Fibromyalgia is a long-lasting disorder causing pain and tenderness throughout the body, along with fatigue and trouble sleeping.1 The single most useful thing to understand about it is the mechanism: people with fibromyalgia have an increased sensitivity to pain, so they feel pain when others do not.1 The problem is in how pain is processed, not in a damaged joint waiting to be found on a scan — which is why normal test results are the rule rather than a sign that nothing is wrong.
What the evidence says about the mechanism
The cause is not known. But brain imaging studies and other research have uncovered evidence of altered signaling in the neural pathways that transmit and receive pain in people with fibromyalgia.1 Those same changes may also contribute to the fatigue, sleep problems and cognitive symptoms.1
This reframes the usual experience of being investigated. If the amplification is happening in pain-signaling pathways, then a clear X-ray is exactly what you would expect, and it is not evidence against your symptoms.
The symptom picture
The main symptoms are chronic widespread pain throughout the body or in multiple areas — often the arms, legs, head, chest, abdomen, back and buttocks, described as aching, burning or throbbing — together with fatigue and trouble sleeping.1
Other symptoms may include muscle and joint stiffness, tenderness to touch, numbness or tingling in the arms and legs, problems with concentration, clear thinking and memory sometimes called “fibro fog”, increased sensitivity to light, noise, odors and temperature, and digestive issues such as bloating or constipation.1
Why the list is so long
Sensitivity to light, noise, odor and temperature sitting alongside pain is consistent with a nervous system amplifying sensory input generally rather than a series of unrelated complaints. Presented one at a time to different clinicians, those symptoms invite separate referrals; presented together, they form a recognizable pattern.
Who develops it
Anyone can develop fibromyalgia, but more women than men are affected. It can occur at any age, including in children, though it usually starts in middle age, and the chance of having it increases with age. It occurs in people of all racial and ethnic backgrounds.1
People who have other diseases — especially rheumatic diseases, mood disorders, or other conditions that cause pain — may be more likely to have fibromyalgia.1 That overlap is a reason to evaluate rather than to assume one diagnosis excludes another.
How it is managed
Treatment typically involves a combination of exercise or other movement therapies, psychological and behavioral therapy, and medications.1 No single element carries it, and the behavioral component is not an add-on — it is one of the three named parts.
At this practice, that behavioral work is delivered in-house rather than referred out. Counseling for chronic pain and the relationship between anxiety, PTSD and chronic pain describe how it is used. Where a specific pain generator coexists with widespread sensitivity, it is worth identifying and treating on its own terms — the range of pain treatments covers those options, and lifestyle medicine addresses the metabolic and activity side.
Frequently asked questions
All my tests came back normal. Does that mean nothing is wrong?
No. Fibromyalgia involves increased sensitivity to pain and altered signaling in the pathways that transmit and receive it, so normal structural imaging is expected rather than contradictory. How imaging fits into pain diagnosis is covered in what imaging can and cannot show about pain.
Is fibro fog a real symptom?
Yes. Problems with concentration, clear thinking and memory are recognized symptoms, and research suggests the same altered pain signaling may contribute to them along with fatigue and sleep trouble. Cognitive assessment is described under cognitive assessment.
Can I have fibromyalgia and another pain condition at the same time?
Yes, and it is common. Having other diseases, especially rheumatic diseases, mood disorders or other painful conditions, makes fibromyalgia more likely. A specific pain generator still deserves its own evaluation — see the range of pain treatments.
Why is counseling part of the treatment for a physical pain condition?
Because psychological and behavioral therapy is one of the three named components of standard management, alongside movement therapies and medication. It is delivered in-house here rather than referred out — see counseling for chronic pain.
Does it only affect middle-aged women?
No. More women than men are affected and it usually starts in middle age, but it occurs at any age including childhood, in people of all racial and ethnic backgrounds. To arrange an evaluation, use the appointment request form.
To have widespread pain evaluated, request an appointment, call (314) 481-5000, or text (314) 886-5902.
Sources
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. Fibromyalgia: Overview, Symptoms & Causes. National Institutes of Health. Accessed August 12, 2026. NIAMS — Fibromyalgia
Dr. Gurpreet Singh Padda, MD, MBA, MHP
