Is Numbness Common in Fibromyalgia, and How Is It Differentiated from Peripheral Neuropathy?

Numbness and tingling (often called “paresthesias”) can occur in fibromyalgia and are reported by many people living with the condition. These sensations are typically intermittent and may affect the arms, legs, hands, or feet, alongside widespread musculoskeletal pain, fatigue, and sleep problems. ^[1] Numbness or tingling is listed among common fibromyalgia-associated symptoms by major health resources. ^[2] Some descriptions also note burning sensations in limbs as part of the sensory complaints seen in fibromyalgia. ^[3]

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How Common Is Numbness in Fibromyalgia?

• Fibromyalgia is characterized by widespread pain and tenderness, but sensory symptoms like numbness and tingling are frequently described. ^[1] Public health and medical encyclopedias similarly include tingling or numbness of the hands and feet as “other symptoms” of fibromyalgia. ^{[2] [4]}
• Historical clinical reviews have found a high proportion of people with fibromyalgia report paresthesias, often without objective nerve damage on standard tests, suggesting the sensations can be common but not always due to a structural nerve injury. ^[5]

Key point: While numbness is not part of the core diagnostic criteria (which focus on widespread pain, fatigue, and sleep disturbance), it is commonly reported by those with fibromyalgia. ^[4]

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Why Do Sensory Symptoms Occur in Fibromyalgia?

• Fibromyalgia involves altered pain processing in the nervous system (sometimes called “central sensitization”), leading to amplified pain signals and abnormal sensory experiences. ^[6]
• In a subset of individuals diagnosed with fibromyalgia, small fiber neuropathy (SFN) damage or loss of very small nerve fibers has been identified on skin biopsy, despite normal nerve conduction studies and EMG. ^[7] This suggests that some fibromyalgia-like sensory symptoms may reflect small fiber involvement in certain people. ^[7]

Takeaway: Sensory symptoms in fibromyalgia are often due to central processing changes; in some cases, small fiber abnormalities may coexist, which can influence evaluation and treatment choices. ^{[7] [6]}

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Peripheral Neuropathy: What It Looks Like

Peripheral neuropathy refers to damage to peripheral nerves and typically presents with:

• Numbness, tingling, and loss of sensation, commonly starting in the feet and hands and progressing upward. ^{[8] [9]}
• Burning, stabbing, or shooting pain, often worse at night. ^{[10] [9]}
• Weakness, balance issues, and a “glove and stocking” pattern of sensory loss. ^{[10] [9]}

Diagnosis of peripheral neuropathy relies on clinical examination plus tests such as nerve conduction studies, EMG, and sometimes skin biopsy for small fiber assessment. ^{[11] [12]}

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Fibromyalgia vs Peripheral Neuropathy: Practical Differentiation

The following comparison highlights key clinical differences and common work-up elements:

Feature	Fibromyalgia	Peripheral Neuropathy
Primary symptom pattern	Widespread musculoskeletal pain with tenderness; fatigue, sleep disturbance; paresthesias can occur	Distal sensory symptoms (numbness/tingling) in “glove and stocking” pattern; burning/shooting pain; potential weakness and balance issues
Sensory distribution	Often diffuse or bilateral limbs; may fluctuate	Starts in feet/hands and progresses proximally; length-dependent
Objective nerve test findings	Nerve conduction and EMG typically normal; small fiber biopsy may be abnormal in a subset	Nerve conduction and EMG often show abnormalities in large-fiber neuropathies; small fiber neuropathy may show reduced epidermal nerve fiber density on skin biopsy
Associated signs	Tender points, nonrestorative sleep, “fibro fog,” headaches	Decreased vibration/pinprick, reduced reflexes, gait instability, autonomic changes
Pathophysiology emphasis	Central sensitization; sometimes small fiber involvement	Peripheral nerve damage (metabolic, toxic, immune, hereditary, etc.)
Diagnostic approach	Clinical diagnosis based on widespread pain ≥3 months plus symptom burden; tests mainly to exclude other conditions	Directed testing: labs for causes (e.g., glucose, B12), EMG/NCS, skin biopsy for small fiber, sometimes autonomic testing

• Fibromyalgia commonly includes numbness/tingling sensations, but standard nerve tests are often normal, supporting a central pain processing mechanism in many cases. ^{[4] [5] [6]}
• Peripheral neuropathy typically shows objective abnormalities (loss of sensation, reduced reflexes, EMG/NCS changes), and symptoms often follow a length-dependent pattern starting in the feet/hands. ^{[10] [8] [11]}

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When to Consider Testing

• If numbness/tingling is accompanied by progressive sensory loss, weakness, falls, or clear “glove and stocking” pattern, clinicians generally consider EMG and nerve conduction studies, and sometimes skin biopsy when small fiber neuropathy is suspected. ^{[11] [12] [9]}
• In fibromyalgia, tests may be used judiciously to rule out neurologic disorders when the presentation is atypical or worrisome, since objective abnormalities are often absent on EMG/NCS. ^[5]

Tip: A targeted evaluation can help differentiate conditions and guide treatment especially if symptoms evolve or don’t fit typical fibromyalgia patterns. ^{[11] [5]}

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Management Implications

• Fibromyalgia management focuses on education, graded exercise, sleep optimization, cognitive strategies, and medications that modulate pain processing (such as certain SNRIs or gabapentinoids), tailored to individual needs. ^[6]
• Peripheral neuropathy treatment aims to address the cause (e.g., diabetes control, nutritional deficiencies) and relieve symptoms (neuropathic pain agents), with safety measures for balance and foot care to prevent injury. ^[8]

Important nuance: If small fiber involvement is demonstrated in someone labeled with fibromyalgia, management may incorporate neuropathy-oriented strategies along with central pain approaches. ^[7]

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Bottom Line

• Yes, numbness and tingling can be common in fibromyalgia, appearing alongside widespread pain and other systemic symptoms. ^{[1] [2] [4]}
• Differentiation from peripheral neuropathy rests on pattern recognition, physical exam findings, and targeted testing: fibromyalgia often has normal nerve studies and diffuse symptoms, whereas peripheral neuropathy more often shows objective nerve dysfunction and length‑dependent sensory loss beginning in the feet/hands. ^{[11] [10] [9] [5]}

If you’re experiencing numbness or tingling with other fibromyalgia features but are unsure about the pattern or if symptoms are progressing discuss with your clinician whether nerve tests or a skin biopsy could clarify the diagnosis and guide treatment. ^{[11] [12] [7]}