Fibromyalgia is a chronic condition involving widespread musculoskeletal pain, fatigue, disturbed sleep and cognitive difficulty. The pain is real and it is not “in the head”.

Fibromyalgia and widespread pain
In fibromyalgia the pain is real; its source lies not in the tissue but in how pain is processed.

Symptoms

Fibromyalgia is recognised not by a single symptom but by a cluster of symptoms occurring together.

Commonly reported symptoms

  • Widespread pain on both sides of the body, lasting more than three months
  • Fatigue that rest does not relieve
  • Waking unrefreshed
  • Fragmented sleep
  • Difficulty with attention and memory (“fibro fog”)
  • Morning stiffness
  • Headache, restless legs, bowel symptoms
  • Anxiety and depressive symptoms

What causes it?

Fibromyalgia is not a disease of tissue damage. The dominant current explanation is central sensitisation: the central nervous system processes pain signals more strongly than it should, and stimuli that would not normally hurt begin to be perceived as painful.

  • Differences in pain processing: a lower pain threshold and heightened sensitivity
  • Disturbed sleep: fragmentation of deep sleep stages lowers the pain threshold
  • Stress and trauma history: among the factors that raise susceptibility
  • Triggers: infection, surgery, physical trauma or prolonged psychological load
To be clear: pain originating in the central nervous system is not imaginary. It is a measurable neurobiological process, and it is treated as such.

Why psychological support is recommended

International guidelines recommend a multi-component approach rather than medication alone: patient education and graded exercise as the first step, with psychological and pharmacological support added where needed.

  • Cognitive behavioural therapy: targets catastrophic interpretations of pain, activity avoidance and sleep
  • Pacing: breaks the cycle of overdoing it on good days and crashing on bad ones
  • Sleep interventions: as sleep improves, the pain threshold rises
  • Graded exercise: the strongest recommendation in the guidelines, started at low intensity

What helps in daily life

  1. See a doctor for diagnosisOther medical causes of widespread pain must be ruled out; assessment is usually via rheumatology or pain medicine.
  2. Start exercise smallFive to ten minutes of walking a day is enough to begin with. Starting too hard causes a setback.
  3. Hold back on good daysThe “I feel well today, let me finish everything” approach sets up the next day’s flare.
  4. Prioritise sleepSleep is one of the areas where the largest gains are made in fibromyalgia.
Note: This article is for general information. It does not diagnose and is not a substitute for professional assessment. If your symptoms are making daily life difficult, consult a mental health professional. If you are having thoughts of harming yourself, call your local emergency number — 112 in Türkiye — or go to the nearest emergency department.

Individual Counselling

Psychological support for living with chronic pain sits alongside medical treatment, not in place of it.

Read more →

References

  1. Macfarlane, G. J., Kronisch, C., Dean, L. E., Atzeni, F., Häuser, W., Flüß, E., … & Jones, G. T. (2017). EULAR revised recommendations for the management of fibromyalgia. Annals of the Rheumatic Diseases, 76(2), 318–328.
  2. World Health Organization. (2019). International Classification of Diseases (11th revision).