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.
