Fibromyalgia and Central Sensitisation
Fibromyalgia is a chronic pain condition in which a sensitised nervous system plays a central role, leading to widespread pain, fatigue, poor sleep, and cognitive “fog” even when scans and blood tests look normal. Central sensitisation helps explain why everyday sensations can feel painful, why symptoms are often disproportionate to tissue findings, and why a multidisciplinary, nervous‑system‑focused approach is recommended.[1]
WHAT IS FIBROMYALGIA?
Fibromyalgia is defined as chronic, widespread musculoskeletal pain accompanied by other symptoms such as fatigue, non‑restorative sleep, and cognitive difficulties (often called “fibro fog”). It is classified in ICD‑11 as chronic primary pain, meaning pain is a disease in its own right rather than simply a symptom of another condition.
Diagnosis is clinical and based on symptom patterns and examination rather than a single blood test or scan.[1]
WHAT IS CENTRAL SENSITISATION?
Central sensitisation describes a state in which pain‑processing pathways in the spinal cord and brain become hypersensitive, so that the “volume” of pain is turned up. In this sensitised state, normal sensations (light touch, mild pressure, gentle movement) can become painful, and existing pain can feel more intense and widespread than would be expected from any local tissue problem. Many researchers consider fibromyalgia a prototypical central sensitisation syndrome, or “nociplastic” pain condition.[1]
HOW FIBROMYALGIA AND CENTRAL SENSITISATION ARE LINKED
In fibromyalgia, studies show:
Widespread tenderness on examination and a lowered pain threshold across the body, consistent with central sensitisation.[1]
Altered pain modulation, including reduced activity in the brain’s own pain‑inhibiting systems and increased activity in regions that amplify pain and threat.[1]
Frequent co‑occurrence with other central sensitisation–related conditions such as chronic headache, irritable bowel‑type symptoms, and temporomandibular pain.[1]
These findings support the idea that the main problem in fibromyalgia lies in the way the nervous system processes pain and sensory information, rather than in ongoing damage to muscles, joints, or nerves.[1]
WHY TESTS CAN BE NORMAL BUT PAIN IS SEVERE
Routine blood tests, X‑rays, and MRI scans are usually normal or show only age‑related changes in people with fibromyalgia. This can be confusing and distressing, but it does not mean the pain is imagined or exaggerated; instead, it reflects that standard tests are designed to detect structural damage or inflammation, not changes in pain processing. Central sensitisation explains how severe, disabling pain can occur even when tissues look structurally “normal.”[1]
SYMPTOMS BEYOND PAIN
Because central sensitisation affects wider brain and body systems, fibromyalgia often involves more than pain alone. Common associated symptoms include:[1]
Fatigue and feeling “wiped out” after modest activity.
Non‑restorative sleep, insomnia, or frequent waking.
Cognitive difficulties such as problems with attention, memory, or word‑finding (“fibro fog”).
Heightened sensitivity to noise, light, temperature, or chemicals.
These symptoms reflect the broader impact of a sensitised nervous system and disturbed stress, sleep, and autonomic regulation.[1]
FACTORS THAT CAN WORSEN OR MAINTAIN SENSITISATION
In fibromyalgia, several factors may contribute to keeping the nervous system in a sensitised state:
Ongoing stress, trauma history, anxiety, or depression.
Poor sleep and irregular routines.
Physical deconditioning and avoidance of movement due to fear of pain or injury.
Persistent inflammation or other medical conditions in some people.
Addressing these drivers does not deny the reality of pain; it offers practical levers to help calm the system and improve function.[1]
TREATMENT: CALMING A SENSITISED SYSTEM
There is no single cure for fibromyalgia, but symptoms can often be improved by combining several strategies that target central sensitisation and overall health.
Evidence‑informed components include:[1]
Education about pain and central sensitisation, which can reduce fear and increase confidence in movement.
Graded physical activity and gentle exercise (such as walking, stretching, or water‑based exercise) to gradually improve fitness and reduce sensitivity.
Psychological therapies (for example, cognitive‑behavioural approaches or acceptance‑based therapies) to support coping, address unhelpful thoughts, and manage stress.
Sleep and lifestyle strategies, including regular sleep–wake times, pacing activities, and stress‑management techniques.
Selected medications that act on pain‑modulating pathways in the nervous system may help some people, usually as part of a broader plan rather than as stand‑alone solutions.
Working with a team that understands both chronic pain and mental health can help tailor these approaches to each person’s situation, aiming to reduce the impact of fibromyalgia and central sensitisation on daily life and wellbeing.[1]
