Post-traumatic stress disorder (PTSD) often co-occurs with fibromyalgia. The 2 disorders have demonstrated a bidirectional relationship in recent research.1 These findings hold significant implications for the optimal care of patients with both disorders.
PTSD and Fibromyalgia Among Veterans
Noting the limited prospective data regarding this topic, researchers with the STRONG STAR consortium examined the link between traumatic events and the development of fibromyalgia in a longitudinal cohort study involving 1761 United States military service members. The results of the study were published in January 2026 in Arthritis Care & Research.1
“The link between fibromyalgia and PTSD has been suggested by prior research, but a stressful event at a population level is difficult to predict, making prior cohort studies necessarily retrospective,” lead author Jay B Higgs, MD, of the Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, and the University of Texas Health Science Center at San Antonio, told Rheumatology Advisor.
“In the STRONG STAR consortium, we had the advantage of observing a large population before and after exposure to an environment that often involves significant stress — specifically, deployment to a warzone,” Dr Higgs continued.
Before and after combat deployment, the researchers assessed participants’ fibromyalgia and PTSD symptoms using the 2011 questionnaire modification of the 2010 American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and the PTSD Checklist Stressor-Specific Version.1 Dr Higgs noted that the modified questionnaire is useful for studying fibromyalgia in large population trends but is not advocated for the diagnosis of individual patients without a bedside evaluation by a qualified provider.
At the predeployment assessment, the service members showed fibromyalgia prevalence rates that were comparable to those found in the general population: 2.2% among men and 2.0% among women. Postdeployment, these rates increased to 8.0% and 11.1%, respectively (P <.001).
The prevalence of PTSD symptoms increased among both men (from 20.7% to 22.7%) and women (from 18.3% to 25.5%) from predeployment to postdeployment, though these increases were not statistically significant (P >.05).
The odds of developing fibromyalgia after returning from deployment were 2.96-times higher among service members who had PTSD before deployment, and the odds of developing PTSD postdeployment were 3.12-times higher among service members who had fibromyalgia before deployment.
“Our data demonstrated bidirectional comorbidity between the 2 disorders — having either 1 significantly predisposed to developing the other after deployment,” Dr Higgs said.
This connection “suggests a potential link in the central nervous system and has implications for management,” according to the study authors.1
Ultimately, the goal is not to separate pain from mental health but to recognize how closely they interact.
PTSD-Fibromyalgia Link in Other Populations
In a recent retrospective, observational study published in BMC Psychiatry, Rahangdale and Ferraro leveraged data from 1516 patients with fibromyalgia from a single US health system to assess rates of several psychiatric disorders. The results showed that the prevalence of PTSD was 8.64% for the entire patient sample and 13.4% among patients aged between 30 and 39 years.2 The findings also showed prevalence rates of 61.02% for anxiety and 39.75% for depression.
Results of a 2025 retrospective cohort study by Avni et al showed higher rates of psychiatric comorbidities among patients with fibromyalgia vs those with other chronic conditions (chronic pain, chronic fatigue syndrome, and rheumatoid arthritis), as well as healthy control participants.3 Regarding PTSD specifically, prevalence rates were substantially higher among patients with fibromyalgia compared with healthy control participants (10.8% vs 0.5%; relative risk, 22.75; 95% CI, 11.10-46.65).
“Fibromyalgia patients experience significantly elevated psychiatric comorbidities compared with other chronic conditions,” the study authors wrote.3 “Comprehensive and integrated multidisciplinary care strategies are necessary to address the distinct psychiatric burden associated with fibromyalgia.”
In a 2025 systematic review by Vidal et al, researchers found evidence indicating greater severity of fibromyalgia symptoms among individuals with co-occurring PTSD.4 Similarly, results of a cross-sectional study by Maire et al revealed a more severe clinical profile among patients with fibromyalgia with vs without PTSD.5
Clinical Recommendations
“Psychiatric symptoms in fibromyalgia should be treated as clinically relevant — not peripheral — as conditions such as depression, anxiety, and PTSD can contribute to many overlapping symptom clusters, including poor concentration, low motivation, fatigue, sleep disturbance, and subjective cognitive complaints that patients may describe as ‘fibromyalgia fog,’” explained Aneesh Rahangdale, MD, a resident physician in Psychiatry at the University of Central Florida and HCA Florida Capital Hospital in Tallahassee.
“That does not mean these symptoms are purely psychiatric or that the pain is not real but rather highlights how fibromyalgia often exists at the intersection of pain, sleep, cognition, mood, and stress physiology,” Dr Rahangdale continued. “Ultimately, the goal is not to separate pain from mental health but to recognize how closely they interact.”
He noted that many patients with fibromyalgia have seen numerous health care providers before seeing a rheumatologist and may feel dismissed and frustrated by the medical system. “Taking time to understand the patient as a person, including what matters most to them in their life and daily functioning, can go a long way in building trust and improving care.”
Dr Rahangdale advised that clinicians maintain a low threshold for PTSD screening when “patients report a trauma history, hypervigilance, nightmares, avoidance, dissociation, severe anxiety, or persistent symptoms that seem out of proportion to what is otherwise being addressed.”
In these cases, rheumatologists may opt to use brief screening tools such as the Primary Care PTSD Screen for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) (PC-PTSD-5); the PTSD Checklist for DSM-5 (PCL-5) can be used for more detailed screening when appropriate.
“Similarly, clinicians should consider screening for depression and anxiety when symptoms such as fatigue, poor concentration, low motivation, or sleep disruption are prominent, as these may significantly affect pain experience and overall functioning,” Dr Rahangdale recommended.
Based on the findings by Dr Higgs and colleagues, a history of deployment should raise suspicion for this comorbidity among veterans with either PTSD or fibromyalgia.
“Referral to mental health care is especially important when PTSD, depression, or anxiety symptoms are impairing function, complicating treatment adherence, worsening quality of life, or raising safety concerns such as suicidality or substance use,” Dr Rahangdale said. “Coordinated care among rheumatology, primary care, pain management, physical therapy, sleep medicine, and mental health can make a meaningful difference for these patients.”
Remaining Needs
“Fibromyalgia presents many unmet needs for patients and their clinicians,” according to Dr Higgs. Despite an abundance of research on the topic, there is still no consensus on etiology or optimal diagnostic approaches in fibromyalgia, and effective treatment strategies remain limited.
“Clinicians understandably want ‘hard’ data to guide treatment, which means prospective randomized controlled data,” he said. “Such data are very difficult and expensive to obtain, but the need is clearly there.”
There is also a need for more prospective studies to elucidate the relationship between fibromyalgia and psychiatric comorbidities such as PTSD, depression, and anxiety, Dr Rahangdale noted.
“We still need clearer answers about which patients are most at risk, how these comorbidities affect symptom severity and functional outcomes over time, and whether identifying and treating them earlier changes the course of illness,” he explained. “We also need more research on integrated treatment approaches that address pain, sleep, cognition, and mental health together rather than in silos.”
In addition, Dr Rahangdale cited the pressing need for better clinician education regarding the overlap between psychiatric comorbidities and fibromyalgia symptoms.
“Clinicians need support in recognizing these overlapping domains without inadvertently suggesting that fibromyalgia symptoms are ‘just psychological,’” he said. “That balance is critically important for preserving trust and validating the patient’s lived experience.”
Dr Rahangdale also highlighted the need for more trauma-informed and integrated models of care to reduce the fragmentation of care that can result from navigating multiple providers. “Better coordination across specialties would likely improve both symptom burden and quality of life” among fibromyalgia patients.
Disclaimer from Dr Higgs: My views expressed herein are my own and do not necessarily reflect the official policy or position of the Defense Health Agency, Brooke Army Medical Center, Carl R Darnall Army Medical Center, the Department of Defense, the Department of Veterans Affairs, nor any agencies under the US Government.