Fibromyalgia
A chronic central pain syndrome with widespread pain, fatigue and sleep disturbance.
Overview
Fibromyalgia is a disorder of central pain processing that causes widespread musculoskeletal pain, fatigue, poor sleep and cognitive symptoms ('fibro fog'). It is real, common and treatable, though there is no single cure.
Symptoms
- • Widespread musculoskeletal pain on both sides of the body, above and below the waist, for ≥3 months
- • Unrefreshing sleep
- • Fatigue
- • Cognitive difficulties ('fibro fog')
- • Headache, IBS, restless legs, mood symptoms
Risk factors
- • Female sex (most cases)
- • Age 30–60
- • Family history
- • Chronic stress, PTSD, depression, anxiety
- • Other chronic pain conditions
Causes
- • Central sensitisation — amplified pain processing in the CNS
- • Genetic susceptibility
- • Often triggered by infection, trauma or major stress
🚨 Red flags — seek urgent care
- • Weight loss, fever, night sweats — suggest alternative diagnosis
- • New focal neurological deficit
- • Severe morning stiffness >1 hour or joint swelling — consider inflammatory arthritis
When to seek care
- • Persistent widespread pain affecting function
- • Symptoms not responding to self-management
- • Mood or sleep severely affected
Diagnosis
- • Clinical — ACR 2016 criteria using Widespread Pain Index and Symptom Severity scale
- • No diagnostic blood test or imaging — investigations exclude mimics
- • Screen for thyroid disease, vitamin D, B12, inflammatory markers
Treatment
- • Education and pacing strategies
- • Graded aerobic exercise (best-evidence intervention)
- • Cognitive behavioural therapy and mindfulness-based stress reduction
- • Medication: amitriptyline, duloxetine, pregabalin for selected patients
- • Treat coexisting depression, anxiety, sleep disorders
- • Avoid opioids — ineffective and harmful long-term
Prevention
- • No proven primary prevention
- • Address sleep, stress and chronic pain early
Complications
- • Functional impairment and work disability
- • Depression and anxiety
- • Sleep disorders
- • Opioid dependence if mismanaged
Prognosis
Symptoms tend to be chronic but fluctuate. Most people improve substantially with self-management, exercise and treatment of coexisting conditions.
Education & self-care
Fibromyalgia is treatable. The strongest evidence supports exercise, education, CBT and selective medication — opioids should be avoided.
Frequently asked questions
Is fibromyalgia 'in my head'?
No. It is a real disorder of nervous-system pain processing, with measurable changes in brain pain pathways.
Will I end up in a wheelchair?
Fibromyalgia does not damage joints or muscles. Most people maintain mobility with regular activity and pacing.
Is fibromyalgia 'all in the head'?
No. It involves real abnormal pain processing in the central nervous system (central sensitisation). Brain imaging studies show measurable differences in pain pathways.
Which medications actually help?
Amitriptyline, duloxetine and pregabalin have the best evidence. Opioids and standard NSAIDs are generally unhelpful and may worsen symptoms long-term.
What non-drug treatments work?
Graded aerobic exercise, CBT, sleep optimisation and pacing have the strongest evidence and outperform most medications for long-term function.