Fibromyalgia is a chronic pain condition affecting the muscles, tendons, and soft tissues throughout the body. Pain most commonly occurs in the head, neck, shoulders, and back, though some patients experience pain across their entire body. The pain is typically described as a persistent dull aching that lasts for more than 3 months.
Beyond pain, fibromyalgia frequently causes a range of additional symptoms — including profound fatigue, unrefreshing sleep, and what patients often describe as "fibro fog": a noticeable decline in concentration, focus, and short-term memory. The condition is diagnosed more commonly in women than men and is most frequently identified in middle age, though it can occur at any stage of life.
What Causes Fibromyalgia?
The exact cause of fibromyalgia is not yet fully understood. Current research indicates that it arises from a combination of interacting factors rather than a single identifiable cause :
- Abnormal pain signal processing — the most widely supported explanation is that fibromyalgia involves a fundamental change in how the central nervous system (the brain, spinal cord, and nerves) processes pain signals. The pain-amplification system becomes dysregulated, leading the brain to interpret normal, non-threatening sensory input as painful. This is known as central sensitisation — the nervous system effectively lowers its pain threshold and becomes hyperresponsive to stimulation. Changes in the levels and activity of key neurotransmitters involved in pain modulation are believed to play a central role.
- Triggering events — fibromyalgia is frequently preceded by an event that places significant physical or psychological stress on the body. Common triggers include serious physical injury, severe infection, major surgery, and significant psychological trauma. In some cases, the condition develops gradually without a clear precipitating event.
- Co-existing conditions — certain health conditions are commonly associated with fibromyalgia and may act as ongoing triggers or contributors, including migraine, myofascial pain syndrome (MPS), inflammatory arthritis, and temporomandibular joint (TMJ) disorders.
Treatment Options
- Exercise Regular physical activity is one of the most evidence-supported treatments for fibromyalgia. Exercise reduces pain intensity, decreases fatigue, improves sleep quality, and strengthens the muscles that support the body. Low-impact aerobic activities — such as walking, swimming, and cycling — are particularly well tolerated. Starting gently and progressing gradually is important; exercising to the point of significant pain flare can be counterproductive. Consulting a physiotherapist or exercise specialist to develop an individually appropriate programme is strongly recommended.
- Therapeutic Approaches
- Physiotherapy — to restore movement, reduce muscle tension, and improve physical function
- Psychological therapy — Cognitive Behavioural Therapy (CBT) in particular is well supported by evidence for fibromyalgia; it helps patients develop coping strategies, reduce pain catastrophising, and address the anxiety and depression that frequently accompany the condition
- Mindfulness and meditation — regular mindfulness practice has demonstrated measurable reductions in pain intensity and improvements in quality of life in fibromyalgia patients; it works in part by altering the brain's attentional relationship to pain signals - Medication : Medication is tailored to each patient's specific symptom profile and is used to reduce pain, ease muscle tension, improve sleep, and modulate the abnormal pain signalling pathways in the central nervous system. Agents commonly used include :
- Antidepressants — particularly SNRIs (duloxetine) and tricyclics (amitriptyline), which have direct pain-modulating effects independent of their antidepressant properties
- Anticonvulsants — such as pregabalin and gabapentin, which reduce abnormal central pain signalling
- Muscle relaxants — to address associated muscle tension and improve sleep Topical anaesthetics — applied to localised areas of heightened surface sensitivity
All medication should be initiated, adjusted, and supervised by a physician. Some agents require time to reach their full effect, and dose adjustments must be made gradually under medical guidance. - Interventional Procedures
The following procedures may be used alongside the above treatments in selected patients :- Intravenous infusion therapy — intravenous ketamine or lidocaine infusions can interrupt central sensitisation pathways and provide meaningful relief in patients with refractory fibromyalgia
- Trigger point injections- local anaesthetic with or without low-dose steroid injected directly into specific painful muscle trigger points
- Peripheral nerve block — targeted nerve block in areas of concentrated or localised painในบริเวณที่มีอาการปวด
Prevention and Flare Management
Because the exact cause of fibromyalgia is not fully understood, itcannot be completely prevented. However, the following habits can significantly reduce the risk of symptom flares and prevent the condition from worsening over time :
- Exercise consistently — regular low-impact physical activity maintains muscle strength and flexibility, and is one of the most effective long-term tools for reducing fibromyalgia symptom burden.
- Manage stress actively — psychological stress is one of the most potent triggers for fibromyalgia flares. Incorporating regular stress-reduction practices — such as relaxation techniques, mindfulness, breathing exercises, and where needed, professional psychological support — can substantially reduce flare frequency and severity.
- Identify and avoid personal triggers — keep track of what tends to worsen your symptoms. Common triggers include physical overexertion, emotional stress, poor sleep, and irregular routines. Adjusting activity levels and daily habits based on this self-knowledge is a practical and effective management strategy.
A note on treatment adherence: If you are currently under medical care for fibromyalgia, the single most important thing you can do is follow your treatment plan consistently and precisely as prescribed.Do not adjust or reduce medication doses on your own. Some medications require weeks to reach their full therapeutic effect, and others must be tapered gradually under supervision to avoid rebound or withdrawal effects.
- บทความจากคณะแพทยศาสตร์ศิริราชพยาบาล (ภาษาไทย) วิมลวรรณ วัฒนวิทวัส. (ม.ป.ป.). Fibromyalgia. คณะแพทยศาสตร์ศิริราชพยาบาล มหาวิทยาลัยมหิดล. https://www.si.mahidol.ac.th/th/department/rehabilitation/admin/news_files/160_18_1.pdf
- เว็บไซต์ NHS (ภาษาอังกฤษ) NHS. (2024, February 20). Causes: Fibromyalgia. https://www.nhs.uk/conditions/fibromyalgia/causes/
- เว็บไซต์ Versus Arthritis (เดิมคือ Arthritis UK) Versus Arthritis. (n.d.). Fibromyalgia. https://www.arthritis-uk.org/information-and-support/understanding-arthritis/conditions/fibromyalgia/
