Fibromyalgia and Cold Intolerance

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Adam Foster

Director at The Fibro Guy

Adam Foster is the founder of The Fibro Guy and one of the leading voices in hypermobility, EDS, and chronic pain rehabilitation. A former Reconnaissance Soldier, he developed chronic pain after an IED blast in Afghanistan and built his approach from the ground up when the medical system had no answers. Since 2009 he has worked with thousands of people across eight countries, drawing on pain neuroscience, motor learning, and sensorimotor rehabilitation. He co-authored "No Pain, No Pain" with trauma psychologist Dr Mairi Harper, directed the documentary "Invisible Monster," and has been featured in Forbes, BBC Radio 4, ITV News, LiveScience, and The Telegraph.

Latest posts by Adam Foster (see all)

• Hypermobile hip exercises we use, and why clamshells aren’t one of them - 17 October 2026
• Is Fibromyalgia a Disability in the UK, and Can You Claim PIP? - 14 October 2026
• Fibromyalgia and Central Sensitisation, What Is It in Plain English? - 8 October 2026

Being cold is one of the more ordinary sounding symptoms of fibromyalgia, yet one of the hardest to get a straight answer about. People describe it the same way over and over. Never properly warm. Hands and feet like ice. A hot water bottle in June. And a particular kind of cold that hurts, rather than a cold that’s simply cold.

Yes, feeling the cold and struggling with it belongs to this condition.

The explanation you’ll have been handed is that your body runs colder than everybody else’s, usually dressed up as a broken thermostat. Measured directly, though, fibromyalgia is more consistently associated with abnormal cold pain processing than with abnormal resting body temperature ^[1][2]. That isn’t a technicality, It changes what the cold is, what it means, what gets checked, and what’s worth doing about it in the cold January months.

Is your body actually colder?

Mostly not. When somebody puts a thermometer on you the reading comes back ordinary, and the interesting part is which thermometer, and where.

What the thermometers say

Track core body temperature around the clock under a controlled circadian protocol and there’s no difference in the phase or the amplitude of the rhythm between women with fibromyalgia and controls ^[3]. The curve peaks at the same time of day and swings by the same amount. Do the same at the skin over a full 24 hours and there’s no overall difference either, although within the fibromyalgia group a higher peripheral temperature went with worse pain and worse depression scores ^[4].

None of which is the dismissal it looks like, and the reason sits in what core temperature is for. Your body defends its middle very hard indeed. The organs that keep you alive sit in a narrow band, and the body will give up almost anything to hold them there, which is why the first thing it does when you get cold is shut down the blood supply to your skin, your hands and your feet. So a normal reading in the middle and freezing hands aren’t a contradiction. Freezing hands are part of how the middle stays normal.

Why the studies disagree with each other

Point a thermal camera at the hands, the sort that reads surface heat without touching you, and several studies find higher tympanic and hand temperatures in fibromyalgia, warmer at the eardrum and warmer at the fingers, which has been read as too much peripheral vasodilation, the vessels in the skin opening up, or as poor cutaneous sympathetic control, the nerve supply that tells them when to do it ^[5][6]. That’s the opposite direction to the one everybody expects. Then point the same camera at tender points and the skin there comes out cooler, with reduced microvascular flux, less blood moving through the smallest vessels, which looks like local vasoconstriction, a narrowing in that patch, rather than any sort of whole body cooling ^[7][8].

Warmer at the fingers, cooler over the sore bits, and no difference overall. It isn’t a mess. The answer keeps depending on where somebody pointed the camera. Whole body scans at rest tend to find little, studies aimed at the hands or that put people through a cold challenge find altered distal vascular responses, the vessels furthest from the middle behaving differently, and tender point studies find local cooling and reduced flux ^[5][7][9].

So the broken thermostat is a metaphor somebody reached for, not an actual measurement. Nothing here supports one setting being wrong throughout you. What it supports is different parts of you behaving differently at the same moment, which is a far better description of what people actually report than a single number ever was. Worth taking that to an appointment, because a normal thermometer isn’t the end of the conversation, and a thermostat is not a thing anybody can examine.

Why cold hurts instead of just feeling cold

Here, the evidence stops arguing with itself.

Pull the cold pain testing together and the cold pain thresholds, the point where cold stops being cold and starts to hurt, come out numerically lower in every single included study, with the difference reaching significance in 14 of 17 of them ^[1]. The same thing turns up from the other direction: people with fibromyalgia report cold pain at warmer temperatures than controls do, and they tolerate cold pressor exposure, the hand in the bucket of iced water, for less time before they stop it ^[2][10]. The strength of that is in the repetition rather than in any one study, and the differences are large ones.

Cold starts hurting sooner, and once it hurts you can bear less of it. That’s a different claim from being colder.

The detector and the alarm

Your skin does two separate jobs with temperature and they run on different wiring.

The first is detection. There are nerve endings whose only work is to report conditions upward, and the message they send is roughly “the air is cool”, which arrives as information rather than as a problem. The second job is the alarm. A different set of endings sits quiet until something starts becoming genuinely bad for the tissue, and those are nociceptors, high threshold, mostly silent. They don’t carry pain, and that isn’t pedantry: what they send is a warning about the tissue, and whether it turns into pain gets decided further up. Like any alarm, the thing that matters is the threshold it’s set at.

In fibromyalgia the detector appears to be doing fine. Non painful cold detection comes back mixed or ordinary across this testing, while nociceptive processing is amplified ^{[2][11][12][15]}. You can tell perfectly well how cold the room is. What fires early is the system deciding whether the cold has become a problem.

When something hurts for long enough, the system carrying that signal gets easier to set off. The endings fire at lower intensities, the spinal cord passes more of the traffic along, and the brain starts treating input that used to be unremarkable as worth reporting. The volume knob moves, and that is sensitisation. Nothing about the room has changed and nothing about your character has either. On top of it, the body’s own ability to damp one pain down by applying another one is often reduced here ^[13], so there’s less to turn the volume back down with.

Which is why the thermometer keeps coming back ordinary. Central sensitisation isn’t a temperature problem.

Why it builds instead of wearing off

Give a healthy nervous system the same mildly nasty cold stimulus over and over and it gets quieter about it. That’s habituation, and it’s the ordinary response. In women with fibromyalgia, repeated cold stimulation went the other way and produced sensitisation instead ^[14]. What it describes is the shape people keep reporting, where the cold doesn’t become background. You come in from the shops, you put the heating on, the room gets warm, but you don’t.

Hands and feet like ice

Hands and feet go first in everybody, and that’s ordinary physiology before it’s anything to do with fibromyalgia. Faced with cold, the body narrows the vessels feeding the skin and the extremities and keeps the warm blood in the middle where the important machinery is. Fingers and toes have an enormous surface area for their volume and very little insulation, so they’re the cheapest thing to give up, and they go first.

Which raises the obvious objection, because some of the work above found hands that measured warm. Here’s the thing to hold on to. A thermal camera reads the surface of your skin, and feeling cold is not a reading. It’s a judgement your nervous system puts together out of what the skin reports, what the air is doing, how fast heat is moving and what it was already expecting. Those two can disagree. A hand can sit at a perfectly respectable temperature and still be telling you, loudly and continuously, that it’s freezing.

The Raynaud’s question

Raynaud’s phenomenon is the one with a name, where the fingers go white, then blue, then red and painful as they refill. People with fibromyalgia do report symptoms that look exactly like it. When that was examined objectively, though, the symptoms came out similar to primary Raynaud’s while the digital microvascular function and morphology, how the tiny vessels in the fingers behave and what they look like under magnification, did not, and the fibromyalgia group had warmer digits and different thermal gradients, which implies a different mechanism underneath a similar complaint ^[16].

Which makes the colour change worth describing to a doctor in exactly those words, white then blue then red, because it’s a specific thing with a specific examination behind it. And it makes “just a bit Raynaud’s” a guess rather than a finding until somebody has looked at your fingers.

Small fibres

The other peripheral candidate is the small nerve fibres themselves. These are the thin, poorly insulated fibres that carry temperature and the dull burning sort of pain, and they can be counted in a punch biopsy, a small disc of skin taken under local anaesthetic.

Pooled across the studies that have counted them, small fibre pathology in fibromyalgia comes out at around 49% ^[17]. Careful with that number, though. It is pathology prevalence rather than proof that half of people with fibromyalgia have clinically defined small fibre neuropathy, and the paper reporting it says so itself ^[17]: finding fewer fibres under a microscope and being given the diagnosis are two different events. It’s common enough to mark out a substantial subgroup while being nowhere near specific enough to explain fibromyalgia as a whole ^{[16][17][18][19]}.

Why it matters on a cold evening: if your cold comes with numbness, with burning in a glove or sock pattern, or with pins and needles that don’t fit anywhere sensible, say those words out loud at the appointment. That’s the sort of description that moves a neurologist to look rather than nod.

Why the usual online explanation doesn’t hold

The explanation you’ll usually be handed for cold hands is an overactive sympathetic nervous system clamping the blood vessels shut, and the evidence waved at it is heart rate variability, the small beat to beat differences in the timing of your heartbeat.

Heart rate variability abnormalities genuinely are common in fibromyalgia, and the low frequency and LF to HF measures that get leaned on, the bands those beat to beat differences get sorted into, are poor stand alone proxies for sympathetic vasoconstrictor activity, the nerve traffic that actually narrows a vessel, so they cannot establish the hands and feet mechanism on their own ^[20][21]. The finding is real. What it can’t do is answer the question it keeps getting used to answer.

The measurements that go at it directly point the other way. Reduced skin conductance, which is how readily the skin carries a small electrical current and which climbs when you sweat, blunted reactivity, sweating that wasn’t coupled to anxiety or body temperature, and weaker responses to cold stress all point to reduced sympathetic functionality rather than to an overactive one ^[22][23]. That’s the opposite of the clamping story, and it sits alongside the warmer hands from the camera work above ^[5][6].

So if somebody has told you your hands are cold because your nervous system is in overdrive, they’ve skipped a step. What’s left is smaller and more useful: the explanation is unsettled, your hands are still cold, and the two things worth your effort are warming them directly and getting the specific signs below looked at by somebody who can examine you.

Chills, shivering, and what to get checked

Chills with no illness attached are a different complaint from feeling cold, and people ask about them as a separate question.

The useful study here put people in the cold and measured them instead of asking them afterwards. Core temperature still didn’t separate the groups. What differed was further out: distal arm and calf skin temperatures fell less in the fibromyalgia group, and shivering was reported more often, which is consistent with altered cold defence rather than with being colder ^[23].

Shivering is skeletal muscle contracting rapidly to generate heat, and it’s a genuinely expensive way of staying warm. In a body that already aches and already runs short of energy, twenty minutes of shivering is a workout nobody signed up for, and the soreness afterwards is real rather than imagined. If a cold morning seems to cost you the rest of the day, there’s nothing mysterious about that.

When it’s worth a phone call

Feeling cold is a symptom that several completely ordinary things produce, and you can’t tell them apart from the inside, which is exactly what a blood test is for. Thyroid function, a full blood count, ferritin and the B vitamins are the usual first things somebody reaches for when a person says they’re always cold. If those haven’t been done since your diagnosis, that’s the thing to go and ask for, and asking isn’t an admission that your fibromyalgia is imaginary. Having one condition has never protected anybody from getting another one. The longer everything gets filed under the diagnosis you already have, the longer something else sits there unexamined.

Beyond the bloods, three things tend to get mentioned in passing when they ought to be the first thing you say. Fingers that change colour in a sequence. Numbness or burning in a glove or sock pattern. And chills that arrive with an actual temperature, which is a different event altogether and is worth a same day call rather than a wait and see.

Does cold weather actually make fibromyalgia worse?

At the level of a group, much less than anybody expects. At the level of a person, sometimes a great deal. Both are true at the same time.

What the diaries found

The good studies here are prospective, meaning people recorded their symptoms day by day while the weather was recorded alongside them. That design matters. Ask somebody in March whether the cold made them worse and what you get back is a memory, and memories tidy themselves up on the way.

A 28 day diary study in 333 women turned up five significant effects across fifty analyses, and all of them were small ^[24]. A five week ecological study, meaning weather and symptoms tracked together while people went about their lives, found only a very small inverse association between barometric pressure and pain at the same moment, with no lagged prediction by weather at all: yesterday’s weather told you nothing about today’s pain ^[25]. A 30 day study collecting symptoms by text message did find lower barometric pressure and higher humidity associated with more pain, and it also found a subgroup responding in the opposite direction ^[26].

So the claim that cold weather uniformly worsens fibromyalgia symptoms is weakly supported, because the group level effects in that prospective work come out small or absent, with subgroups sitting inside them ^{[24][25][26][27]}.

What that means for your winter

A group average is a statement about a group, and the studies that have gone looking for individual variation keep finding it ^[26][27]. If every January is reliably worse for you, you have better evidence about yourself than any of these studies has about you.

What it does mean is that the forecast is a bad thing to organise your life around, partly because you can’t change it. A winter isn’t only a temperature. It’s also less daylight, more time indoors, more time sitting still, more of the day spent braced against the cold, and a general shrinking of what you do. The temperature is the part you’re stuck with, and the rest of that list is where the room to move is.

Which puts the practical answer somewhere duller and more useful than a weather app. Warm the person rather than the room, because heating a whole house to the temperature your hands want is expensive and it doesn’t work anyway. Layers trap your own heat, so several thin ones beat one thick one. Hands, feet and the back of the neck give you the most back for the least effort. A hot water bottle against the small of your back while you’re sitting still isn’t a sticking plaster, and if it makes an evening bearable then it’s done the job that was asked of it. Gloves indoors are not a defeat. And if cold contact sets it off, the cold tap, the fridge, the car door handle on a dark morning, that’s a solvable problem rather than a character flaw.

What to do with all this

The short version, graded by how much is sitting behind each one.

Strongest by a distance: cold hurts sooner and is tolerated for less time in fibromyalgia. Replicated across sensory testing and cold pressor work, it holds when those studies are pooled, and the differences are large ones ^{[1][2][10][14]}. Everything else sits underneath it.

Weak, despite being the thing you’ve been told: that your body runs colder. The evidence contradicts itself across body sites and protocols, with warmer hands in some studies, cooler tender points in others and no overall resting difference in several ^{[3][4][5][7][9]}.

Worth getting checked, once, properly: bloods, then the colour changes, the numbness and any chill that comes with a temperature, said in plain words to somebody who can examine you.

Worth knowing about rather than worrying about: Raynaud like symptoms that behave differently from primary Raynaud’s under objective testing ^[16], and small fibre pathology that is common enough to matter and not specific enough to explain everything ^[17][19].

What the weather evidence won’t give you: a rule. It gives small or absent group effects and real individual variation ^{[24][25][26][27]}, which means your own record of your own winters beats any average somebody quotes at you.

If the cold has been one of the things that made you wonder whether you were exaggerating, hold on to this. The measurement that keeps coming back ordinary is your temperature. The measurement that keeps coming back abnormal is what your nervous system does with cold, which is a different thing entirely from being cold, and a much better match for what you’ve been trying to describe to people.

Adam

References

[1] Berwick, R.J., Siew, S., Andersson, D.A., Marshall, A. and Goebel, A. (2021) ‘A Systematic Review Into the Influence of Temperature on Fibromyalgia Pain: Meteorological Studies and Quantitative Sensory Testing’, The Journal of Pain. https://doi.org/10.1016/j.jpain.2020.12.005

[2] Desmeules, J.A., Cedraschi, C., Rapiti, E., Baumgartner, E., Finckh, A., Cohen, P. et al. (2003) ‘Neurophysiologic evidence for a central sensitization in patients with fibromyalgia’, Arthritis & Rheumatism. https://doi.org/10.1002/art.10893

[3] Klerman, E.B., Goldenberg, D.L., Brown, E.N., Maliszewski, A.M. and Adler, G.K. (2001) ‘Circadian Rhythms of Women with Fibromyalgia1’, The Journal of Clinical Endocrinology & Metabolism. https://doi.org/10.1210/jcem.86.3.7293