Fibromyalgia: Understanding the Condition and How We Can Help

All information in this blog is supported by UK clinical guidelines and peer-reviewed research. There is currently no dedicated NICE guideline for fibromyalgia, but a UK clinical guideline from the Royal College of Physicians is used alongside current evidence throughout. Reference numbers appear throughout, with the full list at the bottom of the page.

What Is Fibromyalgia?

Fibromyalgia is a chronic pain syndrome characterised by widespread pain, fatigue, sleep disturbance, cognitive symptoms, and mood comorbidity. ¹ It's classified as a form of chronic primary pain, pain in one or more parts of the body that persists or recurs for longer than 3 months, alongside significant emotional distress or functional disability. ²

Genuinely importantly, no validated diagnostic biomarker currently exists for fibromyalgia, meaning diagnosis relies on clinical assessment rather than a blood test or scan. ¹ Whilst NICE doesn't currently have a dedicated guideline for fibromyalgia, UK clinical guidelines on its diagnosis have been published by the Royal College of Physicians, providing clear, UK-specific guidance. ²

Common Signs and Symptoms

• Widespread, persistent pain across multiple areas of the body, lasting longer than 3 months

• Significant fatigue

• Sleep disturbance

• Cognitive symptoms, sometimes described as "fibro fog," affecting memory and concentration

• Heightened sensitivity to a range of stimuli, including heat, noise, and strong odours, alongside touch and pressure

• Mood-related symptoms, with depression or anxiety affecting around half of people with fibromyalgia

What Is Central Sensitisation? Understanding the Pathophysiology

This is genuinely the central concept underpinning modern understanding of fibromyalgia, and understanding it can be a meaningful, validating part of making sense of your symptoms.

Central sensitisation describes an augmented responsiveness of the central neurons in the spinal cord and brain to normal, or even subthreshold, sensory inputs. ¹ In plain terms, the nervous system's "volume control" for pain and other sensory signals becomes turned up, meaning ordinary touch, pressure, sound, or temperature can be experienced as genuinely painful or overwhelming, even though there's no actual tissue damage occurring. ³

The International Association for the Study of Pain now classifies fibromyalgia pain as "nociplastic," a term describing pain arising from altered processing within the central nervous system itself, without evidence of actual tissue damage or nerve injury. ¹ This distinction has been genuinely important, helping move understanding away from the outdated and unhelpful view that fibromyalgia is purely psychological, recognising instead that it's a real, measurable change in how the nervous system processes sensory information. ¹

What's happening in the brain and spinal cord?

Research published in 2024 and 2025 has demonstrated that people with fibromyalgia show disrupted functional connectivity in the periaqueductal grey matter, a brain region responsible for descending pain inhibitory pathways, in other words, the brain's natural ability to dampen down pain signals appears to be impaired. ¹ Hypersensitivity, termed central and peripheral sensitisation, of the nervous system to external stimuli can explain many of the sensory symptoms associated with fibromyalgia. ²

There's also evidence at the level of small pain nerve fibres themselves, these display abnormal electrical signalling to standard stimuli in people with fibromyalgia, and their number in the skin is often reduced. ² Central sensitisation has also been linked to autonomic nervous system changes, research comparing people with fibromyalgia to matched controls found measurable differences in autonomic activity alongside evidence of central sensitisation, assessed through cortical brain activity measurements. ⁴

What triggers it?

There is good evidence that experiencing a stressful life-course, or significant life events such as major physical or psychological trauma, increases the risk of developing fibromyalgia. ² It's worth knowing that sensitisation doesn't follow a simple, linear pattern, meaning there isn't clear evidence that smaller, sub-threshold symptoms will always progress in a predictable way toward the full condition. ²

When Should You Be Concerned? Red Flags to Watch For

Whilst fibromyalgia itself is not dangerous, certain features alongside widespread pain warrant medical assessment to rule out other conditions:

• Significant, unexplained weight loss

• Fever or night sweats

• New, focal weakness or neurological symptoms

• Joint swelling or visible inflammation, which may suggest an inflammatory arthritis rather than, or alongside, fibromyalgia

• Symptoms developing rapidly rather than the more typical gradual onset

How We Can Help

This is genuinely a condition where a multidisciplinary, evidence-based approach matters, and we're pleased to say that current research increasingly supports several of the treatments we offer.

Deep tissue and sports massage: a 2025 evidence-based guideline on nonpharmacological treatments for fibromyalgia, using rigorous GRADE methodology, suggests massage for people with fibromyalgia over no intervention at all. ⁵ A meta-analysis of massage therapy for fibromyalgia found genuine improvements in disease impact scores, pain reduction, fatigue, and sleep quality. ⁵ It's worth being honest that the certainty of this evidence is currently rated as low, meaning massage is a genuinely reasonable option to try, though further high-quality research would strengthen confidence in these findings.

Cupping: this is genuinely well-supported in the most recent guideline evidence. Cupping therapy has been shown to improve quality of life scores across multiple domains, including bodily pain, vitality, and mental health, while reducing fatigue scores. ⁵ Cupping has also demonstrated effectiveness in reducing pressure pain sensitivity at specific muscle sites and the area of maximal pain, directly relevant given the central sensitisation underlying fibromyalgia. ⁵ Notably, no treatment-related adverse events were reported across the studies reviewed. ⁵

Medical acupuncture: the same 2025 guideline incorporates acupuncture alongside other approaches as part of evidence-based nonpharmacological management, reflecting growing recognition of its role in fibromyalgia care. ⁶

Osteopathic manual techniques and manual therapy: used as part of a broader, multimodal treatment approach to support overall comfort and function, working alongside exercise rather than as a standalone treatment.

Exercise: A Genuine Cornerstone of Management

Exercise is increasingly viewed as a cornerstone of fibromyalgia care, with research synthesising mechanistic insight alongside clinical trial evidence to support physical activity as a key treatment. ¹

Why exercise helps, mechanistically: given that the pathophysiology of fibromyalgia is believed to involve both central and peripheral processes that amplify pain perception, with the brain and spinal cord becoming overly responsive to pain signals, appropriately dosed exercise has genuine, evidence-supported mechanisms for helping to recalibrate this sensitised system over time. ¹

Getting the dose right matters: a systematic review and meta-analysis specifically investigating the optimal dose and type of exercise for fibromyalgia found that different modes and doses of exercise produced meaningfully different effects across pain, disease impact, quality of life, and anxiety outcomes. ⁷ Separate research evaluating adherence to established exercise guidelines found this genuinely influences treatment outcomes in fibromyalgia. ⁸

Aquatic exercise: a systematic review specifically evaluating aquatic exercise for fibromyalgia found positive results for both pain and quality of life, making this a genuinely well-supported, gentler entry point for many people. ⁹

Personalised, graded approach: developing individualised exercise plans that genuinely match each person's abilities and current symptom levels has been shown to improve both adherence and outcomes, reflecting the importance of starting appropriately and progressing gradually rather than following a generic, one-size-fits-all programme. ¹

A brief but important clarification: fibromyalgia is a distinct condition from ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome), and NICE's specific cautions around graded exercise therapy relate to that separate condition. The exercise evidence summarised here relates specifically to fibromyalgia research.

What to Expect at Your First Appointment

We will take a thorough history, exploring the pattern, duration, and impact of your symptoms, alongside any relevant life events or stressors, given the recognised link between significant life stress and the development of fibromyalgia. We will explain clearly what we understand about central sensitisation and how it relates to your experience, and build a personalised, multimodal treatment plan combining manual therapy, cupping, and a carefully graded exercise programme tailored genuinely to your current symptom levels and capacity.

Frequently Asked Questions

Is fibromyalgia "all in my head"? No, genuinely not, and we want to be clear about this. Central sensitisation is a real, measurable change in how your nervous system processes signals, supported by functional brain imaging and nerve fibre studies. This is a physical condition, not a psychological one, even though psychological factors and stress can genuinely influence it, as they can with many health conditions.

Will exercise make my pain worse? Appropriately dosed, personalised exercise has good evidence for helping fibromyalgia, but the dose and type genuinely matter, which is why we focus on building a graded, individualised programme rather than a generic approach.

Do I need a scan or blood test to diagnose this? No validated biomarker currently exists for fibromyalgia, so diagnosis relies on a thorough clinical history and assessment, in line with current UK clinical guidance, rather than a specific test.

Can cupping and massage genuinely help? Yes, based on current evidence, a recent rigorous evidence-based guideline specifically suggests both as reasonable treatment options, with cupping in particular showing measurable improvements in pain sensitivity and quality of life.

Recognise this pattern of symptoms? Get in touch using the contact form and we will carry out a thorough assessment and build a personalised treatment plan for you.

BOOK YOUR APPOINTMENT HERE

References

1. Fibromyalgia: A Comprehensive Update for 2026, Current Perspectives on Pathophysiology, Diagnosis, and Management. Available at: https://www.asianpainacademy.com/post/fibromyalgia-a-comprehensive-update-for-2026-current-perspectives-on-pathophysiology-diagnosis

2. The diagnosis of fibromyalgia syndrome, UK clinical guidelines. Royal College of Physicians. Available at: https://www.rcp.ac.uk/media/udlhnt1b/the-diagnosis-of-fibromyalgia-syndrome-guidelines_1_2_0.pdf

3. Algometry for the assessment of central sensitisation to pain in fibromyalgia patients: a systematic review. Annals of Medicine. 2022. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9122375/

4. A Cross-Sectional Study on Central Sensitization and Autonomic Changes in Fibromyalgia. PMC. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7417433/

5. Li, et al. Guidelines on Treating Fibromyalgia With Nonpharmacological Therapies in China. Journal of Evidence-Based Medicine. 2025. Available at: https://onlinelibrary.wiley.com/doi/10.1111/jebm.70044

6. Guidelines on Treating Fibromyalgia With Nonpharmacological Therapies in China. PMC. 2025. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12159282/

7. Optimal dose and type of exercise to reduce pain, anxiety and increase quality of life in patients with fibromyalgia. A systematic review with meta-analysis. PMC. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10130662/

8. Adherence to ACSM exercise guidelines and its influence on Fibromyalgia treatment outcomes: a meta-analysis of randomized controlled trials. Frontiers in Physiology. 2024. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12890375/

9. Aquatic Exercise in Physical Therapy Treatment for Fibromyalgia: Systematic Review. PMC. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10969860/