Fibromyalgia: Understanding the Pain You Can’t See

Fibromyalgia is a chronic condition that causes widespread pain, fatigue, and tenderness. It is one of the most misunderstood disorders in medicine and is often misdiagnosed for years before patients get answers.

What Is Fibromyalgia?

Fibromyalgia is considered a disorder of how the nervous system processes pain. Instead of a single injury or disease, it represents an abnormal amplification of pain signals in the brain and spinal cord — a phenomenon called central sensitization [1].

Patients with fibromyalgia often describe their pain as aching, burning, or stabbing, and the pain is usually widespread rather than localized to one spot. It is accompanied by fatigue, poor sleep, and other systemic symptoms.

Symptoms of Fibromyalgia

• Widespread musculoskeletal pain (lasting at least 3 months)

• Fatigue, exhaustion, or lack of restorative sleep

• Morning stiffness

• Tender points throughout the body

• Headaches or migraines

• Irritable bowel symptoms (diarrhea, constipation, bloating)

• Numbness or tingling in the hands and feet

• Cognitive difficulties (“fibro fog” — memory and concentration problems)

• Sensitivity to light, sound, and temperature [1,2]

Causes and Triggers of Fibromyalgia

While the exact cause remains unclear, fibromyalgia often develops after a triggering event or in the presence of other health conditions. Contributing factors include:

• Trauma – Physical or emotional trauma may trigger onset.

• Viral or bacterial infections – Illness can set off long-term nervous system changes.

• Stress – Chronic stress worsens pain sensitivity.

• Hormonal imbalance – Abnormalities in cortisol and thyroid hormones are often seen.

• Sleep disturbances – Poor sleep deepens pain sensitivity.

• Vitamin D deficiency – Muscle weakness, pain, and fatigue can mimic fibromyalgia [3].

• Genetic predisposition – Tends to run in families.

Conditions Commonly Misdiagnosed as Fibromyalgia

• Hypothyroidism

• Lupus

• Rheumatoid arthritis

• Chronic fatigue syndrome

• Depression

• Vitamin D deficiency [4]

Why Is Fibromyalgia Difficult to Diagnose?

• There is no single diagnostic test.

• Diagnosis is based on symptoms, history, and ruling out other conditions.

• Because pain is widespread and invisible, patients are sometimes told their symptoms are “all in their head.”

Treating Fibromyalgia with Nutrition

Nutrition plays a major role in reducing inflammation and supporting energy levels in fibromyalgia patients. Certain foods help calm the nervous system, stabilize blood sugar, and fight oxidative stress, while others worsen pain and fatigue.

Great foods to add to your diet:

• Fresh fruits and vegetables (antioxidants reduce inflammation [5])

• Omega-3–rich fish like salmon and sardines (support brain and joint health [6])

• Nuts and seeds (healthy fats and magnesium)

• Olive oil and avocado (anti-inflammatory healthy fats)

• Beans and lentils (fiber and plant-based protein)

• Green tea (polyphenols for antioxidant support)

• Spices like turmeric and ginger (natural anti-inflammatories [7])

Unhealthy foods to avoid or replace:

• Processed foods high in refined sugar

• Fried foods and trans fats

• Refined grains (white bread, white pasta)

• Artificial sweeteners (aspartame, sucralose) [8]

• Excess caffeine and alcohol (can worsen sleep quality)

Chiropractic and Functional Medicine Approaches

Chiropractic Care

• Gentle spinal adjustments can restore mobility and reduce musculoskeletal stress.

• Myofascial release helps with muscle tension and painful trigger points.

Exercise and Movement

• Low-impact aerobic exercise (walking, swimming, tai chi) reduces pain and stiffness.

• Yoga and stretching improve flexibility and decrease muscle tightness.

• Pilates builds core stability and improves posture, which helps reduce strain on the spine and joints in fibromyalgia patients [9].

Lifestyle and Functional Medicine Support

• Sleep hygiene: Consistent bedtimes, reducing screen use before bed, and a dark, quiet room.

• Stress management: Deep breathing, meditation, counseling, or gentle mindfulness techniques.

• Supplements: Magnesium, vitamin D, and coenzyme Q10 may reduce fatigue, pain, and oxidative stress [10].

Other Treatment Alternatives

Some patients find benefit from additional therapies, including:

• Acupuncture – May reduce pain and improve sleep [11].

• Massage therapy – Helps with muscle relaxation and circulation.

• Cognitive-behavioral therapy (CBT) – Improves coping strategies and reduces the impact of chronic pain [12].

• Hydrotherapy – Warm water therapy may ease stiffness and muscle pain.

• Herbal support – Botanicals such as curcumin and ashwagandha show promise in reducing inflammation and stress [13].

✅ Wellness Tips

• Prioritize sleep — poor rest worsens symptoms dramatically

• Move daily with gentle, low-impact activity like walking, swimming, yoga, or Pilates

• Eat an anti-inflammatory diet and avoid processed foods

• Try complementary therapies like massage or acupuncture

• Practice stress reduction daily to calm the nervous system

The Takeaway

Fibromyalgia is real. It is not “all in your head” — it is a disorder of pain processing that affects millions of people, especially women. While it can be frustrating and debilitating, it is also manageable. Through chiropractic care, targeted nutrition, gentle movement (including Pilates), improved sleep, and complementary therapies, patients can experience significant relief and reclaim quality of life.

References

1. Clauw DJ. Fibromyalgia: a clinical review. JAMA. 2014;311(15):1547–1555. https://doi.org/10.1001/jama.2014.3266

2. Häuser W, Ablin J, Fitzcharles MA, Littlejohn G, Luciano JV, Usui C, Walitt B. Fibromyalgia. Nat Rev Dis Primers. 2015;1:15022. https://doi.org/10.1038/nrdp.2015.22

3. Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc. 2003;78(12):1463–1470. https://doi.org/10.4065/78.12.1463

4. Ablin JN, Clauw DJ. From fibrositis to functional somatic syndromes to a bell-shaped curve of pain and sensory sensitivity: evolution of a clinical construct. Rheum Dis Clin North Am. 2009;35(2):233–251. https://doi.org/10.1016/j.rdc.2009.06.006

5. Kaartinen K, Lammi K, Hypen M, Nenonen M, Hanninen O, Rauma AL. Vegan diet alleviates fibromyalgia symptoms. Scand J Rheumatol. 2000;29(5):308–313. https://doi.org/10.1080/030097400447697

6. Arranz LI, Canela MA, Rafecas M. Dietary aspects in fibromyalgia patients: results of a survey on food awareness, allergies, and nutritional supplementation. Rheumatol Int. 2012;32(9):2615–2621. https://doi.org/10.1007/s00296-011-2010-z

7. Daily JW, Yang M, Park S. Efficacy of turmeric extracts and curcumin for alleviating the symptoms of joint arthritis: a systematic review and meta-analysis. J Med Food. 2016;19(8):717–729. https://doi.org/10.1089/jmf.2016.3705

8. Suez J, Korem T, Zeevi D, et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. 2014;514(7521):181–186. https://doi.org/10.1038/nature13793

9. Altan L, Korkmaz N, Bingol U, Gunay B. Effect of Pilates training on people with fibromyalgia syndrome: a pilot study. Arch Phys Med Rehabil. 2009;90(12):1983–1988. https://doi.org/10.1016/j.apmr.2009.06.021

10. Cordero MD, Cano-García FJ, Alcocer-Gómez E, De Miguel M, Sánchez-Alcázar JA. Oxidative stress correlates with headache symptoms in fibromyalgia: coenzyme Q10 effect on clinical improvement. Clin Biochem. 2012;45(7-8):623–626. https://doi.org/10.1371/journal.pone.0035677

11. Deare JC, Zheng Z, Xue CC, et al. Acupuncture for treating fibromyalgia. Cochrane Database Syst Rev. 2013;(5):CD007070. https://doi.org/10.1002/14651858.CD007070.pub2

12. Thieme K, Gromnica-Ihle E, Flor H. Operant behavioral treatment of fibromyalgia: a controlled study. Arthritis Rheum. 2003;49(3):314–320. https://doi.org/10.1002/art.11124

13. Lakhan SE, Schofield KL. Mind-body therapies in chronic pain: a systematic review of efficacy and mechanisms. CNS Neurosci Ther. 2013;19(6):396–403. https://doi.org/10.1111/cns.12059