OBJECTIVES: To examine the economic impact of fibromyalgia in Japanese adults. METHODS: Data from the 2011-2014 Japan National Health and Wellness Survey (NHWS; N=115,271), a nationally representative, self-administered, Internet-based survey of adults (≥18 yrs.) were analyzed. A greedy-matching algorithm was used to match respondents who self-reported a diagnosis of fibromyalgia (n=128) with those without fibromyalgia (n=128). Outcomes included: the Work Productivity and Activity Impairment questionnaire: General Health V2.0, which assessed percentage of impairment due to one’s health in the past seven days; healthcare resource use (physician visits, emergency room [ER] visits, and hospitalizations in the past six months); and estimated annual indirect and direct costs in Japanese yen (¥). Generalized linear models, controlling for covariates (e.g., age, gender, body mass index categories), examined whether outcomes differed between groups. RESULTS: Sample mean age was 44.5 years (SD=15.0); 62.5% were female. Relative to respondents without fibromyalgia, respondents with fibromyalgia experienced significantly greater absenteeism (adjusted means=24.54% vs. 2.57%), presenteeism (60.08% vs. 28.45%), overall work impairment (69.43% vs. 29.02%), and activity impairment (64.76 % vs. 28.48%); all p<0.001. Additionally, compared with respondents without fibromyalgia, respondents with fibromyalgia had significantly more doctor’s visits (adjusted means=21.29 vs. 7.17), ER visits (0.75 vs. 0.05) and hospitalizations (0.89 vs. 0.11); all p<0.001. Compared with those without fibromyalgia, those with fibromyalgia incurred indirect costs that were more than twice as high (adjusted means= ¥2,826,395 vs. ¥1,201,547) and direct costs that were nearly six times as high (¥1,941,118 vs. ¥335,140), both p<0.001. CONCLUSIONS: This study demonstrated the substantial economic burden associated with fibromyalgia in Japan. Japanese adults with fibromyalgia experienced significantly greater lost work productivity and healthcare utilization that resulted in significantly higher costs than adults without fibromyalgia.  Improving the rates of diagnosis and treatment for this chronic pain condition may be helpful in addressing this considerable economic burden.