The stages of fibromyalgia are not well defined, but the condition may affect a localized area of the body at first and later become widespread. In the later stages, the symptoms may worsen.

Despite this general progression, fibromyalgia may not advance in a straight line, as it tends to wax and wane, according to an older 2016 study.

The main symptoms include chronic (long-term) widespread pain, tiredness, and difficulty sleeping. Although doctors generally do not classify fibromyalgia in stages, they do assess the severity of symptoms when making a diagnosis.

About 4 million adults in the United States have fibromyalgia.

This article discusses the stages of fibromyalgia, including how doctors diagnose and treat them. It also answers commonly asked questions.

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An older 2016 study classified fibromyalgia into four stages. However, health oversight agencies, such as the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH), have not adopted them.

The proposed stages depict how fibromyalgia may initially manifest in a localized area and then later affect many parts of the body. In the later stages, the symptoms can worsen, although research indicates the condition may wax and wane.

The study’s classification system is as follows:

  • Stage 1, which is regional with classic symptoms
  • Stage 2, which is generalized with increasing widespread pain and some additional symptoms
  • Stage 3, which is advanced with increasing widespread pain, chemical sensitivity, and increasing sleep disturbances
  • Stage 4, which is secondary in response to an underlying health condition

Fibromyalgia manifests the following main symptoms:

  • long lasting, widespread pain that people often describe as burning, aching, or throbbing
  • pain that frequently affects the legs, arms, chest, head, back, abdomen, and buttocks
  • trouble sleeping
  • overwhelming tiredness

Other symptoms may involve:

  • tingling or numbness in legs and arms
  • muscle and joint stiffness
  • difficulty with memory, concentration, and clear thinking
  • tenderness to touch
  • constipation
  • bloating
  • higher sensitivity to noise, light, temperature, and odors

Learn more about fibromyalgia flare-ups.

A medical history and physical examination are the tools that provide the basis of a fibromyalgia diagnosis. Lab tests and imaging help rule out other conditions.

Doctors do not diagnose fibromyalgia in stages. However, they use assessments to gauge whether symptoms are mild, moderate, or severe.

One such assessment uses the Widespread Pain Index, which rates pain in various body locations from 0 to 19.

The other assessment is the Symptom Severity Scale, which rates the following characteristics from 0 to 3:

  • tiredness
  • sleep disturbances
  • thinking difficulties
  • general body symptoms

The final score is a summation of scores in these four categories, ranging from 0 to 12.

Doctors may use symptom severity to formulate a treatment plan for people in earlier or later stages of fibromyalgia:

Early stage treatment

In the early stages, treatment includes an exercise program and education about the condition.

An exercise program may involve cardiovascular fitness training or at least 30 minutes of aerobic exercise three times weekly. This can reduce pain and improve sleep.

A person can gradually introduce exercise, starting with a lower duration and intensity. This can help avoid worsening of fibromyalgia pain.

Education includes the following:

  • reassurance that fibromyalgia is a real condition rather than something they are imagining
  • relaxation techniques to manage stress and mood disturbances
  • sleep hygiene techniques and treatment for sleep conditions

Some people may respond sufficiently to the above measures, but when they do not, medications are appropriate. Tricyclic antidepressants, such as amitriptyline (Elavil, Vanatrip), are often the first choice.

When an individual does not respond adequately to or cannot tolerate a tricyclic antidepressant, a serotonin-norepinephrine reuptake inhibitor (SNRI), such as duloxetine (Cymbalta, Drizalma Sprinkle, Irenka), is an option.

Other drugs that are available for fibromyalgia include Milnacipran (Savella) and pregabalin. Both can help treat pain.

Another choice is an anticonvulsant medication, such as gabapentin (Gralise, Horizant, Neurontin).

Learn more about medications for fibromyalgia.

Doctors may recommend any of the above medications if a person has more severe tiredness, sleep disturbances, or depression.

Later stage treatment

When symptoms persist despite taking a single medication, doctors may prescribe a combination of them.

For people who have difficulty reaching an adequate level of low impact aerobics, a supervised exercise program may help. This may entail physical therapy or water-based exercises.

Specialist consultations may be beneficial. For example, a psychiatrist may provide cognitive behavioral therapy to help a person recognize and change unhelpful thought patterns. If someone has complications that fall under the expertise of a rheumatologist, this specialist may offer interventions to address them.

Learn more about treating fibromyalgia.

Below are answers to commonly asked questions:

Why is my fibromyalgia getting worse?

Fibromyalgia has no cure. While the outlook is not favorable for many people, a person could try the following to manage fibromyalgia:

  • exercising regularly, which is one of the most useful ways to fight the condition
  • joining an in-person or online support group
  • adopting habits that foster improved sleep through actions, such as having a regular sleep schedule and avoiding caffeine

What is the progression of fibromyalgia?

It may initially affect one part of the body and later spread widely with worsening symptoms.

Some research reports that, although fibromyalgia is a chronic condition, the symptoms may fluctuate. This can result in periods of waxing and waning. After receiving a diagnosis and getting treatment, some people may find symptoms improve.

Still, there is no way to predict the progression in any one person, as it varies.

How debilitating can fibromyalgia be?

It may be very debilitating, as it can cause disability, pain, and a lower quality of life. Some complications may include:

  • more hospitalizations
  • higher rates of major depression
  • higher rates of conditions, such as osteoarthritis or rheumatoid arthritis
  • higher death rates from injuries and suicide

While an older 2016 study classifies fibromyalgia into four stages, doctors do not generally use this system. The fluctuating nature of the condition may make it difficult to classify a person as being in a particular stage.

However, doctors do assess the severity of symptoms to determine if they are mild, moderate, or severe.

Early in fibromyalgia, treatment may involve education and exercise. When such measures are not adequate, a doctor may prescribe medications. The first choice may be a tricyclic antidepressant, but when this is not effective or well tolerated, other options may include an SNRI or anticonvulsant.