Is Your Fibromyalgia Primary or Secondary?

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.¹

This article discusses primary and secondary fibromyalgia. It explains the different causes, the currently approved fibromyalgia treatments, and off-label options that may help relieve symptoms.

What Causes Fibromyalgia? 

Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory, and mood issues.²

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.²

Risk factors that may contribute to primary fibromyalgia include:³ 

• 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

Fibromyalgia is not an inflammatory condition or autoimmune disease, and there are no definitive tests to confirm it. 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:³¹

• 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
• Sjogren’s syndrome¹¹

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

Only three drugs are approved by the U.S. Food and Drug Administration (FDA) to treat fibromyalgia. These include:²

• Cymbalta (duloxetine), a serotonin-norepinephrine reuptake inhibitor (SNRI) antidepressant 
• Lyrica (pregabalin), an anticonvulsant (anti-seizure medication) that treats nerve pain 
• Savella (milnacipran), an SNRI 

Other medications that help to ease the pain of fibromyalgia include over-the-counter pain relievers like Tylenol (acetaminophen ), Advil (ibuprofen), and Aleve (naproxen sodium), and prescription anti-inflammatories like Celebrex (celecoxib) or Voltaren (diclofenac). 

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 Cymbalta and Savella, other SNRIs prescribed off-label for fibromyalgia include:¹⁴

• Effexor (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 Elavil (amitriptyline) are also prescribed off-label for fibromyalgia.¹⁶ Another tricyclic medication, cyclobenzaprine (formerly Flexeril) and Zanaflex (tizanidine), an alpha-2 adrenergic agonist, work as muscle relaxers to ease muscle pain and help you sleep.¹⁵

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)

How Fibromyalgia Is Treated

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-reliving 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.¹⁷

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:¹⁸

• Arava (leflunomide)
• Azulfidine (sulfasalazine)
• CellCept (mycophenolate mofetil)
• Cuprimine (penicillamine)
• Cytoxan (cyclophosphamide)
• Imuran (azathioprine)
• Neoral/Gengraf (cyclosporine)
• Otezla (apremilast)
• Plaquenil (hydroxychloroquine)
• Rheumatrex/Trexall (methotrexate)

If you have secondary fibromyalgia, it is important to work with your healthcare provider to ensure both conditions are being managed appropriately.