What happens to muscles in fibromyalgia syndrome

  • Ebru UmayEmail author
  • Ibrahim Gundogdu
  • Erhan Arif Ozturk
Original Article



The main somatic symptoms of fibromyalgia syndrome (FMS) are chronic musculoskeletal pain, stiffness, and fatigue, all of which are related to the muscle system and its functioning.


The aim of this study was to evaluate whether the asymptomatic upper and lower extremity muscles evaluated using ultrasonography (US) were different from healthy controls in both newly diagnosed and established FMS and to assess whether muscle measurements were related to fatigue and disease severity, as well as quality of life.


This study was conducted on 152 subjects (102 patients and 50 healthy controls) as a cross-sectional controlled trial. Real-time imaging of cross-sectional thickness (CST) (for deltoid, biceps brachii, triceps brachii, forearm flexor, tibialis anterior, and gastrocnemius medialis), and cross-sectional areas (CSAs) (quadriceps femoris (QF)) measurements were performed using US. Fatigue and disease severity as well as quality of life scales were given to all participants.


In both patient groups, decreased QF muscle CSA was significantly correlated with increased fatigue severity and decreased overall quality of life and energy levels. Moreover, in patients with established disease, there was a significant correlation between the decrease in QF muscle CSA and increased social isolation and between the decrease in biceps brachii muscle CST and increased fatigue severity.


Whether in newly diagnosed or established disease, muscle measurement values and quality of life parameters were significantly decreased in patients with FMS compared with healthy controls.


Fatigue Fibromyalgia syndrome Quadriceps femoris Quality of life Ultrasound 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the local ethics committee, and it was carried out in accordance with the Declaration of Helsinki. Each participant’s caregiver was informed about the purpose of the study before participation, and the completion of the studies was voluntary.


  1. 1.
    Morin AK (2009) Fibromyalgia: a review of management options. Formulary 44:362–373Google Scholar
  2. 2.
    Cohen H (2017) Controversies and challenges in fibromyalgia: a review and a proposal. Ther Adv Musculoskel Dis 9:115–127CrossRefGoogle Scholar
  3. 3.
    Ruiz-Montero PJ, Van Wilgen CP, Segura-Jiménez V et al (2015) Illness perception and fibromyalgia impact on female patients from Spain and the Netherlands: do cultural differences exist? Rheumatol Int 35:1985–1993CrossRefGoogle Scholar
  4. 4.
    Briones-Vozmediano E, Ronda-Pérez E, Vives-Cases C (2015) Fibromyalgia patients’ perceptions of the impact of the disease in the workplace. Aten Primaria 47:205–212CrossRefGoogle Scholar
  5. 5.
    Góes SM, Leite N, Shay BL, Homann D, Stefanello JM, Rodacki AL (2012) Functional capacity, muscle strength and falls in women with fibromyalgia. Clin Biomech (Bristol, Avon) 27:578–583CrossRefGoogle Scholar
  6. 6.
    Larsson A (2018) Controlled, cross-sectional, multi-center study of physical capacity and associated factors in women with fibromyalgia. BMC Musculoskelet Disord 19:121CrossRefGoogle Scholar
  7. 7.
    Pernambuco AP, Schetino LP, Viana RS, Carvalho LS, d’Avila Reis D (2015) The involvement of melatonin in the clinical status of patients with fibromyalgia syndrome. Clin Exp Rheumatol 33:14–19Google Scholar
  8. 8.
    Srikuea R, Symons TB, Long DE, Lee JD, Shang Y, Chomentowski PJ, Yu G, Crofford LJ, Peterson CA (2013) Association of fibromyalgia with altered skeletal muscle characteristics which may contribute to postexertional fatigue in postmenopausal women. Arthritis Rheum 65:519–528CrossRefGoogle Scholar
  9. 9.
    Klaver-Król EG, Zwarts MJ, ten Klooster PM, Rasker JJ (2012) Abnormal muscle membrane function in fibromyalgia patients and its relationship to the number of tender points. Clin Exp Rheumatol 30:44–50PubMedGoogle Scholar
  10. 10.
    Sprott H, Salemi S, Gay RE, Bradley LA, Alarcón GS, Oh SJ, Michel BA, Gay S (2004) Increased DNA fragmentation and ultrastructural changes in fibromyalgic muscle fibres. Ann Rheum Dis 63:245–251CrossRefGoogle Scholar
  11. 11.
    Yunus MB, Kalyan-Raman UP, Kalyan-Raman K, Masi AT (1986) Pathologic changes in muscle in primary fibromyalgia syndrome. Am J Med 81:38–42CrossRefGoogle Scholar
  12. 12.
    Bengtsson A, Henriksson KG, Larsson J (1986) Reduced high-energy phosphate levels in the painful muscles of patients with primary fibromyalgia. Arthritis Rheum 29:817–821CrossRefGoogle Scholar
  13. 13.
    Lund N, Bengtsson A, Thorborg P (1986) Muscle tissue oxygen pressure in primary fibromyalgia. Scand J Rheumatol 15:165–173CrossRefGoogle Scholar
  14. 14.
    Grassi W, Core P, Carlino G, Salaffi F, Cervini C (1994) Capillary permeability in fibromyalgia. J Rheumatol 21:1328–1331PubMedGoogle Scholar
  15. 15.
    Lindh M, Johansson G, Hedberg M, Henning GB, Grimby G (1995) Muscle fiber characteristics, capillaries and enzymes in patients with fibromyalgia and controls. Scand J Rheumatol 24:34–37CrossRefGoogle Scholar
  16. 16.
    Schrøder HD, Drewes AM, Andreasen A (1993) Muscle biopsy in fibromyalgia. J Musculoskelet Pain 1:165–169CrossRefGoogle Scholar
  17. 17.
    Klaver-Król EG, Rasker JJ, Henriquez NR, Verheijen WG, Zwarts MJ (2012) Muscle fiber velocity and electromyographic signs of fatigue in fibromyalgia. Muscle Nerve 46:738–745CrossRefGoogle Scholar
  18. 18.
    Akyol Y, Ulus Y, Tander B, Bilgici A, Kuru O (2013) Muscle strength, fatigue, functional capacity, and proprioceptive acuity in patients with fibromyalgia. Turk J Phys Med Rehab 59:292–298Google Scholar
  19. 19.
    Koca I, Savas E, Ozturk ZA et al (2016) The evaluation in terms of sarcopenia of patients with fibromyalgia syndrome. Wien Klin Wochenschr 128:816–821CrossRefGoogle Scholar
  20. 20.
    Wolfe F, Hauser W (2011) Fibromyalgia diagnosis and diagnostic criteria. Ann Med 43:495–502CrossRefGoogle Scholar
  21. 21.
    Nelson NL (2015) Muscle strengthening activities and fibromyalgia: a review of pain and strength outcomes. J Bodyw Mov Ther 19(2):370–376CrossRefGoogle Scholar
  22. 22.
    Sprott H, Salemi S, Gay RE et al (2004) Increased DNA fragmentation and ultrastructural changes in fibromyalgic muscle fibres. Ann Rhem Dis 63:245–251CrossRefGoogle Scholar
  23. 23.
    Morf S, Amann-Vesti B, Forster A et al (2005) Microcirculation abnormalities in patients with fibromyalgia-measured by capillary microscopy and laser fluxmetry. Arthritis Res Ther 7:209–216CrossRefGoogle Scholar
  24. 24.
    McIver KL, Evans C, Kraus RM, Ispas L, Sciotti VM, Hickner RC (2006) NO-mediated alteration in skeletal muscle nutritive blood flow and lactate metabolism in fibromyalgia. Pain 120:161–169CrossRefGoogle Scholar
  25. 25.
    Gronemann ST, Ribel-Madsen S, Bartels EM, Danneskiold-Samsøe B, Bliddal H (2004) Collagen and muscle pathology in fibromyalgia patients. Rheumatology 43:27–31CrossRefGoogle Scholar
  26. 26.
    Gerdle B, Ernberg M, Mannerkorpi K et al (2016) Increased interstitial concentrations of glutamate and pyruvate in vastus lateralis of women with fibromyalgia syndrome are normalized after an exercise intervention: a case-control study. PLoS One 11:e0162010CrossRefGoogle Scholar
  27. 27.
    Hauser W, Klose P, Langhorst J et al (2010) Efficacy of different types of aerobic exercise in fibromyalgia: a systematic review and metaanalysis of randomized controlled trials. Arthritis Res Ther 12:R79CrossRefGoogle Scholar
  28. 28.
    Brosseau L, Wells GA, Tugwell P, Egan M, Wilson KG, Dubouloz CJ, Casimiro L, Robinson VA, McGowan J, Busch A, Poitras S, Moldofsky H, Harth M, Finestone HM, Nielson W, Haines-Wangda A, Russell-Doreleyers M, Lambert K, Marshall AD, Veilleux L, Ottawa Panel Members (2008) Ottowa panel evidence-based clinical practice guidelines for aerobic fitness exercises in the management of fibromyalgia: part 1. Phys Ther 88:857–871CrossRefGoogle Scholar
  29. 29.
    Busch AJ, Schachter CL, Overend TJ, Peloso PM, Barber KA (2008) Exercise for fibromyalgia: a systematic review. J Rheumatol 35:1130–1144PubMedGoogle Scholar
  30. 30.
    Maquet D, Croisier JL, Renard C, Crielaard JM (2002) Muscle performance in patients with fibromyalgia. Joint Bone Spine 69:293–299CrossRefGoogle Scholar
  31. 31.
    Cardoso FS, Curtolo M, Natour J, Lombardi Júnior I (2011) Assessment of quality of life, muscle strength and functional capacity in women with fibromyalgia. Rev Bras Reumatol 51:344–350CrossRefGoogle Scholar
  32. 32.
    Hakkinen A, Hakkinen K, Hannonen P, Alen M (2000) Force production capacity and acute neuromuscular responses to fatiguing loading in women with fibromyalgia are not different from those of healthy women. J Rheumatol 27:1277–1282PubMedGoogle Scholar
  33. 33.
    Miller TA, Allen GM, Gandevia SC (1996) Muscle force, perceived effort, and voluntary activation of the elbow flexors assessed with sensitive twitch interpolation in fibromyalgia. J Rheumatol 23:1621–1627PubMedGoogle Scholar
  34. 34.
    McLoughlin MJ, Colbert LH, Stegner AJ, Cook DB (2011) Are women with fibromyalgia less physically active than healthy women? Med Sci Sports Exerc 43:905–912CrossRefGoogle Scholar
  35. 35.
    Santos R, Armada-da-Silva PAS (2017) Reproducibility of ultrasound-derived muscle thickness and echo-intensity for the entire quadriceps femoris muscle. Radiography (Lond) 23:51–61CrossRefGoogle Scholar
  36. 36.
    Rudrappa SS, Wilkinson DJ, Greenhaff PL, Smith K, Idris I, Atherton PJ (2016) Human skeletal muscle disuse atrophy: effects on muscle protein synthesis, breakdown, and insulin resistance—a qualitative review. Front Physiol 7:361CrossRefGoogle Scholar
  37. 37.
    Zhang SF, Zhang Y, Li B, Chen N (2018) Physical inactivity induces the atrophy of skeletal muscle of rats through activating AMPK/FoxO3 signal pathway. Eur Rev Med Pharmacol Sci 22(1):199–209PubMedGoogle Scholar
  38. 38.
    Hairi NN, Cumming RG, Naganathan V, Handelsman DJ, le Couteur DG, Creasey H, Waite LM, Seibel MJ, Sambrook PN (2010) Loss of muscle strength, mass (sarcopenia), and quality (specific force) and its relationship with functional limitation and physical disability: the concord health and ageing in men project. J Am Geriatr Soc 58:2055–2062CrossRefGoogle Scholar
  39. 39.
    Burton LA, Sumukadas D (2010) Optimal management of sarcopenia. Clin Interv Aging 5:217–228PubMedPubMedCentralGoogle Scholar
  40. 40.
    Ruggiero L, Manganelli F, Santoro L (2018) Muscle pain syndromes and fibromyalgia: the role of muscle biopsy. Curr Opin Support Palliat Care 12(3):382–387CrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2019

Authors and Affiliations

  • Ebru Umay
    • 1
    Email author
  • Ibrahim Gundogdu
    • 1
  • Erhan Arif Ozturk
    • 1
  1. 1.Department of Physical Medicine and Rehabilitation, Ankara Diskapi Yildirim Beyazit Training and Research HospitalUniversity of Health SciencesAnkaraTurkey

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