Fibromyalgia

Fibromyalgia is a chronic pain disorder characterised by widespread musculoskeletal pain, profound fatigue, sleep disturbance, and often cognitive difficulties. It is now understood as a disorder of central pain processing — sometimes termed "central sensitisation" — in which the nervous system amplifies pain signals, making ordinarily non-painful stimuli feel painful. It is not an inflammatory or autoimmune condition, and does not cause joint or tissue damage.

Fibromyalgia affects approximately 2–4% of the population and is more common in women. It can develop at any age, including in adolescents. It frequently coexists with other conditions — including inflammatory arthritis, lupus, hypermobility spectrum disorders, irritable bowel syndrome and anxiety or depression — which can complicate both diagnosis and management. The condition often develops in the context of physical or psychological stressors.

Fibromyalgia is a genuinely debilitating condition that significantly affects quality of life, work capacity and daily functioning. It deserves the same thorough and compassionate assessment as any other medical condition. A clear diagnosis, with an explanation of the underlying mechanisms, is itself a therapeutic step — allowing patients to understand their condition and engage fully with evidence-based management.

Fibromyalgia is best managed through a multimodal approach combining education, physical activity, psychological support and, where appropriate, pharmacological therapy. Patient education — understanding the neuroscience of central sensitisation — has been shown to improve outcomes and is an integral part of management. Validating the reality and impact of the condition is an important starting point.

Graduated aerobic exercise is the single most evidence-based intervention for fibromyalgia and is recommended in all guidelines. Activities such as walking, swimming and cycling are well tolerated and consistently demonstrate improvements in pain, fatigue and overall wellbeing. Cognitive behavioural therapy (CBT) and other pain psychology approaches address the cognitive and emotional dimensions of chronic pain and are effective adjuncts. Physiotherapy incorporating pain neuroscience education and graded activity can be valuable.

Pharmacological treatments are used as adjuncts rather than primary therapy. Low-dose amitriptyline or nortriptyline taken at night can improve sleep quality and reduce pain. Duloxetine (an SNRI antidepressant) and pregabalin or gabapentin (neuromodulators) are licensed or commonly used for fibromyalgia. Simple analgesics may provide modest benefit and opioids are generally not recommended. Sleep hygiene measures, pacing strategies and addressing mood disorders all contribute to a comprehensive management approach.