Fibromyalgia is a long-term condition that causes widespread pain, along with fatigue, unrefreshing sleep and often difficulty with memory and concentration. It is real, common and treatable in the sense that symptoms can be reduced and life can improve, even though there is no cure. Studies estimate that it affects roughly 2 to 4 in every 100 people, more often women. A pain specialist can confirm the diagnosis, exclude other causes, review medicines, and help build a plan around what the evidence supports, including exercise, psychological approaches and, for some people, carefully chosen medicines.
What is fibromyalgia?
Fibromyalgia involves widespread pain, usually on both sides of the body, above and below the waist, lasting more than three months. It comes with fatigue, sleep that does not refresh, and often headaches, irritable bowel symptoms, sensitivity to noise or light, and low mood or anxiety. Symptoms fluctuate. Many people describe good days and bad days, with flare-ups after stress, poor sleep or overexertion.
Research points to changes in how the central nervous system processes pain, sometimes called central sensitisation. The nerves and the brain amplify signals, so ordinary sensations can be felt as pain. It is not caused by damage in the muscles or joints, which is why scans and blood tests are usually normal. That can make the condition feel invisible, and many people wait years for a diagnosis.
Common symptoms
- Widespread aching, burning or stiffness
- Tiredness that sleep does not fix
- Trouble concentrating or remembering, often called “fibro fog”
- Headaches or migraine
- Bowel and bladder symptoms
- Sensitivity to touch, temperature, light or noise
- Low mood, anxiety or stress that worsens pain
How is fibromyalgia diagnosed?
Diagnosis rests on your symptoms. Widely used criteria consider how many body areas are painful, how severe fatigue, sleep and thinking problems are, and whether symptoms have lasted at least three months. Blood tests are usually done to exclude conditions that can look similar, such as an underactive thyroid, inflammatory arthritis, vitamin deficiencies or side effects from medicines. A specialist assessment also looks for other conditions that commonly overlap with fibromyalgia, including migraine, neuropathy and joint or spinal pain, because treating them can lower the overall pain burden.
What a pain specialist adds
- A clear diagnosis. Confirming fibromyalgia, or identifying another cause, ends the uncertainty for many people.
- A medicines review. Many people with fibromyalgia are on medicines that NICE advises against starting, such as opioids or gabapentinoids. We help you decide, safely and gradually, whether they are worth continuing.
- Treatment of overlapping pain. If you have a specific source of pain, such as a spinal or joint problem, migraine or nerve pain, that may be treatable in its own right.
- A joined-up plan. Coordinating with your GP, physiotherapist, psychologist and rheumatologist so care fits together.
Treatments recommended by NICE
Exercise
Supervised group exercise, adapted to your needs and abilities, is recommended, and it is one of the best-supported approaches for fibromyalgia. The key is to start low and progress slowly, because pushing too hard in a good spell often leads to a flare. Pacing helps.
Psychological therapy
Acceptance and commitment therapy (ACT) and cognitive behavioural therapy (CBT) are recommended. They are not a suggestion that pain is imagined. They help people manage the effects of long-term pain on sleep, stress and daily life, and they can reduce distress and improve function.
Sleep and self-management
Poor sleep amplifies pain, and pain disrupts sleep. Regular routines, limiting caffeine and screens late in the evening, and sleep-focused CBT can help. Self-management programmes help people learn what triggers flares and how to plan their week.
Acupuncture or dry needling
NICE suggests considering a single course of acupuncture or dry needling, delivered by a suitably trained professional, in a community setting.
Antidepressants
NICE allows consideration of amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine or sertraline for adults with chronic primary pain, after a full discussion of benefits and harms. They can improve pain, sleep and distress even when depression is not present. They help some people but not everyone.
Other treatments people ask about
Some patients ask about infusion treatments, injections or implanted devices. Our position is straightforward. NICE advises against starting ketamine, intravenous local anaesthetic or trigger point corticosteroid injections for chronic primary pain outside clinical trials, and the evidence for neuromodulation in fibromyalgia comes mainly from small studies. We therefore do not present these as standard treatments, and we will tell you if we think a treatment is unlikely to help. Where you have a separate, identifiable pain problem, such as chronic migraine or a spinal source of nerve pain, we can discuss suitable treatment for that condition.
What to expect at your consultation
- We listen to your story, including what has and has not helped.
- Dr Poply examines you, reviews your investigations and current medicines, and checks for other treatable causes.
- She explains the diagnosis, what the evidence supports, and what is realistic.
- Together you agree on a plan, with priorities such as sleep, activity and medicines, and who will help with each.
About your specialist
Dr Kavita Poply is a Consultant in Pain Medicine and Neuromodulation at St Bartholomew’s Hospital, London, and a Reader at Queen Mary University of London. Fibromyalgia is among her listed clinical interests. She is Deputy Director of the Pain Research Centre at Barts Health NHS Trust, and she takes an evidence-led approach to treatment.
Frequently asked questions
Q.1 What are the main symptoms of fibromyalgia?
Ans. The main symptoms are widespread pain lasting more than three months, fatigue, and sleep that does not refresh. Many people also have difficulty with memory and concentration, headaches, digestive symptoms and sensitivity to touch, light or noise. Symptoms tend to fluctuate, with flares triggered by stress, poor sleep or overexertion.
Q.2 How is fibromyalgia diagnosed?
Ans. A doctor diagnoses fibromyalgia from your symptoms and an examination. There is no single blood test or scan for it. Tests are often done to rule out other conditions that can look similar, such as thyroid problems or inflammatory arthritis. A pain specialist can review the diagnosis and check for other conditions that often occur alongside it.
Q.3 Can fibromyalgia be cured?
Ans. There is currently no cure, but symptoms can improve and many people learn to manage them well. NICE recommends supervised exercise, psychological therapy and, where suitable, certain antidepressants. Understanding your triggers, pacing activity and improving sleep make a real difference for many people.
Q.4 What does NICE recommend for fibromyalgia?
Ans. NICE treats fibromyalgia as chronic primary pain. It recommends supervised group exercise, ACT or CBT, and a single course of acupuncture or dry needling, and it allows consideration of certain antidepressants. It advises against starting opioids, gabapentinoids, NSAIDs, paracetamol, benzodiazepines, ketamine and corticosteroid trigger point injections.
Q.5 Why should I see a pain specialist for fibromyalgia?
Ans. A pain specialist can confirm the diagnosis, exclude other causes, and review your medicines, including reducing ones that may not be helping. They can also identify and treat overlapping problems such as migraine, spinal pain or nerve pain, and coordinate your care with your GP, physiotherapist and psychologist.