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Fibromyalgia & Central Sensitisation Pain

Widespread pain, fatigue, and sleep disturbance — a real, diagnosable, and treatable condition

Conditions Treated

Neck Pain
Back Pain
Shoulder Pain
Hip Pain
Knee Pain

Overview

Fibromyalgia is a complex central sensitisation syndrome characterised by widespread musculoskeletal pain, fatigue, sleep disturbance, cognitive difficulties ('fibro fog'), and heightened pain sensitivity. It affects 2–8% of the global population, predominantly women aged 30–60.

Although not primarily a structural musculoskeletal disorder, it has significant overlap with myofascial pain and is best managed through a multidisciplinary approach including pharmacological, interventional, and rehabilitative strategies.

Common Symptoms
  1. Widespread pain in multiple body regions — above and below the waist, both sides
  2. Allodynia — pain from normally non-painful stimuli (light touch, mild pressure)
  3. Hyperalgesia — exaggerated pain response
  4. Profound fatigue despite adequate sleep
  5. Non-restorative sleep — waking unrefreshed
  6. Cognitive difficulties — memory, concentration ('fibro fog')
  7. Irritable bowel syndrome, headache, and bladder symptoms frequently co-existing
Common Causes
  1. Central sensitisation — amplified pain processing in the CNS
  2. Dysregulation of descending pain inhibitory pathways
  3. Sleep disturbance — perpetuates pain threshold lowering
  4. Psychological stress, anxiety, and depression
  5. Physical or emotional trauma triggering onset
  6. Genetic predisposition to serotonin/norepinephrine imbalance
  7. Prior peripheral pain conditions triggering central sensitisation

Conservative & First-Line Treatment

  • Aerobic exercise — the single most evidence-based intervention for fibromyalgia
  • Cognitive Behavioural Therapy (CBT) for pain
  • Sleep hygiene and sleep disorder treatment
  • Duloxetine or pregabalin (pharmacological first-line)
  • Mindfulness-based stress reduction (MBSR)
  • Multidisciplinary Pain Rehabilitation Programme

How Vedant Pain Management Clinic Can Help

Our interventional pain specialists offer the following evidence-based procedures, all performed with real-time ultrasound guidance for precision and safety:

  • Pain Rehabilitation Programme combining exercise, psychology support and sleep intervention
  • Trigger point injections for co-existing myofascial pain
  • Nerve blocks targeting regional pain generators
  • Sleep optimisation with referral when necessary
  • Nutritional assessment including Vitamin D, B12 and thyroid function
  • Spinal Cord Stimulation consultation for severe refractory fibromyalgia

Newer Diagnostic Concepts & Advances

The revised 2016 ACR diagnostic criteria have improved recognition of fibromyalgia. The emerging concept of nociplastic pain — pain arising from altered nociception without tissue damage — encompasses fibromyalgia and guides the shift toward central sensitisation-targeted treatments rather than structural interventions.

Frequently Asked Questions

Fibromyalgia is a real, well-documented neurological condition with measurable changes in central pain processing, brain connectivity, and neuroendocrine function. It is recognised by the WHO, ACR, and all major medical bodies. The pain is very real — the mechanism is abnormal pain amplification in the nervous system, not imagination or emotional weakness.

Procedures targeting specific regional pain generators (co-existing myofascial trigger points, facet joints, or other peripheral sources) that perpetuate central sensitisation can reduce the overall pain burden significantly. We do not recommend injections as the sole or primary treatment — a comprehensive multimodal programme is essential.

Graduated aerobic exercise has the strongest evidence, followed by multidisciplinary pain rehabilitation, duloxetine/pregabalin pharmacotherapy, and CBT. At Vedant Pain Clinic, we offer a structured Pain Rehabilitation Programme integrating all evidence-based components.

Complete cure is not typical, but the condition is very manageable with the right programme. Many patients achieve > 50% reduction in pain and significant improvement in function, sleep, and quality of life. Long-term management focuses on maintaining physical activity and coping strategies.

The conditions share significant overlap — both involve central sensitisation, fatigue, sleep disturbance, and cognitive symptoms. They may represent different expressions of the same underlying neurobiological vulnerability. Management principles overlap but differ in emphasis on exercise (avoided in severe ME/CFS, central in fibromyalgia).