Fibromyalgia Fatigue: Why It Happens and What Can Help

By Emilie White

Published February 21, 2024

fibromyalgia fatigue

Ever wake up feeling unrefreshed even after getting 8 hours of restful sleep? If you live with fibromyalgia, you probably can relate.  

Fibromyalgia fatigue goes beyond the usual tiredness individuals feel after a long, taxing day. Instead, it is a constant and relentless sensation of exhaustion that can impact an individual’s quality of life. 

Learn more about fibromyalgia fatigue and your treatment options for combating it. 

Why Does Fibromyalgia Cause Fatigue?

Fibromyalgia fatigue is common; over 75% of those with fibromyalgia report experiencing it.1 Despite its prevalence, experts aren’t clear on what causes fibromyalgia fatigue. It appears to be multifactorial and can present as both physical and psychological fatigue.  

Physical fatigue falls into one of three categories:2

  • Asthenia: the feeling of having little to no energy and needing to take breaks to complete a task
  • Fatigability: tiring faster than others when completing the same task
  • Muscle weakness: a reduction in muscle contractions, leaving you feeling weak

Psychological fatigue can also be grouped into two major categories:2

  • Weariness: a lack of motivation to do anything 
  • Cognitive fatigue: the inability to think clearly, concentrate, or motivate oneself 

You can have different types of fatigue at once, and the kind of fatigue you experience can change. 

Fatigue is subjective, meaning it is based on a person’s opinion, and everyone’s opinion or threshold for fatigue will differ and change over time. You may wonder: can fibromyalgia cause extreme fatigue? You bet. Some may experience fibromyalgia extreme fatigue, leaving them feeling incredibly drained and exhausted. Sleepless nights are also common in those experiencing extreme fatigue. 

But those with fibromyalgia fatigue may find that sleeping more doesn’t always resolve their fatigue. This can depend on what type of fatigue you’re experiencing. For instance, sleep does not affect psychological causes but may benefit those experiencing asthenia or fatigability.2 

A 2023 review analyzed four studies that looked at fibromyalgia fatigue.2 These studies showed fibromyalgia fatigue was commonly associated with:2

  • Female sex
  • Higher body weight
  • Mood disorders, including anxiety and depression
  • Number of tenderness points
  • Pain severity

Like other fibromyalgia symptoms, fibromyalgia fatigue can come and go, and the severity of fatigue will vary for everyone. So, how long does fibromyalgia fatigue last? The unsatisfying answer is that it varies, and will differ from person to person. Sometimes, fatigue may be acute, meaning it comes and goes. But other times, it may stick around for a while. 

Fibromyalgia Symptom Overview

We’ve talked a lot about fibromyalgia fatigue; however, fatigue is not fibromyalgia’s hallmark feature. The presence of widespread musculoskeletal pain is fibromyalgia’s main characteristic. 

Fibromyalgia pain is often described as a dull pain that doesn’t go away. This pain must be present for at least three months and occur on both sides of your body as well as above and below your waist. 

The pain experienced in fibromyalgia differs from other types of pain. Typically, there isn’t a physical trigger, such as an injury. Instead, fibromyalgia pain involves how the brain interprets messages from your nerves and how often these messages are sent. Sometimes, nerves can misfire or overfire, causing your brain to receive tons of messages at once. This can result in a heightened sense of pain to various stimuli. 

Besides pain and fatigue, other symptoms of fibromyalgia include:

  • Sleep disturbances
  • Headaches
  • “Fibro fog” – problems with memory, concentration, or thinking
  • Depressed mood
  • Anxiety
  • Problems with digestion, such as abdominal pain, bloating, or constipation

Pain is rarely the only symptom present in those with fibromyalgia. In fact, based on the American College of Rheumatology (ACR) 2016 diagnostic criteria, individuals must also have other somatic (body) symptoms present, including fatigue.3 Fibromyalgia can also coexist with other medical conditions, such as arthritis, chronic fatigue syndrome, irritable bowel syndrome (IBS), and depression. 

Chronic Fatigue Syndrome vs Fibromyalgia

Chronic fatigue syndrome (CFS) and fibromyalgia are complex medical conditions that cause profound fatigue. But they are separate medical conditions.   

One of the primary symptoms of CFS is extreme and unexplained fatigue that is not improved by rest for at least six months. Besides fatigue, other symptoms of CFS include 

  • Trouble concentrating or thinking (“brain fog”)
  • Headaches
  • Muscle and joint pain
  • Swollen lymph nodes
  • Sleep difficulties
  • Problems with digestion

Although those with fibromyalgia have fatigue, it is not the primary symptom. As mentioned, the hallmark symptom of fibromyalgia is widespread pain for at least three months. But, as you can see, fibromyalgia and CFS have overlapping symptoms. This can make distinguishing between them challenging, especially if you have both medical conditions. 

When comparing CFS and fibromyalgia, one major difference is that pain is not part of CFS diagnostic criteria. As a result, the presence or absence of tender or trigger points only applies to fibromyalgia and not CFS. 

Managing CFS and fibromyalgia often involves a multimodal approach. Treatment plans for both medical conditions may include the following:3,4

  • Medications to manage symptoms
  • Lifestyle modifications
  • Physical or behavioral therapies
  • Psychological support

Everyone’s treatment plan will look different, as the most effective ones are personalized to the individual patient’s symptoms and history.3 

Fibromyalgia Fatigue Treatment Options

Physical activity is often part of fibromyalgia treatment plans as it helps manage fibromyalgia symptoms, including fatigue.3 But when you are suffering from fatigue, the last thing on your mind is probably moving. There are other options, such as medications or behavioral therapies, that you can try as well. 

Medications for Fibromyalgia Fatigue

There are many medication options for managing fibromyalgia symptoms, including fatigue. Some of these fibromyalgia medications for fatigue are FDA-approved for managing fibromyalgia symptoms. 

There are other medications, like amitriptyline, that are not FDA-approved for treating fibromyalgia.5 However, your healthcare provider may still prescribe them. If so, know that your healthcare provider is using it “off-label.” This doesn’t mean it won’t work. It just means researchers are still developing body of evidence supporting its use for this condition or the FDA has not reviewed the evidence.

Your healthcare provider may prescribe one medication over another based on the type of fatigue you experience, other symptoms present, and medical history. Below, we will look at the three FDA-approved medications to treat fibromyalgia symptoms. 

FDA-Approved Medications

Pregabalin (Lyrica) works by reducing extra signals sent out by overactive nerves. By reducing these signals, pain and tenderness may improve. Pregabalin improves fibromyalgia pain, sleep disturbances, and fatigue compared to placebo.4 

Duloxetine (Cymbalta) blocks two hormones – serotonin and norepinephrine – from entering your cells.4 In turn, your blood levels of these hormones increase, resulting in reduced pain and improved mood. 

Milnacipran (Savella) increases your blood levels of serotonin and norepinephrine.4 As a result, pain decreases, and fatigue improves. Those taking milnacipran saw minor improvements in fatigue compared to placebo.4

A 2022 study compared four medications commonly prescribed for managing fibromyalgia symptoms: milnacipran, duloxetine, pregabalin, and amitriptyline.5 All the medications showed an improvement in both fibromyalgia pain and fatigue, but, pregabalin and amitriptyline were the best at combating fibromyalgia fatigue.5 

Lifestyle Changes for Fibromyalgia Fatigue

While medications are helpful, they only make up one part of the treatment plan. Non-pharmacological treatments have high-quality evidence for treating fibromyalgia fatigue, should be considered as part of holistic treatment. 

Best Supplements for Fibromyalgia and Chronic Fatigue

Researchers have looked at the effect different diets have on fibromyalgia symptoms. While studies offer some support for certain diets, the evidence is often limited and conflicting.6 Until further research is conducted, no one diet for chronic fatigue and fibromyalgia is considered better than another overall. 

An anti-inflammatory diet like the Mediterranean diet may reduce inflammation and fibromyalgia symptoms.6 The Mediterranean diet focuses on eating vegetables, fruits, beans, and whole grains. This diet also uses various herbs and spices, such as turmeric and cumin, which may offer additional health benefits. For instance, turmeric for fibromyalgia and chronic fatigue syndrome may help reduce inflammation. Research shows eating a Mediterranean diet may improve fatigue and other fibromyalgia symptoms. 

Studies examining supplements’ effects on fibromyalgia symptoms, including fatigue, are also limited.6 Research shows that there may be a small benefit to taking the following supplements and vitamins for fibromyalgia fatigue:6

  • Vitamin D
  • Vitamin C and E
  • Magnesium
  • Iron (if you are anemic)
  • Zinc
  • Melatonin

Keep in mind: if you eat a well-balanced diet, you will likely get enough of these vitamins to meet your needs. Too much of anything, even vitamins, can be harmful and cause unwanted side effects. Be sure to check with your healthcare provider before starting any supplement or vitamin.

Sleep Hygiene Practices

We have all heard about the benefits of getting a restful eight hours of sleep. Yet many of us still fall short. Improving your sleep habits can help you fall asleep and stay asleep. In turn, this helps with fibromyalgia fatigue and other fibromyalgia symptoms you may be experiencing. 

The American Academy of Sleep Medicine recommends the following tips to improve your sleep hygiene:

  • Keep a consistent sleep schedule during the week, on weekends, and on vacations.
  • Create a relaxing bedtime routine.
  • Set a bedtime. Ensure it is early enough to get at least seven to eight hours of sleep.
  • If you can’t fall asleep within 20 minutes, leave your bed and do a quiet activity with limited light exposure.
  • Shut electronics off at least 30 minutes before bedtime.
  • Dim the lights in the evening to limit exposure to bright light.
  • Adjust your bedroom’s room temperature to keep it cool and comfortable. 
  • Avoid eating a big meal right before bedtime.
  • Stay away from caffeinated beverages in the afternoon and evening.
  • Watch your fluid intake right before bedtime.
  • Get regular exercise and eat a healthy diet.

Behavioral Therapies for Fibromyalgia Fatigue

Behavioral therapies for fibromyalgia focus on managing symptoms through changes to behavior, or learning new behavioral practices. Below, we will learn about the three most common behavioral therapies taught to those with fibromyalgia.

Mindfulness Practices

Mindfulness allows individuals to connect their thoughts and emotions to how their body feels.7 This can be done through meditation practices such as deep breathing, low-impact activity like walking, or body scans.7 

Mindfulness can lead to a clearer connection between mind and body, including bodily pain triggers like stress and anxiety. Besides improving pain, mindfulness practices may help manage mood disorders, stress, and sleep disturbances.7 

Mindfulness-based practices that focus on stress reduction often incorporate yoga and body awareness techniques.8 Most studies that look at mindfulness-based practices in those with fibromyalgia fatigue are based in a group setting.8 These study participants reported a small improvement in fatigue, among other symptoms.8 

Cognitive behavioral therapy 

Cognitive behavioral therapy (CBT) is one of the most studied behavioral therapies.8 The work of CBT is aimed at creating more awareness during these distressing experiences. You can learn to pause, observe what choices are available to you in that moment, and respond from that heightened awareness. Rather than being driven by “fixing” pain, your choices can be about moving toward what matters to you.

To reduce symptoms of fibromyalgia, CBT encourages movement, activity pacing (not overdoing it on good days), and identification of pain behavior.9 Improving your sleep habits also plays an important role in CBT.9

Studies show CBT can provide fibromyalgia fatigue help. Combining CBT with mindfulness-based practices helps individuals better process their thoughts, physical sensations, and emotions.8 This can lead to a greater acceptance of these inner experiences, thus reducing fibromyalgia symptoms.8 

Acceptance and Commitment Therapy

Understanding that pain, grief, illnesses, fear, and anxiety are part of life is the basis of acceptance and commitment therapy (ACT).10 ACT focuses on reducing avoidance behaviors of negative thoughts and beliefs and fostering psychological flexibility.8 

Psychological flexibility allows individuals to handle difficult emotions or thoughts while remaining true to themselves and their values. ACT relieves fibromyalgia symptoms by encouraging individuals to re-engage in life in meaningful ways rather than focusing directly on symptom relief.10 

Where to Find Help for Fibromyalgia Fatigue

Fibromyalgia Specialists

Fibromyalgia and its symptoms are complex. It’s best to work with a fibromyalgia specialist or clinic who is familiar with the symptoms of fibromyalgia and can take a multimodal approach to treatment. You can also check with your primary care provider for a list of fibromyalgia specialists. 

At Swing Care, our fibromyalgia specialists offer services via telemedicine, allowing you to receive top-notch care from the comfort of your home. We use evidence-based treatments, both non-drug and medication-based, to help manage your fibromyalgia symptoms, including fatigue. 

Sleep Specialists

Sleep is essential to your health, and insufficient sleep can impact your body’s functions. Consider working with a sleep specialist for additional in-person guidance on sleep symptoms related to fibromyalgia. 

To find a sleep specialist near you, call your insurance to see which ones are in-network. You can also search for accredited sleep centers near you through the American Academy of Sleep Medicine. Keep in mind –  you may need a referral from your primary care provider for these services to be covered. 

Medically reviewed by Dr. Andrea Chadwick


  1. Vincent, A., Benzo, R.P., Whipple, M.O. et al. Beyond pain in fibromyalgia: insights into the symptom of fatigue. Arthritis Res Ther. 2013;15: 221. doi: https://doi.org/10.1186/ar4395
  2. Beckers E, Hermans K, Van Tubergen A, Boonen A. Fatigue in patients with rheumatic and musculoskeletal diseases: a scoping review on definitions, measurement instruments, determinants, consequences and interventions. RMD Open. 2023;9(3):e003056. doi: https://doi.org/10.1136/rmdopen-2023-003056
  3. Häuser W, Ablin J, Perrot S, Fitzcharles MA. Management of fibromyalgia: practical guides from recent evidence-based guidelines. Pol Arch Intern Med. 2017;127(1):47-56. doi: https://doi.org/10.20452/pamw.3877
  4. Tzadok R, Ablin JN. Current and Emerging Pharmacotherapy for Fibromyalgia. Pain Res Manag. 2020;2020:6541798. doi: https://doi.org/10.1155/2020/6541798
  5. Doucette JA, Eguale T. Comparison of Amitriptyline and US Food and Drug Administration-Approved Treatments for Fibromyalgia: A Systematic Review and Network Meta-analysis. JAMA Netw Open. 2022;5(5):e2212939. doi: https://doi.org/10.1001/jamanetworkopen.2022.12939
  6. Pagliai G, Giangrandi I, Dinu M, Sofi F, Colombini B. Nutritional Interventions in the Management of Fibromyalgia Syndrome. Nutrients. 2020;12(9):2525. doi: https://doi.org/10.3390/nu12092525
  7. Zhang D, Lee EKP, Mak ECW, Ho CY, Wong SYS. Mindfulness-based interventions: an overall review. Br Med Bull. 202;138(1):41-57. doi: https://doi.org/10.1093/bmb/ldab005
  8. Maas Genannt Bermpohl F, Hülsmann L, Martin A. Efficacy of mindfulness- and acceptance-based cognitive-behavioral therapies for bodily distress in adults: a meta-analysis. Front Psychiatry. 2023;14:1160908. doi: https://doi.org/10.3389/fpsyt.2023.1160908
  9. Hassett AL, Gevirtz RN. Nonpharmacologic treatment for fibromyalgia: patient education, cognitive-behavioral therapy, relaxation techniques, and complementary and alternative medicine. Rheum Dis Clin North Am. 2009;35(2):393-407. doi: https://doi.org/10.1016/j.rdc.2009.05.003
  10. Dindo L, Van Liew JR, Arch JJ. Acceptance and Commitment Therapy: A Transdiagnostic Behavioral Intervention for Mental Health and Medical Conditions. Neurotherapeutics. 2017;14(3):546-553. doi: https://doi.org/10.1007/s13311-017-0521-3

Emilie White


Emilie White is a registered clinical pharmacist turned health content writer. Leveraging her residency training and over 10 years of practice, Emilie’s clinical knowledge allows her to create well-researched and engaging health content. Beyond her professional pursuits, Emilie enjoys supporting her kids in their various pursuits, reading historical fiction novels, and running with her favorite iFit trainers.

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