Is Your Fibromyalgia Primary or Secondary?
- Is Your Fibromyalgia Primary or Secondary?
By Adrienne Dellwo Updated
Medically reviewed by Shaheen Lakhan, MD, PhD
Fibromyalgia can be primary, with no known trigger, or secondary, linked to another health condition.
Primary fibromyalgia’s risk factors include age, gender, genes, infections, injuries, stress, and obesity.
Fibromyalgia is treated with medications and self-care, but no single treatment is effective for all symptoms.
Fibromyalgia (FMS), a chronic condition that causes widespread muscle pain and fatigue, can be primary or secondary.
In primary (idiopathic) fibromyalgia—the more common form—the cause is unknown. In secondary fibromyalgia, the symptoms are related to another underlying health condition, such as rheumatoid arthritis, lupus, or Lyme disease.
What Causes Fibromyalgia?
Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood issues.
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Experts still don’t know exactly what’s going on in the body that leads to fibromyalgia. Some research suggests fibromyalgia is a nervous system disorder where an imbalance of brain chemicals like serotonin and norepinephrine alters your reaction to painful stimuli.
Risk factors that may contribute to primary fibromyalgia include:
Age: Fibromyalgia is commonly first diagnosed between ages 35 and 45.4
Gender: People assigned female at birth are twice as likely to develop fibromyalgia.
Genes: Fibromyalgia tends to run in families.
Infections: Viral infections are a potential trigger for fibromyalgia.
Injuries: Fibromyalgia can develop after repetitive injuries.
Stress: Negative life events and emotional or physical trauma are possible triggers.5
Weight: Obesity is associated with an increased risk of fibromyalgia.4
There are no definitive tests to confirm fibromyalgia. A diagnosis is usually made after ruling out other possible causes, which may take several years and visits to different specialists.5
Secondary Fibromyalgia Causes
Secondary fibromyalgia has similar symptoms as primary fibromyalgia, but it is linked to an underlying chronic health condition, such as:
Ankylosing spondylitis
Endometriosis6
Hepatitis C7
Joint hypermobility syndrome8
Lyme disease9
Lupus
Multiple sclerosis (MS)10
Neck injuries
Other chronic pain conditions
Rheumatoid arthritis (RA)
Spinal surgery, particularly in the upper spinal region
Sjögren’s disease11
One theory behind secondary fibromyalgia is that chronic pain changes the brain and central nervous system and leads to central sensitization. As a result, the body overreacts to pain and other stimuli (noise, smell, bright lights, etc.).12
Fibromyalgia Treatments
Primary and secondary fibromyalgia are treated with medication and self-care to help manage symptoms and improve general health. No one treatment works for all symptoms.13
Four drugs are approved by the U.S. Food and Drug Administration (FDA) to treat fibromyalgia. These include:2
Drizalma Sprinkle (duloxetine), a serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressant
Lyrica (pregabalin), an antiseizure medication (ASM) that treats nerve pain
Savella (milnacipran), an SNRI
Tonmya (cyclobenzaprine), a skeletal muscle relaxant
Other medications that help relieve fibromyalgia pain include over-the-counter pain relievers like Tylenol (acetaminophen), Advil (ibuprofen), Aleve (naproxen sodium), and Voltaren Arthritis Pain (diclofenac), as well as prescription anti-inflammatories like Celebrex (celecoxib).
Off-Label Treatments
Other medications may be helpful for treating fibromyalgia symptoms, though not approved to treat the condition. This is known as an off-label use of the drug.
Antidepressants are often prescribed to treat fibromyalgia symptoms. In addition to duloxetine and Savella, other SNRIs prescribed off-label for fibromyalgia include:14
Effexor XR (venlafaxine)
Pristiq (desvenlafaxine)
Another class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) are sometimes prescribed off-label for fibromyalgia. These include:15
Celexa (citalopram)
Lexapro (escitalopram)
Luvox (fluvoxamine)
Paxil (paroxetine)
Prozac (fluoxetine)
Zoloft (sertraline)
Tricyclic antidepressants such as amitriptyline are also prescribed off-label for fibromyalgia.16Another tricyclic medication, Tonmya, and Zanaflex (tizanidine), an alpha-2 adrenergic agonist, work as muscle relaxers to ease muscle pain and help you sleep.1715
Anti-seizure medications designed to treat epilepsy are often useful in reducing certain types of pain. In addition to Lyrica, these include:15
Keppra (levetiracetam)
Neurontin (gabapentin)
Vimpat (lacosamide)
Self-Care Strategies
Fibromyalgia is often managed using self-care strategies and lifestyle changes.
Gentle exercises, like walking, swimming, stretching, and yoga, are helpful for people with fibromyalgia. Simply adding more movement to your day, like taking a flight of stairs instead of the elevator or parking further away from the entrance, can add up.2
Stress-relieving activities are also helpful for easing fibromyalgia symptoms. Deep breathing, meditation, and engaging in relaxing hobbies can help to lower your stress and your pain.
Getting enough rest is also important for people with fibromyalgia. If you aren’t sleeping well, try to set good sleep habits, like going to bed at the same time each night and turning off screens before bedtime.
Physical therapy, massage, and chiropractic may also help. In addition, some people have success with acupuncture in treating their fibromyalgia.18
These lifestyle changes, along with medications, can help reduce pain, improve sleep, and ease fatigue.
Treating Secondary Fibromyalgia
People who have secondary fibromyalgia may find managing their primary condition helps to relieve fibromyalgia symptoms.
For people with rheumatoid arthritis, lupus, ankylosing spondylitis, and other rheumatological conditions, disease-modifying anti-rheumatic drugs (DMARDs) are often prescribed. These include:19
Arava (leflunomide)
Azulfidine (sulfasalazine)
CellCept (mycophenolate mofetil)
Cuprimine (penicillamine)
Cytoxan (cyclophosphamide)
Imuran (azathioprine)
Neoral/Gengraf (cyclosporine)
Otezla (apremilast)
Plaquenil (hydroxychloroquine)
Trexall (methotrexate)
If you have secondary fibromyalgia, it is important to work with your healthcare provider to ensure both conditions are being managed appropriately.