Fibromyalgia: widespread pain, fatigue, and central sensitisation
Widespread pain, fatigue, and poor sleep that isn’t responding to standard back pain treatment?
The myBackPain assessment identifies features consistent with fibromyalgia and central sensitisation — conditions that need a different management approach from structural back pain. Results in minutes.
What is fibromyalgia?
Fibromyalgia is a chronic pain condition characterised by widespread musculoskeletal pain, fatigue, sleep disturbance, and cognitive difficulties. It is not a psychological condition — it reflects real changes in how the central nervous system processes pain signals. It is one of the most common pain conditions and is frequently underdiagnosed or misunderstood.
Fibromyalgia involves central sensitisation — the pain processing system becomes amplified, responding more intensely to stimuli that would not normally be painful, and generating widespread pain from signals that a healthy nervous system would interpret as mild or non-threatening. The pain is real. It is not imagined or exaggerated. But the driver is in the nervous system rather than in the tissues where the pain is felt.
Symptoms
- Widespread pain — affecting multiple areas of the body, often described as aching, burning, or throbbing
- Fatigue — often profound, not relieved by sleep
- Non-restorative sleep — waking unrefreshed despite adequate hours in bed
- Cognitive difficulties — brain fog, poor concentration, memory problems
- Sensitivity to touch, temperature, noise, and light
- Headaches, IBS, and bladder symptoms are common co-occurring conditions
- Symptoms significantly worse with stress, poor sleep, or low mood
Many people with fibromyalgia present initially with back pain as their primary complaint. The widespread nature of the pain, the disproportionate severity relative to imaging findings, and the co-occurring symptoms of fatigue and poor sleep are the features that point toward fibromyalgia rather than a structural back pain cause. Standard mechanical back pain treatment produces limited results in fibromyalgia — the management approach is fundamentally different.
What helps?
Exercise
The most evidence-based treatment. Aerobic exercise, Pilates, swimming, and walking all reduce pain and fatigue in fibromyalgia. The key is to start very low and progress gradually — pushing too hard too soon is a common cause of flare. Even short walks are a valid starting point.
Sleep management
Addressing sleep quality is fundamental. Sleep hygiene, amitriptyline (at low dose), and CBT for insomnia all improve fibromyalgia outcomes. Poor sleep directly amplifies central sensitisation — it must be treated, not just accepted.
Medication
Duloxetine, pregabalin, and amitriptyline are the most evidence-supported medications for fibromyalgia. NSAIDs and opioids have limited evidence and opioids may worsen sensitisation over time. Discuss with your GP.
Psychological support
CBT, ACT, and mindfulness-based stress reduction all have good evidence in fibromyalgia management. They address the catastrophising, fear-avoidance, and stress amplification that maintain symptoms.
Manual therapy
Gentle soft tissue work, massage, and movement-based therapy can complement other management and reduce localised pain. Aggressive or deep tissue work can flare symptoms significantly. If you are working with a manual therapist, communicate clearly about how your body responds to treatment.
Pain that is widespread, persistent, and not responding to standard treatment?
The myBackPain assessment identifies features consistent with fibromyalgia and central sensitisation, and guides you toward the management approaches with the best evidence.