Fibromyalgia: Symptoms, Causes, and Related Conditions
What is Fibromyalgia?
Fibromyalgia is a chronic condition defined by widespread pain, fatigue, and sensory hypersensitivity. It is classified as a disorder of pain processing rather than structural tissue damage. The current consensus (European League Against Rheumatism, American College of Rheumatology, 2022–2025) is that fibromyalgia belongs to a group of central sensitivity syndromes, where the central nervous system (brain and spinal cord) becomes more reactive to normal sensory input.
Fibromyalgia affects about 2–4% of the population, with higher prevalence in women, but it can affect people of all genders and ages. It is a recognised medical condition, with diagnostic criteria updated in 2016 and widely accepted across Europe and North America.
Physiological Processes and Current Theories
Research shows multiple interacting mechanisms:
Central sensitisation: Pain signals are amplified within the spinal cord and brain. The “volume knob” for pain is turned up, leading to disproportionate responses to normal input. Functional MRI studies consistently show altered pain processing pathways in the brain.
Autonomic nervous system dysregulation: Many patients have an overactive sympathetic nervous system (“fight-or-flight”), with reduced parasympathetic activity. This is linked to fatigue, poor sleep, and pain flares.
Neuroinflammation: Studies using PET imaging suggest that activated glial cells in the brain may contribute to pain hypersensitivity and fatigue.
Sleep dysfunction: Disruption of slow-wave sleep reduces the body’s ability to recover, lowers pain thresholds, and worsens fatigue.
Small fibre neuropathy: Up to 40–50% of patients with fibromyalgia show evidence of small fibre neuropathy on skin biopsies or corneal confocal microscopy. This suggests peripheral nerve dysfunction may play a role in symptoms such as tingling, numbness, and burning pain. Research is ongoing to determine whether small fibre neuropathy is a distinct subgroup of fibromyalgia or a common overlapping feature.
Genetics and stress response: Certain genetic markers (e.g. serotonin transporter polymorphisms) and early-life stress are associated with increased risk, pointing to complex interactions between biology and environment.
Common Symptoms
Persistent, widespread musculoskeletal pain
Fatigue that does not improve with rest
Non-restorative sleep or insomnia
Morning stiffness
Cognitive symptoms (“fibro fog”) including reduced attention, memory lapses, and slowed information processing
Headaches and migraines
Less Common Symptoms
Tingling, numbness, or burning sensations in hands and feet
Sensory hypersensitivity (light, sound, odours, temperature)
TMJ pain or jaw stiffness
Restless legs syndrome
Pelvic pain or bladder urgency
Comorbidities and Associated Conditions
Fibromyalgia often overlaps with other conditions, which can complicate diagnosis and treatment:
Chronic fatigue syndrome (ME/CFS)
Irritable bowel syndrome (IBS)
Migraines and tension-type headaches
Mood disorders such as depression and anxiety
Autoimmune diseases including rheumatoid arthritis, systemic lupus erythematosus, and autoimmune thyroid disease
Hypermobility spectrum disorders (including hEDS)
Small fibre neuropathy (as above, increasingly recognised as an overlapping condition)
Diagnosis
Diagnosis remains clinical, usually made by a rheumatologist or pain specialist, based on:
Widespread pain lasting >3 months
Presence of associated symptoms such as fatigue and sleep problems
Exclusion of other causes through blood work or imaging
There is no single biomarker, but research into objective markers such as corneal confocal microscopy (for small fibre neuropathy) and advanced imaging of central pain processing is ongoing.
Current State of Knowledge
Fibromyalgia is now well recognised as a chronic pain condition rooted in nervous system dysfunction. While no cure exists, understanding has shifted away from dismissing it as “psychological” to recognising it as a real, biologically based syndrome with measurable physiological changes. Research continues to refine which subgroups exist (e.g. those with confirmed small fibre neuropathy) and how this might influence treatment strategies.
If you are living with fibromyalgia in Cork and are searching for clear, science-based information about your treatment and rehabilitation options, read more about fibromyalgia treatment here.
Fibromyalgia Treatment and Rehabilitation in Cork
International Standards of Care
Fibromyalgia is a chronic condition. While there is no cure, international guidelines (EULAR 2023, American College of Rheumatology, NICE) agree on a multimodal treatment approach. This means combining medical care, lifestyle interventions, psychological support, and rehabilitation.
The cornerstone recommendations are:
Patient education about the condition and self-management
Exercise-based therapy tailored to the individual
Cognitive and acceptance-based psychological therapies (CBT, ACT) for coping with pain and fatigue
Mind–body interventions such as yoga, relaxation, and mindfulness
Pharmacological support where appropriate (e.g. duloxetine, pregabalin, amitriptyline)
The focus is not on “erasing symptoms” but on building capacity, reducing flare severity, and restoring quality of life.
Medical and Psychological Management
Medication can help manage pain, sleep disruption, and mood symptoms, but it is not considered a stand-alone solution. Common options include:
Antidepressants (duloxetine, amitriptyline) – for pain modulation and sleep improvement
Anticonvulsants (pregabalin) – for neuropathic pain features
Occasional use of sleep aids where clinically indicated
Equally important are psychological therapies. Evidence shows that:
Cognitive Behavioural Therapy (CBT) helps restructure unhelpful thoughts and behaviours around pain and fatigue.
Acceptance and Commitment Therapy (ACT) teaches patients to live in alignment with personal values while managing ongoing symptoms, reducing suffering even if pain persists.
Pacing education prevents the cycle of overexertion followed by flare-ups, helping individuals sustain activity more evenly.
Why Exercise is Central
Among all non-drug treatments, exercise has the strongest evidence base. Studies consistently show it improves pain, fatigue, sleep, mood, and physical function. Both aerobic and strengthening exercises are recommended, with flexibility and mobility work added as tolerated.
But exercise in fibromyalgia is not “one size fits all.” Many people have experienced setbacks from generic advice like “just go to the gym”. Without guidance, activity can easily trigger flare-ups. This is because every nervous system responds differently, and the right entry point is unique to each person.
A specialised physiotherapist trained in fibromyalgia rehabilitation helps you:
Find your personal baseline – the safe starting level of activity for your body
Progress gradually and sustainably, with careful pacing
Learn to interpret early warning signs from your body
Build confidence until you can manage independently
Integrate exercise into daily life without constant fear of “crashes”
Exercise is not only about physical strength. It actively re-trains the nervous system, improves mitochondrial efficiency, and enhances pain inhibition pathways in the brain. Done correctly, it is one of the most powerful ways to regain stability and resilience.
The Role of Mind–Body and Somatic Practices
Movement alone is not enough. Fibromyalgia involves nervous system overactivation, poor stress tolerance, and disrupted rest cycles. This is where mind–body approaches become essential.
Yoga therapy: Adapted yoga practices improve flexibility, reduce stiffness, and regulate breathing. Clinical trials show yoga reduces both pain intensity and fatigue when delivered in a therapeutic context.
Mindfulness training: Learning to focus awareness without judgment reduces the brain’s amplification of pain signals and improves emotional regulation.
Guided relaxation and breathwork: Techniques such as diaphragmatic breathing, progressive relaxation, and body scans reduce sympathetic overdrive and help restore restorative parasympathetic activity.
Somatic awareness practices: These help reconnect movement, attention, and body sense, shifting the nervous system out of a constant state of threat. Patients often report feeling safer, more grounded, and more in control of their bodies.
Research shows that combining exercise with mind–body interventions leads to better outcomes than either approach alone.
Rehabilitation at Neurokinetica
At Neurokinetica, we understand fibromyalgia is not just about pain. It is about the daily challenge of managing energy, the fear that one wrong move could trigger a flare, and the frustration of being told to “just exercise” when you have already tried that.
Our approach is designed for these realities. We start by helping you find your personal baseline, the level of movement you can tolerate today without payback tomorrow. From there, we support you in making steady progress. We teach you how to notice your body’s signals, adjust before problems escalate, and build confidence in your own ability to move.
Rehabilitation here combines targeted physiotherapy with yoga-based movement, guided relaxation, breathwork, and mindfulness practices. These tools calm the nervous system, reduce the background stress response, and bring back a sense of safety in your body. Patients often report that they not only feel stronger but also calmer, clearer, and more capable of managing their lives.
Our goal is not temporary relief. It is giving you the skills, confidence, and physical capacity to live more fully with fibromyalgia.
If you are looking for fibromyalgia treatment in Cork and want a professional approach that combines science, exercise, and nervous system regulation, book a session to get an assessment and learn more about our rehabilitation programme.