The average FMS patient suffers for several years and spends thousands of dollars in medical bills before receiving an accurate diagnosis. People are relieved when they finally get a diagnosis and realize it’s not all in their heads.

FMS can have different symptoms each time a doctor is visited, and the symptoms don’t appear to be related to each other. This can be a source of frustration to many physicians, because FMS is very complex. Also, no two people have exactly the same symptoms. Furthermore, the symptoms in a child can be different from those of an adult. Diagnosis in a child is also harder, because children have more trouble describing their pain.

While not everyone has the same symptoms, or even all of them, some of the potential symptoms of FMS are:

- abdominal pain
- bladder irritability or spasms
- blurred vision
- chest pains and pressure beneath the breast bone
- cramps
- dizziness
- dry eyes and mouth
- falling
- fatigue
- gastroesophogeal reflux (GERD) – sometimes called heartburn or acid stomach
- general aches and pains
- hearing loss
- intermittent hearing problems and low-frequency hearing loss
- memory and reasoning problems ("brain fog")
- migraine or tension headaches
- morning stiffness
- muscle twitching
- nighttime grinding of teeth (bruxism)
- pelvic pain
- pre-menstrual syndrome
- skin sensitivity to temperature
- sleep problems, insomnia
- temporomandibular joint disorder (TMJ)
- tingling or numbness in arms, legs, feet or face
- water retention and swelling; especially in the hands, face and feet

Symptoms can be made worse or triggered by:

- anxiety
- cold or drafty environments
- depression
- hormonal changes, before periods or during menopause
- physical overexertion
- stress
- weather changes

Pain is the most prominent and common symptom. It can be all over, or in just one main region. Some people describe it as "knife-like" or a "muscle cramp." Some say it’s like having a persistent flu and can be quite severe in some. Other factors that effect pain are level of activity, the weather, a person’s sleep patterns and stress. Most people with FMS say that at least some degree of pain is always present. The pain generally is present in all four quadrants of the body, for at least three months. That means pain is present on both the right and left sides of the body, and above and below the waist.

Fatigue is also a very common symptom. About 90% of people with FMS have moderate to severe fatigue. This fatigue can range from simple listlessness and decreased exercise endurance to total exhaustion.

According to past studies about 75% of people with fibromyalgia have sleep disorders. That means people with fibromyalgia sleep lightly, can be awakened by the slightest sound and don’t feel rested or refreshed when they wake in the morning. They also report feeling tired, achy and stiff. One person describes it like this: "You wake up in the morning looking for the eighteen-wheeler that mistook your bed for the interstate." It is still not known if the pain causes the sleep disturbances, or the other way around.

Another common symptom is mood changes. Many people with FMS report feeling "blue" or "down," but only about 25% of these people are clinically depressed according to past studies. Some people also report being anxious, with difficulty concentrating. They complain of decreased short-term memory and trouble performing simple tasks. Many of these symptoms are also common in anyone whose sleep is disturbed.

Standard medical tests come back negative, and often a person "looks" just fine. In addition, symptoms can change from day to day, and even hour to hour. They can also change with illness, stress and increased physical exertion.

Sometimes people are sent for physical therapy, psychological counseling or other inappropriate treatments. Unfortunately, some treatments can actually aggravate FMS.

Technically, FMS is not a disease, but is rather a "syndrome." Fibromyalgia is a specific set of signs and symptoms that occur together. It is chronic, but is not inflammatory, degenerative or progressive. FMS is systemic however, meaning symptoms can be found all over the body. Also, it is not in the joints, but mainly in the muscles. Joints may be sore, but generally the source of the pain is the tendons or ligaments that attach to the muscles.

One of the frustrations with FMS is that there is currently no X-ray or blood test to diagnose it. For a correct diagnosis to be made, a health care professional must first identify the symptoms and then rule out other disorders. A proper diagnosis may be confounded by the fact that fibromyalgia can co-exist with other disorders.

In 1990, the American College of Rheumatology (ACR) defined FMS as "the presence of unexplained widespread pain or aching, persistent fatigue, generalized morning stiffness, non-refreshing sleep, and multiple tender points." By the ACR definition, a person should have at least 11 of 18 tender points that hurt when pressed. The tender points are present in all four quadrants of the body, and the pain is widespread and continuous for about three months or more.

Tender points can vary from day to day. The exact tender point locations may also vary slightly from person to person. If your doctor doesn’t find at least 11 tender points on exam, he or she could give a diagnosis of "possible FMS" and recheck the tender points at another time. Sometimes, tender points can be unnoticed until a health care professional applies pressure.

FMS is "part of a wider syndrome encompassing headaches, irritable bladder, dysmenorrhea, cold sensitivity, Raynaud’s phenomenon, restless legs, atypical patterns of numbness and tingling, exercise intolerance and complaints of weakness". 

There seems to be a link between depression, anxiety and FMS but researchers still are not sure if it’s a cause or an effect.

Major symptoms of FMS can sometimes be traced to a triggering event such as:

- prolonged grief
- body trauma, such as an automobile accident
- infection – viral, bacterial or otherwise
- difficulty in pregnancy, labor and delivery
- open-heart surgery

It is very important to note that even if you have one or more signs and symptoms, it doesn’t mean you have fibromyalgia. You should get a thorough medical exam and rule out any other possible causes for your symptoms.

Not enough really is known about fibromyalgia to point to one exact cause. Unfortunately, until a cause or causes are identified no cure is possible. However, current research points to several main theories.

• Metabolic dysfunction – a problem with making or using substances in the body, for example, serotonin. It seems that in people with fibromyalgia, either too little serotonin is produced or it is reabsorbed too soon. Also in people with FMS, phosphates do not seem to be excreted properly.

• Immune system dysfunction – FMS may possibly be linked to allergies or yeast, viral or bacterial infections.
• Heredity – there seems to be a link among family members with fibromyalgia. What is not known at this time if it is a genetic or behavioral link (learned reaction to pain.)
• Illness or injury – often fibromyalgia can be traced back to a major illness or automobile accident
• Prolonged stress – many people with fibromyalgia can identify a prolonged period of stress in their lives.

There are several potential causes of fibromyalgia that have pretty much been eliminated by extensive research. They are:

- Toxic exposure
- Vascular or circulatory problems
- A degenerative condition
- Mental or psychological problems
- Tumors or growths (there is no relationship between fibromyalgia and cancer.)

Even when you are armed with knowledge about FMS, getting the right health care professional for diagnosis and treatment can be difficult. Doctors with a negative bias against FMS can have a bad effect on your diagnosis and care. If your doctor isn’t familiar with fibromyalgia, or doesn’t believe it exists, find another doctor.

If you are confronted by a doctor who discounts the fibromyalgia’s existence because it can’t be proved, you might want to remind the doctor that until the connection between the pancreas and sugar metabolism was discovered, doctors considered diabetes to be a psychological disorder.

Once you do get a diagnosis of fibromyalgia, sometimes people don’t believe that anything is wrong with you, because you look fine. For you, and your family and friends, education is the key. Learn all you can about this syndrome. Then make sure a good support system is in place. There will be more on this issue in a future article.