterioration and loss of joint cartilage
  • Rheumatoid arthritis, which is the most severe form of arthritis and characterized by swelling, pain, and rigidity in the joints of the feet and hands
  • Chronic fatigue syndrome, which is a complicated disorder characterized by extreme fatigue with no identifiable cause
  • Tension-type headaches
  • Migraine headaches
  • Myofascial pain syndrome, which is a disorder characterized by muscle trigger point pain
  • Polymyalgia rheumatica, which is an inflammatory disorder causing muscle pain and stiffness
  • Hypothyroidism, which is a condition characterized by the thyroid gland producing low levels of thyroid hormone

Diagnosing fibromyalgia can be complicated because of these related conditions. Your doctor will start with a detailed medical history and physical examination. An exhaustive medical history, thorough physical exam, and lab testing can lead to a proper diagnosis. Imaging studies are not routinely done, but may be needed, in an evaluation for this condition.

Lab testing may include:

  • Complete metabolic panel
  • Complete blood count
  • Urinalysis
  • Thyroid function tests
  • Vitamin D, vitamin B 12, iron, and magnesium levels
  • Sedimentation rate
  • Anti-nuclear antibody (ANA)

Fibromyalgia | PainDoctor.com

Diagnosing Fibromyalgia

Before 1990, no standard diagnostic guidelines existed for fibromyalgia. The diagnosis of this condition was completely subjective. Some physicians even questioned the existence of such a syndrome. In 1990, the American College of Rheumatology (ACR) published criteria for the formal diagnosis of fibromyalgia.

The 1990 ACR criteria for fibromyalgia diagnosis include:

  1. Widespread pain involving the left and right portions of the body and below and above the waistline. Axial skeletal pain must also be present.
  2. Pain in 11 of 18 trigger, or tender, points during physical examination.
  3. Other clinical signs and symptoms, including fatigue, mood disorders, trouble sleeping, and memory impairment.

These symptoms must last three months or more before it is considered chronic. Trigger, or tender, point sites include:

  • Low cervical
  • Occiput
  • Supraspinatus
  • Trapezius
  • Lateral epicondyle
  • Second rib
  • Gluteal
  • Knee
  • Greater trochanter

Fibromyalgia Tender Points | PainDoctor.com

Source – American College of Rheumatology 

2010 Revised Diagnosis Guidelines

In 2010, the ACR revised their guidelines. This was meant to simplify the diagnosis of fibromyalgia. They removed trigger, or tender, point examinations. These were replaced with the widespread pain index (WPI) and a symptom severity (SS) scale score.

The ACR’s revised guidelines for 2010 include:

  1. WPI greater than or equal to seven and SS scale score greater than or equal to five or WPI equaling three to six and SS scale score greater than or equal to nine
  2. Symptoms have to persist for at least 90 days, or three months
  3. There is no alternate disorder that can explain the pain
  4. The WPI notes the number of areas in which the patient has felt pain over the past week. The score will be between zero and 19. The areas surveyed must include:
    • Shoulder girdle, right and left
    • Upper arm, right and left
    • Lower arm, right and left
    • Hip, right and left
    • Upper leg, right and left
    • Lower leg, right and left
    • Jaw, right and left
    • Abdomen
    • Chest
    • Upper back, right and left
    • Lower back, right and left
    • Neck

The symptom severity (SS) scale score takes into account fatigue, sleep, and cognition over the prior week. The SS scale score follows:

  • Zero = No problem
  • One= Mild problems
  • Two = Moderate problem
  • Three = Severe problems

General symptoms that are also considered include:

  • Muscle pain
  • Muscle weakness
  • Fatigue
  • Irritable bowel syndrome
  • Headache
  • Cognitive impairment
  • Abdominal pain
  • Numbness
  • Dizziness
  • Depression
  • Insomnia
  • Nausea
  • Diarrhea
  • Vomiting
  • Chest pain
  • Anxiety
  • Impaired vision
  • Fever
  • Dry mouth
  • Wheezing
  • Pruritis (itching)
  • Wheezing
  • Hives
  • Raynaud’s phenomenon
  • Rash
  • Tinnitus (ringing in ears)
  • Heartburn
  • Loss of taste
  • Dry eyes
  • Seizures
  • Loss of appetite
  • Shortness of breath
  • Sun sensitivity
  • Hair loss
  • Easy bruising
  • Urinary frequency
  • Bladder spasm
  • Dysuria

The general symptoms are tallied as follows:

  • Zero = No symptoms
  • One = Few symptoms
  • Two = A moderate number of symptoms
  • Three = A great deal of symptoms

The SS scale score is the sum of the severity of the three symptoms (fatigue, sleep, and cognition) plus the severity of general symptoms. The SS scale final score is from zero to 12.

Find out more facts about fibromyalgia in the following video.



Fibromyalgia Treatments

There is currently no cure for fibromyalgia. But, that doesn’t mean there isn’t relief from symptoms.

Patient education, lifestyle adjustments, and medications can help you find relief. Fibromyalgia treatments include:

Furthermore, treatment requires a large multidisciplinary treatment team. Your team may include a number of dedicated healthcare professionals, including:

  • Internists
  • Rheumatologists
  • Neurologists
  • Pain management physicians
  • Physiatrists
  • Psychiatrists
  • Nurses
  • Psychologists
  • Chiropractors
  • Exercise physiologists
  • Acupuncture specialists
  • Physical and occupational therapists

Fibromyalgia medications

Treatment focuses on improvement of pain, mood, and sleep. Most of these treatment options are evidence-based and primarily derived from randomized, controlled clinical trials. A variety of drug classes are utilized in the treatment of this disorder, which is no surprise since this syndrome has a myriad of symptoms.

Fibromyalgia medications include:

Fibromyalgia | PainDoctor.com

Tricyclic antidepressants (TCAs)

In clinical trials, tricyclic antidepressants (TCAs) in a low dose have been proven to provide short-term relief of pain, mood disorders, and sleep disorders associated with this condition. These drugs were some of the first antidepressants developed by pharmaceutical companies. Today, they are seldom used to treat depression, but they are used to treat other disorders.

Tricyclic antidepressants include:

  • Clomipramine (Anafranil)
  • Amitriptyline (Elavil)
  • Doxepin (Sinequan)
  • Desipramine (Norpramin)
  • Nortriptyline (Pamelor)
  • Imipramine (Tofranil)
  • Protriptyline (Vivactil)

Selective serotonin reuptake inhibitors (SSRIs)

Another class of antidepressants are selective serotonin reuptake inhibitors (SSRIs). These antidepressants inhibit the reabsorption of the neurotransmitter serotonin in the central nervous system. Blocking reabsorption of this neurotransmitter can lead to elevated levels in the brain, which is helpful for some of the symptoms of this condition.

Serotonin plays a major role in:

  • Mood and social behavior
  • Sleep
  • Appetite and digestion
  • Sexual desire and function
  • Memory

Low levels of serotonin are thought to play a key role in the development of depression. In clinical trials, SSRIs in low doses were shown to improve pain and depression.  SSRIs include:

  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Fluvoxamine (Luvox)
  • Sertraline (Zoloft)
  • Escitalopram (Lexapro)
  • Citalopram (Celexa)

Serotonin/norepinephrine reuptake inhibitors (SNRIs)

A third class of antidepressants are the serotonin/norepinephrine reuptake inhibitors (SNRIs). These inhibit the reuptake of the neurotransmitters serotonin and norepinephrine.

A sampling of SNRIs include:

  • Desvenlafaxine (Pristiq)
  • Venlafaxine (Effexor)
  • Duloxetine (Cymbalta)
  • Milnacipram (Savella)

The first SNRI approved and brought to market was venlafaxaine. In controlled trials, this SNRI provided significant reductions in the pain of fibromyalgia. Duloxetine and milnacipram have specific indications for the treatment of this condition and are approved by the U.S. Food and Drug Administration (FDA). In controlled studies, milnacipram significantly reduced the pain and fatigue associated with fibromyalgia. In controlled trials, duloxetine provided significant improvement in quality of life and fatigue.

While antidepressants have proved beneficial in the treatment of this condition, they can also have adverse effects. Potential adverse side effects of antidepressants may include:

  • Dry mouth
  • Changes in vision
  • Increased sweating
  • Nausea and vomiting
  • Diarrhea
  • Drowsiness
  • Weight gain
  • Erectile dysfunction
  • Decreased sexual desire
  • Urinary retention
  • Insomnia
  • Constipation
  • Headache

Abrupt discontinuation of SSRIs is not recommended due to an increased risk of developing serotonin syndrome. Signs and symptoms of this syndrome include confusion, headache, agitation, rapid heart rate, excessive sweating, nausea, vomiting, diarrhea, and impaired muscle coordination.


A key symptom of fibromyalgia is poor sleep. Benzodiazepines are a group of antianxiety medications helpful in treating sleep disturbances. These medications also ease muscle pain as they have a relaxing effect. Benzodiazepines can be habit forming and should be used judiciously.

Benzodiazepines include:

  • Clonazepam (Klonopin)
  • Alprazolam (Xanax)
  • Lorazepam (Ativan)
  • Diazepam (Valium)

Fibromyalgia | PainDoctor.comAnalgesics

Pain-relieving analgesics can also help treat fibromyalgia symptoms. These medications inhibit prostaglandins. One of the functions of prostaglandins is to mediate the inflammatory response in the human body. By inhibiting the production of prostaglandins, analgesics reduce inflammation and pain that is associated with this condition.

Non-steroidal anti-inflammatory drugs (NSAIDs) have the ability to reduce pain as well.

NSAIDs include:

  • Ibuprofen (Advil, Motrin)
  • Naproxen (Aleve)
  • Acetaminophen (Tylenol)
  • Aspirin (Bayer)
  • Diclofenac (Cataflam)
  • Indomethacin (Indocin)
  • Celecoxib (Celerbrex)
  • Piroxicam (Feldene)
  • Oxaprozin (Daypro)

Common adverse effects from NSAIDs include rash, dizziness, swelling, vomiting, nausea, and diarrhea. The most serious adverse effects are ulcers, bleeding, kidney failure, and liver failure.

Muscle relaxants

Muscle relaxants are another option utilized in treating fibromyalgia. These medications help relieve pain by reducing or eliminating muscle tension. They also may be helpful in the treatment of sleep disorders accompanying this condition. In controlled studies, the muscle relaxant cyclobenzaprine achieved clinically significant reductions in pain. Potential adverse effects includedizziness, dry mouth, loss of coordination, confusion, visual disturbances, and drowsiness.

Furthermore, muscle relaxants lower a person’s seizure threshold and should not be prescribed to those suffering with epilepsy or alcoholism. The elderly are at great risk for confusion and loss of coordination when taking muscle relaxants. Some muscle relaxants, such as carisoprodol, have high potential for abuse and addiction.

Muscle relaxants include:

  • Carisoprodol (Soma)
  • Cyclobenzaprine (Flexeril)
  • Orphenadrine (Norflex)
  • Tizadine (Zanaflex)

Anticonvulsants (antiepileptic drugs)

Anticonvulsants are another drug class for treating the symptoms of fibromyalgia. In controlled studies, these drugs achieved significant clinical reductions in fatigue and pain while improving sleep in patients. Historically, anticonvulsants are used in the treatment of epilepsy. Over the years, they have developed off-label uses. These drugs may inhibit sodium channels and control upregulation or downregulation of particular neurotransmitters. These actions ultimately decrease pain transmission.

The first anticonvulsant approved by the FDA to treat this condition was pregabalin. Potential adverse effects of anticonvulsants are drowsiness, vomiting, nausea, and liver damage.

Anticonvulsants include:

  • Pregabalin (Lyrica)
  • Carbamazepine (Tegretol)
  • Gabapentin (Neurontin)
  • Divalproex (Depakote)
  • Phenytoin (Dilantin)
  • Valproic acid (Depakene)
  • Topiramate (Topamax)

Atypical antipsychotics

Atypical antipsychotics can treat psychosis related to bipolar disorder or schizophrenia. Recently olanzapine, an atypical antipsychotic, has been found to provide clinically meaningful reductions in pain for those suffering with fibromyalgia. It can help decrease pain hypersensitivity for patients. Potential adverse effects of atypical antipsychotics include hypotension, drowsiness, dry mouth, diminished muscle strength, fatigue, weight gain, and headache.

Atypical antipsychotics include:

  • Quetiapine (Seroquel)
  • Olanzapine (Zyprexa)
  • Risperidone (Risperdal)
  • Clozapine (Clozaril)
  • Aripiprazole (Abilify)

Other Treatments And Strategies For Fibromyalgia

If you’re suffering from fibromyalgia, you should use both drug and non-drug therapies in your treatment approach. You can reduce your pain by ensuring that you’re:

  • Eating a fibro-friendly diet
  • Reducing stress
  • Prioritizing sleep
  • Getting regular exercise
  • Limiting alcohol and caffeine
  • Quitting smoking


Use these sleep hygiene recommendations to manage your sleep disturbances:

  • Limit daytime naps
  • Avoid caffeine just before bedtime
  • Go to bed and wake up at the same time every day
  • Avoid exercise just before bedtime
  • Avoid overeating just before bedtime

Fibromyalgia | PainDoctor.com


According to research from the American Journal of Medicine, poor conditioning can actually exacerbate the symptoms of fibromyalgia.

Regular aerobic exercise can significantly reduce the symptoms associated with this condition. Initially, exercise may cause pain spikes in those with the disorder. But the pain usually decreases if exercise is done consistently. Physical therapists can help you create an appropriate home exercise regimen.

To get started, try:

  • Resistance training
  • Swimming
  • Biking
  • Yoga
  • Water aerobics
  • Tai chi

Complementary and alternative treatments

Today, complementary and alternative treatments are increasingly being included in the treatment of fibromyalgia. These include:

In recent controlled trials, significant pain reduction was achieved using biofeedback techniques. The Journal of Rheumatology recently published a trial that concluded acupuncture temporarily reduced the pain associated with fibromyalgia. Furthermore, trials with cognitive behavioral therapy have been noted to reduce pain and reduce depression in patients.


Fibromyalgia is a complex condition that requires a multi-faceted approach, both for diagnosis and treatment.

If you’re suffering from unexplained widespread bodily pain, cognitive issues, and fatigue, you could be suffering from fibromyalgia. Both drug and non-drug treatments can help you reduce your symptoms.

Today, patients suffering from fibromyalgia may achieve the best possible outcomes due to recent and ongoing research. To get a diagnosis for your condition and start taking steps to reduce your pain, it’s time to talk to a pain doctor. They can help find treatments that work and help you get your life back. Find a PainDoctor.com-certified pain specialist in your area by clicking the button below.

Find Your Pain Doctor


  1. Abeles AM, Pillinger MH, Solitar BM, et al. Narrative review: the pathophysiology of fibromyalgia. Ann Intern Med. 2007;146:726-734.
  2. Anema C, Johnson M, Zeller JM, et al. Spiritual well-being of individuals with fibromyalgia syndrome: relationship with symptom patterns variability, uncertaintity, and psychological adaptation. Res Theory Nurs Pract. 2009;23(1):8-22.
  3. Arnold L. Stratagies for managing fibromyalgia. Am J Med. 2009;122:31-43.
  4. Arnold LM, Hess, EV, Hudson JI, et al. A randomized, placebo-controlled, double blind, flexible dise study on the treatment of women with fibromyalgia. Am J Med. 2002;112:191.
  5. Bennett RM, Jones J, Turk DC, et al. An internet survey of 2,596 people with fibromyalgia. BMC Musculoskelet 2007;8:27.
  6. Berger A, Dukes E, Martin S, et al. Characteristics and health care costs of patients with fibromyalgia syndrome. Int J Clin Pract. 2007;61:1498-1508.
  7. Bradley L. Pathophysiology of fibromyalgia. J Am Med. 2009;122:22-30.
  8. De Silva V, El-Metwally A, Ernst E, et al. Evidence for the efficacy of complementary and alternative medicines in the management of fibromyalgia: a systematic review. Rheumatology. 2010;49:1063.
  9. Goldenberg DL, Burckhardt C, Crofford L. Management of fibromyalgia syndrome. JAMA. 2004;292:2388.
  10. Hassett AL, Gevirtz RN. Nonpharmacologic treatment for fibromyalgia: patient education, cognitive-behavioral therapy, relaxation techniques, and complementary and alternative medicine. Rheum Dis Clin North Am. 2009;35:393.
  11. Hausser W, Bernardy K, Uceyler N, et al. Treatment of fibromyalgia syndrome with antidepressants: a meta-analysis. J Am Med. 2009;301:198-209.
  12. Karvelas D, Vasudevan S. Fibromyalgia syndrome. Pain Manage. 2010;1(6):557-570.
  13. Van Koulil S, Van Lankveld W, Kraaimaat F, et al. Risk factors for longer term psychological distress in well functioning fibromyalgia paptients: A prospective study into prognostic factors. Patient Education and Counseling. 2010;10:126-129.
  14. Langhorst J, Klose P, Musial F, et al. Efficacy of acupuncture in fibromyalgia syndrome – a systematic review with meta-analysis of controlled clinical trials. Rheumatology. 2010;49:778-788.
  15. Lawrence RC, Felson DT, Helmick CG, et al. Estimates of the prevelance of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008;58:26.
  16. Perez E, Castano J, Caliz R, et al. Risk factors for fibromyalgiaL the role of violence against women. Clin Rheumatol. 2009;28:777-786.
  17. Schmidt-Wilcke T, Clauw DJ. Fibromyalgia: from pathyphysiology to therapy. Nat Rev Rheumatol. 2011;7:518.
  18. Terre L. Does exercise benefir fibromyalgia? Am J Lifestyle Med. 2010;11:410-412.
  19. Traynor L, Thiessen C, Traynor A. Pharmacotherapy of fibromyalgia. Am J Health Syst Pharm. 2011;68(140):1307-1319.
  20. Wolfe F, Ross K, Anserson J, et al. The prevalence and characteristics of fibromyalgia in general population. Arthritis Rheum. 1998;38:19-28.