Fibromyalgia Aggravating Factors

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These are factors which make the symptoms in an existing case or episode of fibromyalgia worse. This is in contrast to a precipitating factor, which is a factor that brings about a first episode of symptoms. Suppose a person has been healthy and never had fibromyalgia, then they go through a rough period of stress and bad sleep followed shortly after with their first episode if fibromyalgia like pains: In this situation, the poor sleep and stress would be called precipitating factors.

If on the other hand they have had fibromyalgia for years and they are in some pain every day, but their pain gets worse if they lose their temper or miss their sleep, then their episode of anger and insomnia would be considered aggravating factors.

Benefit of clarifying a patient’s aggravating factors[edit]

The main value of having the patient use a list to clarify their aggravating factors (and also use lists for clarifying their precipitating and relieving factors) is as an aid to their treatment. It gives them insight on what they can try to avoid.

Bennett’s list of fibromyalgia aggravating factors[edit]

Perhaps the most comprehensive list of fibromyalgia aggravating factors is the one given in the 2007 study by Bennett et al. Table 4 is entitled “Factors perceived to worsen FM symptoms [in descending order of frequency]”.

When assessing fibromyalgia patients, I recommend presenting a version of it to the patient (without the frequency column) and replacing this column with three other columns for: “never”, “sometimes”, or “often”. Upon completion I suggest the doctor devote a counselling session to brainstorm with the patient and devise a plan to try to reduce any potentially modifiable aggravating factors. The focus should be on those that the patient marked as occurring “often”.

Perceived stressor Frequency
Emotional distress 83%
Weather changes 80%
Sleeping problems 79%
Strenuous activity 70%
Mental stress 68%
Worrying 60%
Car travel 57%
Family conflicts 52%
Physical injuries 50%
Physical inactivity 50%
Infections 43%
Allergies 37%
Low-to-moderate physical activity 36%
Lack of emotional support 36%
Time zone changes 34%
Airplane travel 34%
Perfectionism 32%
Work related conflicts 29%
Menses 27%
Medication side effects 27%
Chemical exposures 27%
Sexual intercourse 17%
"Factors perceived to worsen FM symptoms [in descending order of frequency]"
Source of table: An internet survey of 2,596 people with fibromyalgia. Robert M Bennett, Jessie Jones, Dennis C Turk, I Jon Russell, and Lynne Matallana, BMC Musculoskelet Disord. 2007; 8: 27, available in full online at: Copyright © 2007 Bennett 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.

Author’s comments on the items in the table by Bennett et al.[edit]

Many items in the table are psychological in nature including the most common one which is listed as “emotional distress”. This is consistent with psychological theories of fibromyalgia. Note also that they have identified some factors which are very interesting but which do not apply here, such as perfectionism which is a personality trait and so it is not really a direct aggravating factor. It is probably better placed in the risk factor table.

Revised checklist for clinical use[edit]

Here is a slightly revised version for clinical use in which the frequencies have been removed and there are columns so that the patient can indicate if the issue never occurs, sometimes occurs or often occurs:

Perceived stressor/aggravator Never Sometimes Often
Emotional distress
Weather changes
Sleeping problems
Strenuous activity
Mental stress
Car travel
Family conflicts
Physical injuries
Physical inactivity
Low-to-moderate physical activity
Lack of emotional support
Time zone changes
Airplane travel
Work related conflicts
Medication side effects
Chemical exposures
Sexual intercourse

Instructions to patient completing the checklist[edit]

This tool is to help determine what factors if any make your pain worse, once it has already occurred. If you are filling out this form before you have been properly diagnosed with fibromyalgia, then you cannot assume that these are fibromyalgia aggravating factors.

It is not unusual for patients to have a mix of fibromyalgia pains and other pains from their other ailments.

There is a separate table that patients can fill out for factors that seem to have triggered there first attack of fibromyalgia pains in their lifetime. It is the precipitating factors checklist.

If you have longstanding (more than three months) of unexplained muscle pains over many areas of your body, it might be due to fibromyalgia even if you have never been formally diagnosed with it.

Fibromyalgia pains are typically, but not always experienced by the patient as being in their muscles.

If your muscle pains are aggravated by any of the following factors shortly after the pain occurs, then tick off the appropriate box. For example. if you have pains but they get even worse just after you get upset then getting upset would be classified here as an aggravating factor. If this occurs only occasionally, then check off “sometimes”. If it is a common occurrence, then check off “often”.

(Note that getting upset can be both a precipitating factor and an aggravating factor in a patient even on the same day.)

Further information[edit]

Authors that have looked into aggravating factors include: Selfridge 2001, Waylonis 1992, Yunus 1985, Clauw 2001, Sheon 1987.