Core and Common Symptoms

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Author’s opinion[edit]

In the opinion of the author, there are three crucial features:

1) The symptoms of widespread unexplained pain (“it hurts all over” pattern). This is generally but not always muscular, and 2) Poor sleep. In the experience of the author, even on those few cases that the patient says they sleep well, closer analysis will find that they wake feeling unrefreshed (this is called the “non-restorative sleep pattern”). 3) Mechanical allodynia. This is evident as severe tenderness to pressure applied to the surface of the body in general and especially to the tender points and which is indicative of central sensitization in the brain.

The widespread pain pattern is weighted very heavy in the way ACR-2016 does the scoring. In the original ACR-1990 criteria, a reduced pressure pain threshold was an essential sign.

Symptoms of considerable importance is anxiety and or agitation. Memory loss and fibrofog are important but in the opinion of the author they are usually a result of por sleep. Depression and headache are common, but the author does not consider them essential features, nor does the ACR-2016. Furthermore, what is often scored as depression by a casual review is often what the author calls “pseudo-depression”, which has many features depression but without profound sadness.

Bennett’s opinion[edit]

Bennett et al. studied 26 symptoms in fibromyalgia patients and had the patient rate them in severity from 1-10 in the last week (using a visual analogue scale). The five best were: persistent deep aching over most of my body, poor balance, environmental sensitivity, tenderness to touch and pain after exercise. (Which symptoms best distinguish fibromyalgia patients from those with other chronic pain disorders? Robert M. Bennett MD,Kim D. Jones PhD,Jonathan H. Aebischer DNP,Amanda W. St. John DNP,Ronald Friend PhD, 27 September 2021

The Choy study[edit]

Choy et al. conducted a major study in mullite countries which include a survey of symptoms. (A patient survey of the impact of fibromyalgia and the journey to diagnosis. Ernest Choy,1 Serge Perrot,2 Teresa Leon,3 Joan Kaplan,3 Danielle Petersel, 3 Anna Ginovker,4 and Erich Kramer4, BMC Health Serv Res. 2010; 10: 102, doi: 10.1186/1472-6963-10-102, available in full online at:, Copyright ©2010 Choy et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

They recorded the percentage of patients that had them and the patient’s rating of their severity. Generally, the most common were also the most disruptive. For the full details see

  • Chronic widespread pain: 65%
  • Joint pain: 65%
  • Headache 63%
  • Low back pain: 59%
  • Fatigue: 56%
  • Problems sleeping: 55%
  • Difficulty concentrating: 54%
  • Stiffness: 52%
  • Heightened sensitivity to touch: 51%
  • Leg cramps: 50%
  • Numbness and/or other tingling 47%
  • Feelings of depression: 46%
  • Facial pain: 38%
  • Feelings of anxiety: 33%

Comments on Choy list[edit]

The high frequency of joint pain is often overlooked. Symptoms occurring in fibromyalgia patients are a combination of symptoms of fibromyalgic and symptoms of a fibromyalgia co-morbidity. Low back pain and facial pain might be due to fibromyalgia muscle pains in the back area and face muscles. Tension-type headache with pericranial tenderness is similar to having fibromyalgia in the muscles of the head. Migraine is a common fibromyalgia comorbidity causing headache but it is not fibromyalgia. The same is true of depression. Poor concentration is largely due to poor sleep.

Siracusa’s opinion[edit]

In the opinion of Siracusa et al.: “The main symptoms of this disease are muscle stiffness, joint stiffness, insomnia, fatigue, mood disorders, cognitive dysfunction, anxiety, depression, general sensitivity and the inability to carry out normal daily activities [1,2].” (Fibromyalgia: Pathogenesis, Mechanisms, Diagnosis and Treatment Options Update. Rosalba Siracusa,1 Rosanna Di Paola,1,* Salvatore Cuzzocrea,1,2,* and Daniela Impellizzeri1 Int J Mol Sci. 2021 Apr; 22(8): 3891, doi: 10.3390/ijms22083891 Copyright © 2021 by the authors. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (

Plethora of symptoms in some fibromyalgia patients and the need to get at the underlying issues[edit]

Some patients with fibromyalgia have dozens of symptoms especially if they have a chronic severe case with multiple co-morbidities. The major co-morbidities are largely other types of central sensitization especially migraine and IBS.

Some extremely severe cases of fibromyalgia have as many as 10 co-morbidities, and this can create a shocking number of symptoms. It is often a practical impossibly in most busy office clinical situations for the doctor to explore eve¬ry one of them detail. Therefore, tools are need to try get at the core symptoms.

Six main symptoms[edit]

This list is partially a matter of opinion. Someone might argue there are more or less. However, what is not in doubt is that this list is useful for patients and their doctors to help understand their condition.

The six items are: widespread pain for more than 3 months, poor sleep, depression with excessive sadness, excessive anxiety, memory problems and excessive fatigue.

It is advisable to use a form to question each patient as to the presence of six main symptoms and how long they have occurred (the duration) and the order in which they occurred, is advisable. This helps the doctor and the patient to gain a picture of how fibromyalgia unfolded over time.

The form created by the author is part of his recommended “Fibromyalgia Registration and Patient History Form” and is called “Six Main Symptoms of Fibromyalgia Table”. It collects information on both the duration and severity of each symptom.

Other common symptoms[edit]

The following list was assembled Daniel Wallace and Daniel Clauw, two leaders in the field of fibromyalgia. It appeared with a supporting bibliography.

  • stiffness
  • morning fatigue (sometimes called the unrefreshing sleep pattern even if one sleeps the full night)
  • paresthesias
  • dizziness
  • subjective swollen feeling
  • cognitive difficulties
  • psychological distress in the form of anxiety or depression or other feelings of being stressed.
  • environmental sensitivity to weather and noise
  • symptoms of fibromyalgia common co-morbidities such as headaches

(For the original list and bibliography see: Fibromyalgia and Other Central Pain Syndromes, Daniel J Wallace; Daniel J Clauw; Lippincott Williams and Wilkins, Philadelphia, 2005) See page 139, available in Google Books in preview mode at: The chapter on symptoms is by Yunus and it is not visible.)

A symptom would qualify as core if it is a defining symptom that is present in most or all patients with a disorder.

Walitt Study[edit]

In the Walitt study, 67.5 percent of FM patients admitted to insomnia in the past year but 81.3 admitted to fatigue. (See Table 5. Symptom and functional ability variable association with Fibromyalgia. in The Prevalence and Characteristics of Fibromyalgia in the 2012 National Health Interview Survey, Brian Walitt , Richard L. Nahin, Robert S. Katz, Martin J. Bergman, Frederick Wolfe. September 17, 2015,,