Fibromyalgia: A Real Disease of Pain Processing
Multimodal treatment outperforms any single therapy.
Dr. Inès Da Costa
Rheumatologist
Widespread pain >3 months, severe fatigue, non-restorative sleep, cognitive 'fog', and often coexisting irritable bowel and migraines.
Diagnosis
Clinical; no specific test. Rule out hypothyroidism, vitamin D deficiency, inflammatory arthritis.
Treatment
- Education and pacing strategies
- Graded aerobic exercise (the most consistent evidence)
- Sleep hygiene
- Cognitive behavioural therapy
- Selected medications: duloxetine, pregabalin, amitriptyline
What does NOT help
Strong opioids worsen long-term outcomes; chronic NSAIDs offer limited benefit.
Pacing, not pushing through, prevents the boom-and-bust cycle typical of fibromyalgia.
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