Fibromyalgia

What it is

Fibromyalgia is a disorder of pain processing. The nervous system amplifies pain signals and lowers the threshold at which ordinary sensation becomes painful - central sensitisation - and the same process affects sleep, fatigue and cognition. It is measurable in research settings and it is entirely real.

The absence of tissue damage is why investigations come back normal, and that fact is too often delivered as though it means nothing is wrong. It also explains why treatments aimed at tissue do not work and why graded exercise, sleep and pacing do.

What it feels like

• Widespread pain on both sides of the body, above and below the waist, for months
• Exhaustion that sleep does not relieve
• Waking unrefreshed however long you were in bed
• Brain fog - difficulty concentrating and finding words
• Tender everywhere to touch, and sensitive to noise, light and temperature

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Central sensitisation

The spinal cord and brain amplify incoming signals, so normal input produces pain. This is the core mechanism and it is demonstrable with quantitative sensory testing.

Non-restorative sleep

Deep sleep is disrupted, and experimental disruption of deep sleep produces fibromyalgia-like symptoms in healthy volunteers. Sleep is not just a symptom here - it is part of the mechanism.

Altered pain-inhibiting pathways

The descending systems that should dampen pain signals are less effective. There is less braking as well as more accelerating.

Physical or emotional trauma as a trigger

Onset frequently follows an injury, an illness, surgery or a period of significant stress. The trigger is not the cause of the ongoing pain but it often starts the process.

Deconditioning

Pain and fatigue reduce activity, which reduces capacity, which produces more pain from less. It is not the cause and it is a large part of what makes it worse over years.

Stress and autonomic dysregulation

Sustained sympathetic activation is common and it amplifies pain processing. Fibromyalgia frequently coexists with other conditions involving the same pathways - IBS, migraine, bladder pain.

Genetics

It clusters in families and there is a demonstrable genetic contribution to pain sensitivity, which is part of why two people with the same trigger have different outcomes.

Mood and anxiety

Depression and anxiety are common and share pathways with pain processing. They are neither the cause nor irrelevant - they are levers on the same system.

Boom and bust activity

Doing a great deal on a good day and paying for it for three is the most common pattern and it steadily reduces the baseline. Pacing to a repeatable level is one of the core treatments.

Years of not being believed

Not a physical cause but a significant one in practice. Repeated dismissal increases distress, reduces engagement with treatment and delays effective management by years.

Who tends to get it

• Women, in whom it is diagnosed several times more often
• Anyone with another central sensitisation condition - IBS, migraine, chronic bladder pain
• People with a history of significant physical or emotional trauma
• Anyone with long-standing poor sleep
• People with a family history of chronic pain conditions

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineGentle Start (Fatigue & Flare-Ups)

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Sudden new focal weakness, joint swelling or fever is not fibromyalgia - reassess

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Exercise improves pain, function and quality of life in fibromyalgia and it is recommended in every guideline - but it has to start small and progress slowly, because too much too soon produces a flare and the conclusion that exercise does not work. Improvement is measured over months in what you can do rather than in the pain score. Fibromyalgia usually persists rather than resolving, and a great many people move from severely limited to living well with it, which is a genuine and achievable goal.

Prevalence basis: Rheumatology criteria-based estimates

Others the same routine covers

These share the Gentle Start (Fatigue & Flare-Ups) routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.