If you are reading this, you are probably trying to make sense of pain that moves around your body, will not settle, and does not seem to match any injury. Fibromyalgia is one explanation. It is real, it is common, and it is not in your head, even though the science says the pain system itself is part of what has changed.
01 . What it is
What fibromyalgia is and how it works
Fibromyalgia is a chronic pain condition with widespread pain that lasts at least three months, alongside fatigue, sleep disturbance, and difficulty thinking clearly (sometimes called “fibro fog”). It is one of the most common chronic pain conditions in Australia and is recognised by Arthritis Australia as a significant cause of pain and disability.
The change is in the central nervous system, not at the painful sites. In fibromyalgia, the brain and spinal cord become more sensitive to incoming signals. Things that would not be painful for most people, like a firm hand on the shoulder, a hot shower, or a long day on your feet, are read by the nervous system as painful. Clinicians call this central sensitisation, and the RACGP describes it as the underlying change that explains the widespread, persistent pain pattern.
This is not the same as saying the pain is imagined. The pain is real. What has changed is how the nervous system processes signals, which is why imaging and blood tests usually come back clear.
02 . What it feels like
What fibromyalgia feels like
The pain can take different forms and intensities. It might be dull, sharp, or aching. It can also feel like burning, tingling, or pressure. The pain can move around the body from week to week, which can make it hard to describe to a GP or family member.
Most people with fibromyalgia also report:
- Fatigue that does not improve with rest
- Sleep that does not feel refreshing
- Difficulty concentrating or finding words (“fibro fog”)
- Sensitivity to light, sound, temperature, or pressure
- Stiffness, especially in the morning
These symptoms overlap with other conditions, which is part of why diagnosis can take time.
03 . Diagnosis
How fibromyalgia is diagnosed
Diagnosis has changed. The older 1990 American College of Rheumatology (ACR) criteria required a clinician to test 18 specific tender points and find at least 11 of them painful. Many older articles (including the previous version of this page) still describe diagnosis this way.
The current approach uses the ACR 2010 criteria and the 2016 revisions (Wolfe and colleagues, Seminars in Arthritis and Rheumatism, 2016). Instead of tender-point counts, it uses two symptom scales:
- The Widespread Pain Index (WPI). A list of 19 body areas; the score is how many have been painful in the past week.
- The Symptom Severity Scale (SSS). Rates fatigue, unrefreshing sleep, and cognitive symptoms, plus a short checklist of associated symptoms.
A person meets the criteria if their WPI and SSS scores cross set thresholds and the symptoms have been present for at least three months and are not better explained by another condition. The original ACR 2010 paper is on PubMed: Wolfe and colleagues, 2010.
Your GP is the right person to confirm a diagnosis. Fibromyalgia is a clinical diagnosis, which means it is based on the pattern of symptoms and the exclusion of other causes, not on a single test.
04 . How we help
How Physiotherapy and Exercise Physiology can help
Chronic pain often leads people to move less, which makes sense in the short term but creates a longer-term problem. Less movement means muscles weaken and joints stiffen, which can add a second layer of mechanical pain on top of the central sensitisation pain. Many people with fibromyalgia get stuck in a cycle that looks like this:
- Pain leads to less movement
- Less movement leads to weakness and stiffness
- Weakness and stiffness add their own pain on top of the original pain
- Total pain goes up, movement goes down further
- The cycle continues
Breaking this cycle is what graded movement is for. In the most recent international guideline, EULAR (the European rheumatology body) reviewed over 100 systematic reviews of fibromyalgia treatments and gave only one therapy a “strong for” recommendation: exercise. Every other treatment was rated only “weak for”. A Cochrane review of aerobic exercise for fibromyalgia (Bidonde and colleagues, 2017) found it probably improves quality of life, and may slightly reduce pain and improve physical function. The evidence for fatigue and stiffness was less clear.
What this looks like in practice:
- A Physiotherapist can assess how your muscles and joints are moving, identify mechanical contributors to your pain, and build a graded exercise program that respects flare-ups rather than fighting them.
- An Exercise Physiologist can build a longer-term strengthening and aerobic conditioning program, often progressing the work the Physiotherapist starts.
The shared principle is “start low, go slow”. Beginning at a level well below what feels manageable, then progressing in small steps, gives the nervous system time to adapt without triggering a flare.
Across international guidelines, exercise is the only fibromyalgia treatment with a “strong for” recommendation.
05 . What helps overall
What multimodal management looks like
There is no single treatment that completely removes the pain of fibromyalgia. The same EULAR guideline recommends a multimodal approach: exercise as the backbone, plus education, pacing, sleep support, and, when appropriate, medication prescribed by a GP. Many people find their day-to-day function improves with the right combination of these over time.
A typical multimodal plan can include:
- Graded exercise. Aerobic, strengthening, and gentle movement (such as warm-water exercise or yoga), built up slowly.
- Pain education. Understanding how central sensitisation works changes how people respond to pain signals, which can reduce fear and avoidance.
- Pacing. Spreading activity across the day or week to avoid the “boom and bust” cycle, where a good day leads to overdoing it and a multi-day flare.
- Sleep support. Sleep disturbance both worsens pain and is worsened by pain. Sleep habits, and sometimes medical input, help.
- GP-led medication review. Some medications (low-dose tricyclics, certain anticonvulsants, certain antidepressants) have evidence in fibromyalgia. This is a GP decision, not an allied health one.
If you are unsure where to start, a GP appointment is usually the right first step. A GP can confirm or work up the diagnosis, rule out other conditions, and refer to Physiotherapy or Exercise Physiology where appropriate.
