Since I so often think of fibromyalgia in terms of Constitution, Dexterity, Wisdom etc. I wanted to try and formalise that into some potential rules.
Please note that these are based on realism, not on playability! I have no idea how well this would actually work if used in a game.
Each time a player recovers from an illness or from more than 2 levels of exhaustion, they must roll a D100. On a roll of 01, they develop fibromyalgia.
For an advanced version of these rules, each player who develops fibromyalgia rolls a d100. On a roll of 01-10 they develop severe fibromyalgia, 11-65 normal, and 66-00 mild.
Fibromyalgia consists of the pained condition and a number of other symptoms. To determine secondary symptoms, roll a d100 on the chart below until you have selected five different symptoms. (For mild fibromyalgia, select three secondary symptoms; for severe, select eight.)
Pained - At all times while experiencing fibromyalgia, you are in constant pain, which reduces your ability to function. Gain a permanent -2 to constitution and reduce your number of hit dice by 25%, to a minimum of one hit dice.
01-15 - Hyperalgesia (pain sensitivity) - You are hyper-sensitive to pain. Whenever you take damage, you must make a Constitution saving throw of DC 10. On a failure, you become Incapacitated for 1 turn. If you fail by 5 or more, you become Stunned, and must make a Constitution saving throw of DC 15 at the start of each turn. On a successful saving throw, you then become Incapacitated and recover fully at the end of that turn.
16-28 - Fatigue - You quickly become fatigued. You take one level of exhaustion at the end of each combat encounter or after each hour of non-combat activity. You may reduce your level of exhaustion by 1 during a short rest by expending a hit dice. Each long rest removes 1d6 levels of exhaustion.
29-41 - Stiffness - Your muscles are constantly stiff. Your movement is reduced by 10 feet and you have a permanent -2 to Dexterity.
42-53 - Non-restorative Sleep - You struggle to sleep restfully. Each time you take a long rest, make a Constitution saving throw with DC 10. If you fail the throw, you gain the benefits of a short rest instead.
54-65 - Fibro Fog - Your mind is muddied and you have difficulty focusing on the world around you. You have disadvantage on all Intelligence checks. When performing an action that requires Concentration, including non-magical actions as determined by the DM, you must make an Intelligence saving throw of DC 15 at the start of each turn. If you fail your throw, your Concentration is broken.
66-75 - Hypersensitivity - You are very sensitive to bright lights and loud noises. You have disadvantage on all checks against being Blinded or Deafened. When experiencing any bright light or loud noise which does not usually require a saving throw, you must make a Constitution saving throw with DC 10 or else become Blinded or Deafened as appropriate.
76-84 - Headaches - You are prone to migraines. Once per hour or at the start of each hour, roll a d20. On a natural 1, you have a migraine. At any point during the next hour at the DM’s discretion, you become Incapacitated for a duration of up to 1 minute.
85-89 - Irritable Bowel Syndrome - You develop allergies to some foodstuffs. The DM selects three common food ingredients in your setting. When eating food that contains these ingredients, you must make a Constitution saving throw of DC 10. If a failure, you become Poisoned for a duration of 3 hours. Once per month of game time, the DM may change one ingredient on the list.
90-94 - Clumsiness - You are clumsy and uncoordinated. Whenever you make an ability check to perform an action that includes physical motion, a natural 2 also counts as a critical failure.
95-97 - Poor Temperature Regulation - You are unable to properly regulate your body temperature. In cold or hot weather conditions such as high winds, snow or a heat wave, you must make a Constitution saving throw of DC 10 each hour or gain a level of exhaustion. If improperly clothed, you automatically fail the saving throw.
98-00 - Restless Leg Syndrome - You experience compulsions to fidget and tap your leg. You have disadvantage on all Dexterity checks.
There is no natural cure for fibromyalgia. Magical cures should be equivalent to a Level 6 spell or above, with appropriate cost (min. 2500GP) and rarity. Such cures must be tailored to the individual and cannot be used on multiple sufferers simultaneously.
Fibromyalgia symptoms may be treated using a combination of spells, potions and medicine as appropriate. However, these treatments are of limited duration and each treatment can only counter-act one of the symptoms listed. Each time a treatment is used, roll a d20; on a natural 1, the treatment experiences a critical failure and you instead experience a mild negative side effect as determined by the DM.
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