Fibromyalgia
Real pain, a sensitized nervous system, and a plan built around function.

Fibromyalgia is a form of nociplastic pain: the nervous system amplifies pain signals (central sensitization). Common symptoms are widespread aching, tenderness, fatigue, unrefreshing sleep, brain fog, headaches and irritable bowel symptoms. It often overlaps with other pain conditions.

There is no single test. Diagnosis rests on the pattern of widespread pain and related symptoms over at least three months, as defined in the 2016 American College of Rheumatology criteria. An exam and blood work rule out conditions that can look similar, such as thyroid disease, inflammatory arthritis or vitamin deficiencies.

Use the Function Method, and measure function first: sleep, activity tolerance and daily-life goals. The plan includes:

• a graded exercise program that starts low and builds (aerobic and strength)
• pacing
• sleep care
• referral for cognitive behavioral therapy when helpful
• a review of every medication
• targeted care for any overlapping pain generator: myofascial, joint or nerve pain

Opioids are generally not recommended for fibromyalgia.

Four medicines are FDA-approved for fibromyalgia:

• pregabalin (Lyrica)
• duloxetine (Cymbalta)
• milnacipran (Savella)
• sublingual cyclobenzaprine (Tonmya, approved in August 2025)

Low-dose amitriptyline is used off-label. Low-dose naltrexone is also used off-label, and recent controlled trials have been mixed. Any prescribing is physician-supervised after assessment and never guaranteed.