What is Fibromyalgia?
Fibromyalgia is a disorder of central pain processing. The nervous system amplifies normal signals, so ordinary pressure, temperature or activity is perceived as pain. Imaging studies show measurable changes in how pain is processed centrally.
It is not inflammatory and it does not damage joints — but the suffering, fatigue and functional loss are entirely real, and patients are too often dismissed after normal blood tests.
Fibromyalgia frequently coexists with rheumatoid arthritis, lupus and spondyloarthritis. Recognising it is essential: escalating immunosuppression for fibromyalgia pain exposes patients to risk without benefit.
IllustrativeSymptoms of Fibromyalgia
Early signs
- Widespread pain above and below the waist, on both sides, for more than three months
- Non-restorative sleep — waking tired regardless of hours slept
- Profound fatigue, often worse than the pain itself
- 'Fibro fog' — difficulty concentrating and word-finding problems
- Marked tenderness to light pressure across muscles
If left untreated
- Irritable bowel symptoms, bladder frequency and chronic headaches
- Increased sensitivity to noise, light, cold and odours
- Anxiety, low mood and social withdrawal
- Progressive deconditioning from fear of movement
- Loss of work capacity and disrupted family roles
Causes & risk factors
- Central sensitisation with altered descending pain inhibition
- Genetic predisposition and family clustering
- Physical or emotional trauma, infection or surgery acting as a trigger
- Chronic sleep disruption, especially loss of deep sleep
- Coexisting inflammatory rheumatic disease or thyroid disorder
How Fibromyalgia is diagnosed
No single test diagnoses a rheumatic disease. The diagnosis comes from combining the pattern of symptoms, the examination findings, and only the investigations that answer a specific question.
ACR 2016 criteria assessment
Widespread Pain Index plus Symptom Severity Scale over at least three months. The diagnosis is positive and clinical — it is not a diagnosis of exclusion made by default.
Targeted exclusion tests
Thyroid function, vitamin D and B12, CRP and ESR, calcium, CPK and a coeliac screen where indicated. The aim is a focused panel, not endless repeat testing.
Screening for coexisting inflammatory disease
Because fibromyalgia commonly overlaps with RA, lupus and spondyloarthritis, and each of those needs different treatment.
Sleep and mood evaluation
Obstructive sleep apnoea, restless legs, anxiety and depression are actively looked for, because treating them often improves pain more than analgesics do.
Treatment options
Education and validation first
Understanding the mechanism reduces fear and measurably improves outcomes. Being told the pain is real and explainable is itself therapeutic.
Graded aerobic exercise
The single most effective intervention. Started at a genuinely low level — even five minutes of walking or pool work — and increased slowly to avoid boom-and-bust cycles.
Sleep restoration
Sleep hygiene, treating apnoea, and low-dose amitriptyline or cyclobenzaprine at night where appropriate.
Evidence-based medication
Duloxetine, milnacipran or pregabalin as first-line drug options. Opioids are avoided — they worsen central sensitisation over time and offer no long-term benefit.
Cognitive behavioural therapy and pacing
CBT and activity pacing have some of the strongest evidence in fibromyalgia, addressing the cycle of overexertion and collapse.
Managing overlap conditions
Where fibromyalgia coexists with RA or lupus, disease activity is scored objectively so immunosuppression is escalated only for genuine inflammation.
Living with Fibromyalgia
- Consistent sleep and wake times, seven days a week
- Pace activity: plan a steady moderate level rather than a productive day followed by three bad ones
- Warm-water exercise is exceptionally well tolerated
- Reduce caffeine and evening screen exposure
- Address stress actively — mindfulness and structured relaxation have real, measurable effects here
Seek urgent medical attention if you have
- Fever, night sweats or unexplained weight loss
- Objective joint swelling, rash or mouth ulcers
- Progressive muscle weakness rather than pain-limited weakness
- New neurological deficit
- Symptoms starting for the first time after age 60
Do not wait for a scheduled appointment for any of the above. Call the clinic on +91 70571 19999 or attend the nearest emergency department.
Frequently asked questions about Fibromyalgia
All my tests are normal. Does that mean nothing is wrong?
Will fibromyalgia damage my joints?
Why exercise when movement hurts?
Are painkillers useful?
Get an expert opinion on Fibromyalgia in Pune
Consultations at the Ravet clinic in Pimpri-Chinchwad. Bring your previous reports — a properly reviewed history usually saves repeating tests.
Part of a wider group
Osteoporosis, Osteoarthritis & Soft-Tissue PainThe conditions where structured exercise outperforms most drugs.Related conditions
Osteoarthritis
India's most common joint disease — and far more treatable than 'nothing can be done'.
Rheumatoid Arthritis
Symmetric small-joint swelling that responds best when treated within the first 12 weeks.
Lupus (SLE)
A multi-system autoimmune disease where early kidney screening changes the entire prognosis.