Fibromyalgia Pain Guide

Chronic Overlapping Pain Conditions

Chronic Overlapping Pain Conditions (COPCs) are long-lasting pain conditions that often occur together, such as fibromyalgia and migraine.

These conditions share common features: pain that lasts months or years, symptoms in multiple areas of the body, and normal test results despite very real pain. Many experts believe COPCs are related to an overly sensitive nervous system that amplifies pain signals.

Treatment focuses on calming the nervous system, improving sleep, managing pain, and supporting daily function. COPCs are real medical conditions, and with proper care, symptoms can often be better managed

Fibromyalgia

Fibromyalgia is part of a group of conditions called Chronic Overlapping Pain Conditions (COPCs). These are long-lasting pain conditions that often occur together in the same person. In simple terms, this means someone may live with more than one type of chronic pain at the same time.

These conditions are called “overlapping” because they share common features:

Pain lasts for months or years
The pain may be widespread or affect different parts of the body
Tests and scans often look normal, even though the pain is very real

Many experts believe COPCs are linked to how the nervous system processes pain. Instead of pain coming only from injured tissues, the brain and nerves become extra sensitive, amplifying pain signals. This can make everyday sensations feel painful and cause symptoms such as fatigue, poor sleep, headaches, and difficulty concentrating (“brain fog”).

Living with chronic overlapping pain conditions can be frustrating, especially when symptoms don’t fit neatly into one diagnosis. Treatment often focuses on improving sleep, calming the nervous system, managing pain, and supporting overall quality of life—rather than treating just one body part.

Most importantly, COPCs are real medical conditions, and people who live with them are not imagining their symptoms. With the right care and support, many patients can find ways to reduce symptoms and improve daily functioning.

What is Fibromyalgia?

Fibromyalgia (FM) affects approximately 10–20 million individuals in the U.S. FM is a chronic condition associated with widespread pain and tenderness along with other symptoms such as problems with sleep, memory, mood, and fatigue. Women tend to be more susceptible to fibromyalgia, usually in middle age (20 years–50 years), and there is some evidence to suggest that it may run in families. If you have fibromyalgia, the pain and fatigue can affect many areas of your life including work, daily activities, enjoyment of hobbies, and taking care of your family. Currently there is no known cure for fibromyalgia, but the symptoms of FM can be managed successfully.

Symptoms

Pain and tenderness: The most common symptoms of FM are widespread pain and tenderness. These symptoms tend to be highly variable with some days being better than others. The location of pain may also change over time – people often describe FM as “whole body pain” since the pain and tenderness of FM is not confined to a single location within the body.
Fatigue: The fatigue of FM is described as both physical fatigue and mental fatigue. Both types of fatigue are described as being more profound than “general tiredness”. People with FM are more easily fatigable and when fatigued, slower to recover. People with FM fatigue often consider the fatigue to be as problematic as the pain.
Sleep Problems: Some individuals with FM may have difficulty falling asleep or staying asleep. Others may sleep through the night but upon wakening, feel unrefreshed as though they were unable to sleep at all.
Cognitive and Memory Problems: Problems with thinking (also referred to as “Fibro-Fog”) can take many forms including: difficulty concentrating, difficulty remembering, difficulty finding the right words for objects or people, mental cloudiness, difficulty navigating, and sensing that thinking is slower than usual.
Depression and Anxiety: While FM used to be misdiagnosed as a variant of depression, depression and anxiety often co-exist with FM. When present, anxiety and depression can make FM symptoms worse. The depressive symptoms and anxiety do not need to be at the level of a diagnosable disorder to influence pain perception. Simply experiencing the symptoms of FM will likely have a negative impact on mood which in turn can make other FM symptoms worse.
Sensory Sensitivity: In addition to pain, individuals with FM tend to experience hypersensitivity to light, sound, touch, taste, odors, and medications. This means that for people with FM, sensations will become unpleasant at intensities that do not bother other people. For example, individuals with FM may feel chilled or overly warm at temperatures that seem normal to others, movies or concerts may seem uncomfortably loud, or common perfumes may seem noxious.
Stiffness: Stiffness upon wakening is common for individuals with FM. Stiffness can also occur after sitting or standing or when there are changes in barometric pressure.
Dryness of Eyes or Mouth: Some individuals with FM report excessively dry eyes and/or mouth even when tear production or saliva is normal.
Chronic Overlapping Pain Conditions (COPCs): If you have FM, you may also have one or more of the other COPCs found on this page. It is thought that these conditions may share common underlying causes.

What Causes FM?

About half of people with FM can identify some triggering event that they suspect led to the onset of FM. Others however report that FM started spontaneously – for no apparent reason.

Normally we experience pain when there is some injury (e.g., a broken bone, cut, or fall). This represents the body’s pain processing mechanism working adaptively to protect us from harm.

FM is an example of a disorder where sensory information (both normal and threatening) gets amplified by the brain. Thus in the case of FM, the problem is not necessarily an injury but a problem in how the brain processes nociceptive information and produces pain. The underlying problem in FM is thought to be nociplastic pain or centrally augmented pain, a disorder of pain processing.

It should be noted that pain experienced in response to an injury is indistinguishable from pain associated with central augmentation. Both are “real” forms of pain and both can result in comparable levels of suffering. Many factors can contribute to central pain augmentation including genetics, infections, hormonal abnormalities, physical and/or psychological trauma, repetitive injuries, and sustained physical/psychological stress.

Diagnosis of FM

Currently there are no reliable laboratory tests, x-rays, or other objective tests for diagnosing FM (even though there are some tests that purport to do so). In part this is because the problem is not the result of an injury or disease, but how the brain produces the experience of pain. Often individuals with FM will have seen many doctors before receiving a diagnosis of FM because FM can mimic many other illnesses. It is important to note however that you can have FM in addition to having other illnesses.

In the U.S., a doctor familiar with FM will typically take a careful medical history, and then utilize the diagnostic criteria from the American College of Rheumatology (ACR) to make the diagnosis of FM. These criteria take into account the following elements:

The areas of your body in which you feel pain and its duration (e.g., pain wide-spreadedness)
The presence of additional symptoms (e.g., fatigue, sleep problems, cognitive problems)

Who treats FM?

FM is often treated by family doctors, rheumatologists, or internists. While these doctors often coordinate the care, optimal care often requires a team approach. This team might include the following specialists:

Rheumatologist – physicians specializing in arthritis and other diseases of the bones, joints, and muscles
Nurse educators – specialists who can educate about the condition and help develop or refine a personalized treatment plan
Physical therapists – specialists trained in mobilizing muscles, bones, and joints through exercise, hands-on care, and patient education
Occupational therapists – specialists trained in teaching ways to protect joints, conserve energy, engage more fully in activities of daily living, and patient education.
Psychologists or social workers – specialists who can help initiate and maintain self-care approaches to pain management and who can help address social challenges associated with dealing with chronic pain
Dietitians – specialists who teach about optimal diets and maintaining a healthy weight
Acupuncturists – specialists who may influence pain perception, promote healing, and improve functional status by stimulating specific points on the body often by inserting needles into the skin

Most importantly however YOU need to be a member of the team. Much of FM management can be done at home, by you, and does not require seeing a doctor. The parts that you can do may require some changes in how you live your life. You will need to stick to this plan for better pain control.

It is likely that you and your doctor will need to team up to identify the best combination of professional and self-care approaches that work for you. This plan will need to be reviewed and potentially revised over time as your needs shift.

Treatment of FM

The treatment/management of FM can take many forms. We identify the various approaches below. You can follow the links to learn more about each treatment/management strategy.

Self-Care – There are many changes in your lifestyle that can help you to improve the symptoms of FM. What you choose to focus on needs to be personalized to your specific situation. The link below will take you to a description of the many self-management approaches others have found helpful. You may want to talk with your doctor to identify the self-care approaches that would be best for you at the present time.
Professional Care – Combining self-care with professionally lead care can create an optimal approach to successful management of FM. The link below will take you to a description of the many professionally lead approaches to chronic pain management. For FM, the most common approaches include medications (e.g., anti-depressant, and anti-seizure), cognitive-behavioral therapy, and aerobic exercise.