Fibromyalgia and Chronic Pain: What Drives It, What to Test, Where Functional Medicine Starts

Dr. Rose says it's real, and that it's not a diagnosis of exclusion the way irritable bowel syndrome is, even though it often gets treated that way. What is recognized underneath it is central sensitization along with a dysregulation in the neurotransmitter system, so the nervous system processes signals differently and the pain threshold is different. Light touch or light pressure that another person would barely notice genuinely hurts, and she is clear that nobody is making that up.

No. Dr. Rose says normal results can be really good news, because they mean there is nothing dangerous going on, and that is not the same as nothing happening. There is a huge gap between those two things, and she says that is often when those people come to them. Normal results don't mean the pain isn't real, and they don't mean it's all in your head or just stress.

Dr. Rose names hypothyroidism, iron deficiency including anemia, severe vitamin D or B12 deficiency, inflammatory arthritis, other autoimmune conditions affecting connective tissue and muscle, polymyalgia rheumatica, untreated sleep apnea, celiac disease, side effects of certain medications such as statin-related muscle problems, and depression. She also says it is possible to have several of these at once, fibromyalgia included, so finding one does not close the file on the rest. Colin added that ruling out the serious causes always comes first, whatever the complaint is.

Colin points to several things stacking up. There's no confirmatory blood test, the diagnosis runs off clinical criteria, the symptoms overlap with anxiety and depression, and appointments are short. He also points to the referral pattern, since the share of fibromyalgia patients who are women is much higher in referral clinics than in unselected patient samples, which he said tells us something uncomfortable about who gets referred and who is ultimately believed. He called it a systems problem.

Dr. Rose is a licensed acupuncturist and her answer was measured. Acupuncture can help some people some of the time, and no single modality helps every person every time. She thinks it is worth trying, as long as you find an acupuncturist who understands the nuances of fibromyalgia and this kind of pain sensitivity, because the points chosen and even the needles used should be personalized. If it works for you, it can be a good part of an overall treatment plan.

Colin says his understanding is that fibromyalgia is not a progressive disease and does not necessarily cause physical damage to the body, but symptoms can feel worse over time because of aggravating factors: a stressor, nervous system dysregulation, years of poor sleep, and reduced physical activity. Dr. Rose added that hormonal changes with age affect it too, and that pain limiting movement and exercise can become a vicious cycle that keeps inflammation high. Colin was explicit that this is not the patient's fault. People don't feel well, and reduced stamina makes things worse.