Individuals with fibromyalgia had lower sleep quality and efficiency, as well as longer wake time after sleep start, shorter sleep duration, lighter sleep, and greater trouble initiating sleep when objectively assessed, and more difficulty initiating sleep when subjectively assessed. Sleep problems may contribute to pain by decreased release of IGF-1 and human growth hormone, leading to decreased tissue repair. Improving sleep quality can help people with fibromyalgia minimize pain. Cognitive problems
Many people with fibromyalgia experience cognitive problems (known as "fibrofog" or "brainfog"). One study found that approximately 50% of fibromyalgia patients had subjective cognitive dysfunction and that it was associated with higher levels of pain and other fibromyalgia symptoms. The American Pain Society recognizes these problems as a major feature of fibromyalgia, characterized by trouble concentrating, forgetfulness and disorganized or slow thinking. About 75% of fibromyalgia patients report significant problems with concentration, memory, and multitasking. A 2018 meta-analysis found that the largest differences between fibromyalgia patients and healthy subjects were for inhibitory control, memory, and processing speed. It is hypothesized that the increased pain compromises attention systems, resulting in cognitive problems. Hypersensitivity
In addition to a hypersensitivity to pain, patients with fibromyalgia show hypersensitivity to other stimuli, such as bright lights, loud noises, perfumes and cold. A review article found that they have a lower cold pain threshold. Other studies documented an acoustic hypersensitivity. Comorbidity
Fibromyalgia as a stand-alone diagnosis is uncommon, as most fibromyalgia patients often have other chronic overlapping pain problems or mental disorders.
In a 2020 Cochrane review cognitive behavioral therapy (CBT) was found to have a small but beneficial effect for reducing pain and distress but adverse events were not well evaluated. CBT and related psychological and behavioural therapies have a small to moderate effect in reducing symptoms of fibromyalgia. Effect sizes tend to be small when CBT is used as a stand-alone treatment for FM patients, but these improve significantly when CBT is part of a wider multidisciplinary treatment program.A 2010 systematic review of 14 studies reported that CBT improves self-efficacy or coping with pain and reduces the number of physician visits at post-treatment, but has no significant effect on pain, fatigue, sleep, or health-related quality of life at post-treatment or follow-up. Depressed mood was also improved but this could not be distinguished from some risks of bias. A 2022 meta-analysis found that CBT reduces insomnia in people with chronic pain, including people with fibromyalgia. Sleep hygiene interventions, however, were not as effective. Patient education
Patient education is recommended by the European League Against Rheumatism (EULAR) as an important treatment component. As of 2022, there is only low-quality evidence showing that patient education can decrease pain and fibromyalgia impact.Sleep hygiene interventions show low effectiveness in improving insomnia. Manual therapy
A 2021 meta-analysis concluded that massage and myofascial release diminish pain in the medium-term. As of 2015, there was no good evidence for the benefit of other mind-body therapies.