Possible Causes of Leg Pains With Fibromyalgia

Fibromyalgia can cause pain anywhere, including leg pain. Some common overlapping conditions can cause or contribute to leg pain, as well. This can make it hard to recognize pain from other sources rather than writing them off as just part of fibromyalgia.

This article explores causes of leg pain that may be related to fibromyalgia or that may come from a different condition, the symptoms to watch for, and how different types of leg pain are treated.

Fibromyalgia Leg Pain

Fibromyalgia causes abnormal pain types that can strike the legs. These include:

• Allodynia: Pain from things that shouldn't hurt (the brush of soft fabric, sock elastic, mild cold temperatures)
• Paresthesia: Abnormal nerve sensations including tingling, itching, burning, crawling, shooting, or electrical "zaps"
• Hyperalgesia: Amplifies pain signals from other sources, making them more intense

Leg pain from these causes may feel like fibromyalgia pains in the rest of your body or it may have a different quality.

If your leg pain is from fibromyalgia, your healthcare provider will NOT find physical abnormalities such as joint wear and tear, a lot of inflammation, heat, or redness. X-rays and imaging studies will show what looks like healthy bones and tissues.

That doesn't mean the pain isn't real—it is. However, it's in the nerves themselves and not the tissues. This makes fibromyalgia different from other pain conditions such as rheumatoid arthritis and lupus.

Treating Fibromyalgia Leg Pain

Leg pain from fibromyalgia should go away when your fibromyalgia is properly treated. Treatment options include:

• Approved medications: Lyrica (pregabalin), Cymbalta (duloxetine), Savella (milnacipran)
• Off-label medications: Neurontin (gabapentin), tricyclic antidepressants, opioid painkillers, muscle relaxers
• Non-drug therapies: Physical and occupational therapy, cognitive behavioral therapy, exercise that's tailored to your tolerance level
• Complementary and alternative (CAM) treatments: Gentle massage, myofascial release, acupuncture, cupping, chiropractic, yoga, tai chi
• Supplements: Magnesium malate, 5-HTP, rhodiola rosea, vitamin D
• Cannabis products: Medical marijuana, cannabidiol (CBD)
• Topical painkillers: Topical CBD, capcaisin, BioFreeze, Icy Hot With Lidocaine, lidocaine patches

It takes time and experimentation to come up with the right combination of treatments for you.

Neuropathy

Neuropathy is pain from nerve damage. Some studies suggest fibromyalgia may involve certain types of nerve damage. Also, diabetes is common in people with fibromyalgia and can cause neuropathy.

Symptoms of neuropathy include:

• Shooting, stabbing, burning pain or electric "zaps" that can be mild or severe
• Muscle weakness, twitching, and cramping
• Loss of muscle and bone
• Numbness in some areas
• Loss of balance (as a side effect of numbness in the legs)

To diagnose neuropathy in your legs, your healthcare provider may use:

• A neurological exam
• Muscle strength tests
• Blood and spinal fluid tests
• Computed tomography (CT) scans
• Magnetic resonance imaging (MRI)
• Nerve conduction studies and electromyography (EMG)
• Nerve and skin biopsies

Treating Neuropathy

Common treatments for neuropathy include:

• Medications: Lyrica, Neurontin, and other antiseizure drugs; tricyclic antidepressants, mexiletine
• Topical or local painkillers: Lidocaine patches or injections
• Surgery: In severe cases, a surgeon can destroy nerves or repair injuries that cause neuropathy

Neuropathy can't be cured, but it can often be well managed.

Restless Legs Syndrome

Restless legs syndrome (RLS) is a sleep disorder that causes unpleasant sensations in the legs and an urge to move them. Movement generally makes the sensations stop temporarily.

The sensations are often described as throbbing, creeping, or pulling. In many people, these sensations aren't painful. However, in fibromyalgia, the brain interprets all unpleasant sensations as painful.

Some people with RLS also have uncontrollable leg movements, such as jerking, while asleep or awake and relaxing.

RLS is believed to be caused by a combination of genetic and environmental factors, but exactly what many of these factors are remains unknown.

No diagnostic tests can identify RLS so it's typically diagnosed based on your symptoms and tests to rule out other possible causes.

Treating Restless Legs Syndrome

Some cases of RLS are caused by another medical condition. These include:

• Neuropathy
• Diabetes
• Iron-deficiency anemia

In those cases, treating the underlying condition may alleviate RLS.

Other treatment options include:

• Lifestyle changes: Less alcohol or tobacco use, a regular sleep pattern, moderate exercise, leg massage, ice or heat therapy
• Devices: Special devices that deliver vibrations to the legs may alleviate the sensations
• Antiseizure drugs: Gabapentin enacarbil, Lyrica, Neurontin
• Parkinson's disease drugs: Requip (ropinirole), Mirapex (pramipexole), Neupro (rotigotine) patches
• Opioid painkillers: Vicodin, OxyContin
• Benzodiazepines: Klonopin (clonazepam), Ativan (lorazepam)

ITB Syndrome

The iliotibial band (ITB) is a strong band of tissue that runs from hip to knee. When it's aggravated, you may develop ITB syndrome (or "runner's knee").

The pain of ITB syndrome usually starts on the outside of your knee. It may spread up the thigh clear to the hip, as well. It may be especially noticeable when you go up or down stairs.

It's unknown whether ITB syndrome is more common in people with fibromyalgia. However, studies show fibromyalgia involves lax connective tissues and hypermobile joints, which may make conditions like ITB syndrome more likely.

Healthcare providers often diagnose ITB syndrome based on symptoms and a physical exam. If they're not sure what's causing the pain, they may order imaging tests, too.

Treating ITB Syndrome

Treatment strategies for ITB syndrome include:

• Ice
• Limiting activities that cause pain and reintroducing them gradually
• Over-the-counter (OTC) pain medications like Advil (ibuprofen) or Tylenol (acetaminophen)
• Steroid shots
• Physical therapy with stretching and strengthening exercises

If these measures don't alleviate your knee pain, your healthcare provider may recommend surgery that can help.

Myofascial Pain Syndrome

Myofascial pain syndrome (MPS) involves trigger points—taut areas in connective tissues that radiate pain to other areas. Trigger points in the legs are common. Many people with fibromyalgia also have MPS.

Symptoms of MPS include:

• Localized muscle pain that's activated by trigger points
• Pain that may be distant from the trigger point
• Muscle stiffness
• Fatigue and poor sleep due to pain

MPS doesn't have a diagnostic test. It's diagnosed based on:

• Symptoms, especially reproducible pain or twitches from pushing on a trigger point
• Imaging and blood tests to rule out other potential causes
• A physical exam

Treating Myofascial Pain Syndrome

MPS is generally treated by focusing on the trigger points. Possible treatments are:

• Acupuncture or a similar therapy called dry needling
• Trigger point injections using a numbing medication
• Cold laser therapy (also called low-level light therapy) using near-infrared light
• Electrical stimulation
• Massage, including myofascial release and trigger point pressure release
• Stretching, sometimes through physical therapy
• Therapeutic ultrasound
• Heat
• OTC pain medications
• Muscle relaxers
• Topical pain relievers
• Cymbalta and other antidepressants
• Antiseizure drugs
• Botox

Autoimmune Diseases

In autoimmune diseases, your immune system mistakenly identifies a healthy part of your body as a threat, such as a virus or bacterium. It then creates specialized cells called antibodies that attack and try to destroy that particular part.

Contemporary research suggests fibromyalgia may be an autoimmune disease. Whether it is or not, it's established that some autoimmune diseases, such as rheumatoid arthritis, make you more likely to develop fibromyalgia.

That was once thought to be a one-way relationship. Now, though, newer research suggests fibromyalgia may predispose you to autoimmunity.

Dozens of different autoimmune diseases exist, all with different targets. Autoimmune diseases that could cause leg pain include:

• Rheumatoid arthritis: Often affects knees or ankles, may also affect hips and low back, causing pain to radiate to the legs. Usually symmetrical (affecting joints on both sides).
• Lupus: Can cause muscle pain, stiffness, and sometimes inflammation in many places, including the thighs.
• Multiple sclerosis: Nerve damage affecting leg muscles may cause cramping, pulling, or other painful sensations.
• Ankylosing spondylitis: Damage to the lower back can radiate to the buttocks and sometimes the backs of the thighs.
• Myositis: Causes muscles to grow weak, tired, and sore, especially in the thighs, hips, and shoulders.
• Sjögren's syndrome: Can cause swollen, painful joints and muscles in the legs and elsewhere plus nerve sensations in the limbs.

Blood tests for antibodies are often used to diagnose autoimmune diseases. Other tests vary depending on what your healthcare provider suspects.

Treating Autoimmune Disease

Treatment depends on which autoimmune disease you have.

However, the most common treatment is immunosuppressants or immunomodulators, (medications that suppress or change immune system activity). By calming the immune system, these drugs scale back the attack on your body.

Common immunosuppressants/immunomodulators include:

• Plaquenil (hydroxychloroquine)
• Sulfasalazine
• Dapsone
• Methotrexate
• Cellcept/Myfortic (mycophenolate mofetil)
• Imuran (azathioprine)
• Humira (adalimumab)
• Enbrel (etanercept)
• Cosentyx (secukinumab)

Other treatments may replace something the body can no longer produce on its own, such as thyroid hormones or insulin, or help manage symptoms.

Summary

Leg pain is common in fibromyalgia. It may be caused by fibromyalgia itself or by other conditions that are common in fibromyalgia. These include neuropathy, RLS, ITB syndrome, MPS, and certain autoimmune diseases including rheumatoid arthritis and lupus.

Treatment depends on your diagnosis. It may include medications, physical therapy, lifestyle changes, and CAM treatments.

A Word From Verywell

Leg pain can affect your mobility and have a big impact on daily life. Don't think you just have to live with it—talk to your healthcare provider about what might be causing it. If it's not "just" another fibromyalgia symptom, you may be able to treat it successfully.