FIBROMYALGIA & ALPIMS
Fibromyalgia: looking at the wider picture
Fibromyalgia is a long-term condition involving widespread pain, often alongside fatigue, unrefreshing sleep and difficulties with thinking or memory.
About 2 in 100 people are affected. [1]
In ALPIMS, fibromyalgia fits mainly within Pain & Bodily Sensitivity. Other domains can help explore overlapping symptoms, conditions and support needs.
ALPIMS is a framework for exploring overlaps, not a diagnosis. These connections can help identify support needs and questions for your clinician. They do not mean every symptom has the same cause.
Prevalence varies by population and diagnostic method. Clinic figures cannot predict an individual’s diagnoses, and an association does not prove causation.
Explore the six ALPIMS domains
Open any coloured panel for the connection, evidence, practical tips and resources.
Anxiety & Autonomic
Anxiety can coexist with fibromyalgia. Dizziness or palpitations may also warrant assessment for orthostatic intolerance or PoTS; they should not automatically be attributed to anxiety.
What do we know? Anxiety is a recognised associated concern. PoTS is a separate diagnosis requiring assessment; symptoms alone do not establish it. [1] [6]
What may help?
- Mention symptoms that change with standing, heat or meals.
- Choose comfortable positions and manageable routines. Follow an individual autonomic plan if prescribed.
- Calm support may reduce distress without implying that distress caused the illness.
Resources
Laxity & Connective Tissue
Hypermobility spectrum disorders (HSD) and hypermobile Ehlers–Danlos syndrome (hEDS) can coexist with fibromyalgia. Joint instability and widespread pain may need different, complementary supports.
What do we know? In one EDS specialist-clinic study, 56.5% of 733 patients had both hEDS/HSD and fibromyalgia. This is a selected clinic sample, not a population estimate or the rate of hypermobility in all people with fibromyalgia. [4]
What may help?
- Tell your clinician about recurrent sprains, dislocations or joints that feel unstable.
- Ask about physiotherapy or occupational therapy adapted to joint stability, pain and fatigue.
- Use comfortable positioning and task adaptations; avoid forcing joints into painful end ranges.
Resources
Pain & Bodily Sensitivity
This is the main ALPIMS domain for fibromyalgia. Widespread pain and tenderness can coexist with headaches, migraine, bowel symptoms and other pain conditions. Each concern still deserves appropriate assessment.
What do we know? Altered pain processing is an important part of current understanding. Fibromyalgia pain is real; its intensity does not necessarily match visible tissue injury. There is no single routine blood test that confirms fibromyalgia. [2] [3]
What may help?
- Discuss the whole pain picture, including headaches, jaw pain, bowel or bladder symptoms.
- Ask for a shared plan covering pain, sleep, daily function and treatment tolerability.
- New or changing symptoms should be reviewed rather than assumed to be another flare.
Resources
Immune & Inflammatory
Fibromyalgia can coexist with inflammatory or autoimmune conditions such as rheumatoid arthritis or lupus. Having both can make it harder to identify which condition is contributing to pain.
What do we know? Fibromyalgia is not routinely classified as an inflammatory arthritis or autoimmune disease. Biological mechanisms remain under study. Its diagnosis alone does not establish MCAS, allergy or a need for immune treatment. [2] [7]
What may help?
- Ask about assessment if you have persistent joint swelling, fever or other new systemic symptoms.
- Treat a confirmed inflammatory condition alongside fibromyalgia care.
- Avoid broad elimination diets or detox programmes based only on the fibromyalgia diagnosis.
Resources
Mood, Mental Health & Trauma
Low mood, anxiety and emotional strain may accompany persistent pain, disrupted sleep and reduced participation. Trauma-related needs can also matter for some people; trauma is not a requirement for fibromyalgia.
What do we know? Mental health support can sit alongside physical symptom care. Psychological therapies may help with coping and function; recommending them does not mean the pain is imagined. [1] [3]
What may help?
- Choose support that validates pain and respects your preferences.
- Ask for practical help as well as emotional support.
- Discuss persistent low mood, distress or loss of enjoyment with a trusted clinician.
Resources
Sensory & Neurodevelopmental
Light, sound, smell and temperature sensitivity, along with brain fog, can be part of fibromyalgia. Autism or ADHD may add separate sensory, communication or planning needs when they coexist.
What do we know? Sensory sensitivity is recognised in fibromyalgia. It does not, by itself, establish autism, ADHD, misophonia or hyperacusis. This panel describes support needs rather than claiming a reliable prevalence for those overlaps. [2]
What may help?
- Adjust the input that bothers you most: lighting, noise, scent or temperature.
- Use short written instructions, reminders or help with planning if useful.
- Seek assessment for persistent visual or hearing symptoms instead of attributing everything to fibromyalgia.
Resources
Start with one useful support
You do not need to investigate every domain. Choose the difficulty that most affects daily life: pain, poor sleep, sensory input, meal preparation or getting through essential tasks.
Fibromyalgia care usually combines education, individually adapted activity, sleep support, psychological approaches and sometimes medicines. Agree a manageable plan with your clinician, including side effects and your other conditions. [3]
If you also have ME/CFS or post-exertional malaise (PEM)
Fibromyalgia and ME/CFS are distinct conditions that can coexist. If activity causes a delayed, prolonged worsening of symptoms, discuss this with your clinician. General fibromyalgia exercise advice may need adapting.
For ME/CFS, NICE recommends staying within individual energy limits and advises against programmes using fixed increases in activity. Do not push through PEM or follow an automatic weekly increase. [5]
Resources & references
Practical information: External resources open in a new tab.
- Healthdirect Australia: symptoms, diagnosis and treatment ↗
- Better Health Channel Victoria: fibromyalgia ↗
- NHS: fibromyalgia ↗
- NIAMS: treatment and daily life ↗
- Healthdirect Australia: fibromyalgia — prevalence, symptoms and care. ↗
- NIAMS: fibromyalgia — symptoms, possible mechanisms and associated conditions. ↗
- NIAMS: diagnosis, treatment and living with fibromyalgia. ↗
- Fairweather et al. (2023): overlap of fibromyalgia and hEDS/HSD in a specialist clinic. ↗
- NICE NG206: ME/CFS — individual energy management and activity guidance. ↗
- NHS: PoTS — symptoms, diagnosis and individual treatment. ↗
- Better Health Channel Victoria: fibromyalgia information. ↗
General information only. This page does not diagnose conditions or replace personalised care. Seek assessment for new or changing symptoms, especially joint swelling, fever, unexplained weight loss or progressive weakness. Call 000 in Australia for an emergency such as severe chest pain or sudden stroke-like symptoms.