What is widespread muscle pain?
Widespread muscle pain is pain felt in many areas of the body at the same time, usually persisting over a long period. It is frequently accompanied by fatigue, disturbed sleep and waking unrefreshed. There is no single test that establishes the diagnosis; it is reached by clinical assessment and by ruling out other conditions that cause similar symptoms.
The World Health Organization (opens in a new tab) lists fibromyalgia separately as a widespread pain condition among musculoskeletal conditions, a group covering more than 150 diseases, and reports that approximately 1.71 billion people worldwide have a musculoskeletal condition. The same organisation reports that low back pain (opens in a new tab), which falls within this group, affected 619 million people worldwide in 2020 and is the single leading cause of disability.
Patients in this group commonly share one experience: going a long time without an answer. “I ache everywhere, but my tests come back normal” is a sentence heard often. This does not mean that the complaint is not real; it means the assessment needs to be approached differently.
What the assessment covers
The duration and distribution of the pain. How long it has been going on, which areas of the body it covers and whether it is present on both sides.
Sleep routine. Difficulty falling asleep, frequent waking at night, waking unrefreshed. Sleep problems and widespread pain most often occur together.
Fatigue. Its level and how far it affects daily life.
Accompanying symptoms. Morning stiffness and its duration, swelling or redness in the joints, rash, dryness of the mouth and eyes, fever, weight change, bowel complaints, headache.
Ruling out conditions that could produce a similar clinical picture. Thyroid function, anaemia, vitamin D status, blood sugar, liver and kidney function and inflammatory markers are assessed.
Current medication. Some medicines may cause muscle pain; cholesterol medicines in particular are asked about.
Mental state and the burden of stress. In widespread pain this forms part of the assessment, and it does not mean that the pain is “all in the head”.
How does the assessment proceed?
- Detailed medical history. The history of the pain, sleep, fatigue and the effect on daily life are recorded.
- Physical examination. The joints, muscles and tender areas are examined, with attention to any signs of joint inflammation.
- Laboratory tests. Investigations are requested to distinguish conditions that cause similar symptoms. There is no single test that shows widespread pain itself.
- Referral where necessary. Where the findings suggest joint inflammation, a rheumatology assessment may be requested.
- Drawing up the plan. Sleep routine, gradual movement and pain management are planned together; the follow-up interval is set.
In which patients is it assessed differently?
- In patients in whom fever, night sweats and weight loss accompany the pain
- In patients with swelling, redness and increased warmth in the joints (inflammatory joint diseases are investigated separately)
- In patients with widespread pain newly starting over 50 years of age and stiffness of the shoulder and hip girdle
- In patients with a history of cancer
- In patients taking cholesterol medicine (medication-related muscle pain is assessed separately; do not stop the medicine on your own initiative)
- In patients with thyroid disease or vitamin D deficiency (these are addressed first)
- In patients who are pregnant or breastfeeding (the medicines that may be used are limited)
- In patients under 18 years of age (assessment lies within the field of paediatrics; this page has been prepared for adults)
How long does it take, and how many appointments are needed?
The assessment may require more than one appointment; ruling things out takes time. A single number of appointments cannot be given in advance.
In a long-standing clinical picture, follow-up is not confined to a short period; it continues at intervals. The interval is set at the end of the examination and reviewed at each follow-up.
What should you do before and after the consultation?
When you come to your appointment, bring:
- A list of all the medicines and supplements you use
- All your previous test and imaging results
- A few weeks’ notes on your pain and sleep routine
Older results are particularly valuable in this clinical picture. For detailed preparation, see our article How Should You Prepare for a Consultation?.
After the appointment, you are given a written plan. Apply the movement advice gradually; intense exercise begun suddenly may make the complaint worse. The time it takes for an effect to appear varies from person to person.
Risks and points to be aware of
The diagnosis is not made with a single test. The assessment works by ruling things out and may require more than one appointment. This does not mean it has been done incompletely.
Results that come back within the healthy range do not mean that there is no complaint. In widespread pain conditions, laboratory results are most often within the healthy range.
Inactivity may sustain the clinical picture. Stopping activity altogether because of the pain is generally not advised; the appropriate level is determined after the examination.
Do not start a medicine or supplement on your own initiative. Products recommended for widespread pain may interact with your current medication.
Interventional procedures carry risks of their own. Pain at the site of the procedure, bruising, bleeding and, rarely, infection may occur. The suitability criteria are set out on the relevant pages.
Results vary from person to person. The path to be followed and the response are not the same in every patient.
When should you see a physician without delay?
If you notice these symptoms, consult a physician without delay:
- Fever accompanying the pain
- Unintentional weight loss, night sweats
- Swelling, redness and increased warmth in the joints
- Morning stiffness lasting longer than an hour
- Muscle weakness (difficulty climbing stairs or combing your hair)
- A skin rash, or dryness of the mouth and eyes, developing alongside
- New-onset shoulder and hip girdle pain with stiffness over 50 years of age
In the case of widespread and severe muscle pain together with darkening of the urine, go directly to the emergency department.
Frequently asked questions
My tests came back normal, so why am I in pain?
In widespread pain conditions, laboratory results most often come back within the healthy range. This does not mean that there is no complaint. The purpose of the investigations is to distinguish other conditions that cause similar symptoms; there is no single test that shows widespread pain itself.
How is a diagnosis of fibromyalgia made?
The diagnosis rests on the duration and extent of the pain, the accompanying symptoms and the ruling out of other conditions that could produce a similar clinical picture. It is not made with a single blood test or imaging study, and the assessment may require more than one appointment.
Will this pain go away?
The course varies from person to person and a length of time cannot be given in advance. A plan is drawn up in which sleep routine, gradual movement and pain management are addressed together, and it is reviewed at the follow-up appointments.
Should I exercise when I have widespread muscle pain?
Keeping up movement is generally advised, but its type and level are set for each person and increased gradually. Intense exercise begun suddenly may make the complaint worse. The level suitable for you is planned after the examination.
Does vitamin D deficiency cause widespread pain?
Vitamin D status is one of the factors looked at in the assessment of widespread pain. Finding a deficiency, however, does not show that this is the only cause of the pain; the other factors are addressed alongside it. Supplement use is planned following assessment by a physician.
Does being asked about my mental state mean that my pain is not real?
No. In widespread pain, sleep routine, the burden of stress and mental state may all affect the severity and duration of the pain, which is why they form part of the assessment. The reality of the pain is not called into question.
Which procedures may be planned for widespread muscle pain?
If considered suitable following the assessment, procedures such as hijama and major ozone therapy may be added to the plan. Each has its own suitability criteria, steps and possible side effects, and these are described separately on the relevant pages.
Sources
- World Health Organization, Musculoskeletal health fact sheet, 14 July 2022. https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions (opens in a new tab)
- World Health Organization, Low back pain fact sheet, 19 June 2023. https://www.who.int/news-room/fact-sheets/detail/low-back-pain (opens in a new tab)
