Fibromyalgia Treatment: What Works for Widespread Chronic Pain

Fibromyalgia is one of the most misunderstood and underserved diagnoses in pain medicine. Patients with fibromyalgia are often told their pain is psychosomatic, dismissed with inadequate treatment, or given a prescription for a single medication and sent home.

That is not appropriate care. Fibromyalgia is a real neurobiological condition with identifiable mechanisms — and there are treatments that work.

What Is Fibromyalgia?

Fibromyalgia is characterized by:

• Widespread musculoskeletal pain (above and below the waist, both sides of the body)
• Fatigue, sleep disturbance, and cognitive fog ("fibro fog")
• Heightened pain sensitivity (allodynia and hyperalgesia)
• Often co-occurring with irritable bowel syndrome, headaches, and mood changes

The core mechanism is central sensitization — the central nervous system becomes hyperactivated and amplifies pain signals throughout the body. This is why fibromyalgia pain is real, measurable, and not "imagined" — it reflects a genuine malfunction in central pain processing.

What Helps

Multimodal treatment is essential. No single intervention addresses all aspects of fibromyalgia.

Medications with Evidence

• Duloxetine (Cymbalta) — FDA-approved for fibromyalgia; reduces central pain amplification
• Pregabalin (Lyrica) — FDA-approved; calms overactive pain signaling
• Milnacipran (Savella) — FDA-approved; SNRI with specific fibromyalgia indication
• Low dose amitriptyline — improves sleep quality and pain; often used at bedtime
• Low dose naltrexone (LDN) — my preferred adjunct; directly targets the neuroinflammatory mechanism of fibromyalgia with an excellent safety profile

Exercise

Aerobic exercise is one of the most strongly evidence-supported non-pharmacological treatments for fibromyalgia. It must be introduced gradually — starting too aggressively often triggers flares — but consistent low-to-moderate intensity aerobic exercise (water aerobics, swimming, cycling) produces long-term improvement in pain, function, and quality of life.

Cognitive Behavioral Therapy (CBT)

CBT addresses the thoughts and behaviors that amplify pain experience. In fibromyalgia, the brain-body connection is unusually strong, and CBT specifically targeting pain catastrophizing produces meaningful benefit.

Sleep Optimization

Sleep disturbance in fibromyalgia is bidirectional — poor sleep worsens pain, and pain worsens sleep. Targeted sleep interventions (sleep hygiene, low-dose tricyclics for sleep architecture, or cognitive behavioral therapy for insomnia) are important.

What Doesn't Help (or Makes It Worse)

• Opioid medications: Strong evidence that opioids worsen central sensitization over time in fibromyalgia — they are not recommended as a primary treatment
• Injections: The pain in fibromyalgia is central, not peripheral; injections don't address the mechanism

My Approach

I work with fibromyalgia patients to build a multi-modal treatment plan — typically combining medication optimization (with LDN as a cornerstone where appropriate), supervised exercise guidance, and coordination with behavioral health when indicated.

If you have fibromyalgia and feel like you haven't been offered adequate treatment, call 516-492-3100 to discuss your options.