ConditionBones, joints & muscles
Chronic Widespread Pain
Chronic widespread pain (CWP) is pain felt in many parts of the body, on both sides, above and below the waist and along the spine, lasting 3 months or longer. It affects roughly 1 in 10 adults. In most people it reflects a sensitized pain system, as in fibromyalgia, rather than damage in each painful area. Doctors first check for treatable causes such as inflammatory arthritis, thyroid disease and vitamin D deficiency. Exercise, sleep improvement, psychological therapies and some medicines help most.
Also called: CWP, widespread chronic pain, chronic primary widespread pain, nociplastic pain
At a glance
- What it is
- Pain in multiple regions on both sides of the body and the spine for at least 3 months.
- How common
- About 10% of adults; more common in women and with age.
- Main mechanism
- Central sensitization: the nervous system amplifies pain signals.
- Overlaps with
- Fibromyalgia, fatigue, poor sleep, depression, anxiety, irritable bowel syndrome.
- What helps most
- Graded exercise, sleep, CBT and pain education; some medicines such as duloxetine or amitriptyline.
When to get help
Call 911 or go to the ER
- Thoughts of suicide or self-harm: call or text 988 (US) or your local crisis line
See a doctor within a day or two
- New widespread pain with fever, weight loss, night sweats or a rash
- Sudden muscle weakness, dark urine or severe muscle pain, especially after starting a statin
- Morning stiffness in shoulders and hips over age 50 with difficulty getting out of bed (possible polymyalgia rheumatica)
Book a routine appointment
- Pain in many areas lasting more than 3 months
- Joint swelling, morning stiffness over 30 minutes, or a family history of inflammatory arthritis
- Widespread pain with tiredness, poor sleep and low mood
- Pain that limits work, exercise or relationships
Usually safe to manage at home
- Generalized aches during a viral illness or after unusual exertion that resolve within 2 weeks
What chronic widespread pain is
Doctors define widespread pain using a body map. The American College of Rheumatology criteria count pain in at least 4 of 5 regions: left upper, right upper, left lower and right lower body, plus the axial region (neck, back, chest or abdomen). Pain must be present for at least 3 months.
CWP is a description rather than a single disease. It includes:
- Fibromyalgia: widespread pain plus fatigue, unrefreshing sleep and cognitive problems ("fibro fog")
- Chronic primary pain: an ICD-11 category for pain that is not better explained by another condition
- Secondary widespread pain from conditions such as inflammatory arthritis or hypothyroidism
Why the pain spreads
In most people, CWP reflects central sensitization, also called nociplastic pain. The brain and spinal cord turn up the volume on pain signals. Normal sensations, pressure and movement are felt as pain, and pain spreads beyond the original area. This is a real change in nerve processing, not imagined pain.
Contributing factors include:
- poor sleep, which lowers pain thresholds
- chronic stress, anxiety and depression
- previous injuries or regional pain that became chronic
- physical inactivity and deconditioning
- trauma, including childhood adversity
- genetic factors and family history
- other conditions such as irritable bowel syndrome, migraine and chronic fatigue
Symptoms
- aching, burning, throbbing or stabbing pain in many areas
- tender muscles and soft tissues
- stiffness, especially in the morning
- fatigue and unrefreshing sleep
- difficulty concentrating and memory lapses
- headaches
- sensitivity to cold, noise or light
- anxiety and low mood
Conditions to rule out
| Condition | Clues |
|---|---|
| Polymyalgia rheumatica | Over 50, shoulder and hip stiffness, high inflammatory markers |
| Rheumatoid arthritis and other inflammatory arthritis | Swollen joints, prolonged morning stiffness |
| Lupus and other connective tissue diseases | Rash, mouth ulcers, joint swelling, kidney changes |
| Hypothyroidism | Tiredness, weight gain, cold intolerance |
| Vitamin D deficiency and osteomalacia | Bone pain, muscle weakness |
| Statin or other drug side effects | Muscle aches after starting a medicine |
| Inflammatory myopathy | Weakness more than pain, raised CK |
| Hypermobility syndromes | Flexible joints, frequent sprains |
| Cancer with bone involvement | Weight loss, night pain, older age |
Diagnosis
A doctor will take a detailed history, including the pain map, sleep, mood, function and medicines, and do a physical examination including joints, muscles and nerves.
Usual blood tests:
- blood count
- ESR and CRP (inflammation)
- thyroid function
- calcium, vitamin D, kidney and liver function
- CK (muscle enzyme)
- further tests such as rheumatoid factor or antinuclear antibodies only when clinical features suggest them
Results are usually normal in fibromyalgia and primary CWP. Extensive repeated testing is discouraged once serious causes are excluded, because it rarely helps and can increase worry.
Treatment
The best results come from combining approaches, and the focus is on function and quality of life rather than eliminating pain entirely.
Education
Understanding how central sensitization works reduces fear and helps people re-engage with activity.
Exercise
The most strongly recommended treatment. Start low and build gradually:
- walking, cycling, swimming or water aerobics
- strength training 2 to 3 times a week
- gentle stretching, yoga or tai chi
Expect some increase in soreness at first. Pacing activity, avoiding boom-and-bust cycles, is key.
Sleep
Regular sleep and wake times, limiting caffeine and screens in the evening, and cognitive behavioral therapy for insomnia (CBT-I). Screen for sleep apnea if snoring or daytime sleepiness are present.
Psychological therapies
Cognitive behavioral therapy, acceptance and commitment therapy (ACT) and mindfulness-based programs improve coping, mood and function.
Medicines
- Duloxetine or amitriptyline (low dose at night) can reduce pain and improve sleep in some people.
- Pregabalin helps a minority with fibromyalgia.
- Simple analgesics such as acetaminophen and NSAIDs have limited benefit for central pain.
- Opioids are not recommended: they are ineffective long term and may worsen pain sensitivity.
Other approaches
Physical therapy, acupuncture and massage help some people, mainly as part of an active program.
Outlook
CWP is often long-lasting, but symptoms fluctuate and many people improve substantially with active management. Staying in work and physical activity, good sleep and treatment of mood problems are linked to better outcomes.
Frequently asked questions
What causes pain all over the body?
Short-term widespread aches are often from viral illness or exertion. Long-term widespread pain usually reflects a sensitized pain system, as in fibromyalgia, but inflammatory arthritis, polymyalgia rheumatica, thyroid problems, vitamin D deficiency and medicines must be ruled out first.
Is chronic widespread pain the same as fibromyalgia?
Not exactly. Chronic widespread pain describes the pattern of pain. Fibromyalgia is a diagnosis that includes widespread pain plus fatigue, sleep problems and cognitive symptoms. Most people with fibromyalgia have chronic widespread pain, but not everyone with widespread pain has fibromyalgia.
What is the best treatment for chronic widespread pain?
Regular, gradually increased exercise is the most effective single treatment. Combining it with better sleep, cognitive behavioral therapy and, in some people, duloxetine or low-dose amitriptyline gives the best results. Opioids are not recommended.
Will blood tests show chronic widespread pain?
No single test confirms it. Blood tests are used to rule out other causes, such as inflammation, thyroid disease and vitamin deficiencies. In fibromyalgia and primary widespread pain, test results are usually normal.
Sources
This guide was written from current patient and clinical guidance, including:
- American College of Rheumatology: Fibromyalgia diagnostic criteria
- NICE Guideline NG193: Chronic pain (primary and secondary) in over 16s
- EULAR: Revised recommendations for the management of fibromyalgia
- NIAMS: Fibromyalgia
- International Association for the Study of Pain: ICD-11 classification of chronic primary pain