At times the TMJ region and the anterior chest can be affected. Symptoms are most dominant early in the morning and late a night. Patients frequently feel tired all the time with an associated sense of weakness throughout multiple muscular parts. Sleep patterns are poor with morning fatigue, frequent awakenings during the night, and difficulty falling asleep. The typical physical examination for patients with fibromyalgia reveals multiple tender points throughout the body, often numbering eleven to eighteen spots.
Joints are often tender, and range of motion is often restricted due to pain.
Laboratory tests, however, inclusive of blood chemistry, complete blood count, erythrocyte sedimentation rate, and rheumatoid factor are negative. Sleep studies at times show a lack of restorative sleep. The origins of fibromyalgia have remained unclear. It has most recently been postulated that central pain mechanisms are involved whereby neurotransmitters and neurohormones have been altered in their production and regulatory functions. These aberrations in neuroendocrine balance often sensitize peripheral tissues producing reports of pain.