Fibromyalgia: when the body feels the pain of the mind

Fibromyalgia: pain can also originate in the brain, without being generated by external or internal body stimuli

What is fibromyalgia

Fibromyalgia is a chronic disorder characterised by persistent and widespread musculoskeletal pain due to hypersensitivity to painful stimuli and reduced pain threshold.

Other symptoms are chronic fatigue, insomnia, headache, morning stiffness and fibromyalgia fog (memory impairment, confusion, attention and concentration deficits).

Fibromyalgia affects 1.5-2 million Italians, predominantly women in a 3:1 female:male ratio [1, 3].

The diagnosis of exclusion

The causes of this syndrome are unclear.

The uncertainty about the pathophysiological mechanisms that determine it makes fibromyalgia a diagnosis of exclusion, to be tackled with a multidisciplinary approach involving rheumatologists, psychiatrists and psychologists.

The rheumatologist must exclude rheumatic diseases easily confused with fibromyalgia.

Pain is obviously the main symptom to be assessed.

Fibromyalgia pain is widespread and can vary in location and intensity

In the 1990s, for the diagnosis of fibromyalgia, great importance was attached to the presence of pain on palpation for a minimum of three months in at least 11 out of 18 specific areas of the body, called ‘tender points’.

New criteria were established in 2010 [2, 3, 5]. The diagnosis is essentially clinical and based on the presence of symptoms such as:

  • chronic fatigue,
  • cognitive disorders,
  • insomnia,
  • psychological symptoms and difficulties in daily actions.

Through questionnaires filled in by patients, the intensity of pain (diffuse pain index) and the severity of other clinical manifestations characteristic of fibromyalgia (symptom severity scale) are assessed.

Psychiatrist and drug therapy in fibromyalgia

Depression and anxiety are associated with fibromyalgia in 60% of cases [2, 6].

Sleep disturbances are also a constant feature and possibly a trigger [6].

Many antidepressant drugs, particularly serotonin and noradrenaline reuptake inhibitors, and some anti-epileptic drugs are effective in treating these psychopathological pictures.

On the contrary, non-steroidal anti-inflammatory drugs and opioid analgesics, typical rheumatological drugs, have not shown particular efficacy, while cortisone drugs are even contraindicated.

The intervention of the psychiatrist becomes essential for the diagnosis of anxiety and mood symptoms associated with pain and for professional management of antidepressant therapy.

The role of the psychologist

Mindfulness, integrated with drug therapy, is among the most promising psychotherapeutic approaches in fibromyalgia.

The aim: to encourage an attitude of radical acceptance, to invest energy and resources towards what is useful for the individual, changing his or her relationship with their pain states and substantially improving their quality of life.

Other remedies for fibromyalgia

Physical therapy can be helpful: stretching, ‘gentle’ aerobic activities, yoga, Pilates and massage can increase tendon-fascial elasticity and muscular endurance in order to control pain [7].

Diet also appears to influence fibromyalgia pain hypersensitivity [8].

Limit sweeteners, foods containing glutamate, aged cheeses and soy sauce.

Some supplements may be helpful in reducing pain perception: magnesium, zinc, B vitamins, vitamins C and E, omega three fatty acids.


Arnold L.M. et al. AAPT Diagnostic Criteria for Fibromyalgia. The Journal of Pain, Vol 20, No 6 (June), 2019: pp 611−628.

Stahl’s Essential Psychopharmacology, IV Edition, 2013. pgg 420-443.

Häuser Fitzcharles M.A. Facts and myths pertaining to fibromyalgia. Dialogues in Clinical Neuroscience – Vol 20. No. 1. 2018: pp 52-62.

Hench P.K. Nonarticular rheumatism, 22nd rheumatism review: review of the American and English literature for the years 1973 and 1974. Arthritis Rheumatol 1976, 19, 1081-1089.

Marchi L., Conversano C., Vivere con la fibromialgia. Strategie psicologiche per affrontare il dolore cronico, Erickson, 2018.

Siracusa R. et al.Fibromyalgia: Pathogenesis, Mechanisms, Diagnosis and Treatment Options Update.Int. J. Mol. Sci. 2021, 22, 3891.

Mendonça Araújo F., Melo DeSantana Physical therapy modalities for treating fibromyalgia. F1000Research 2019, 8:2030 (

Holton K. The role of diet in the treatment of fibromyalgia. Pain Manag. (2016) 6(4), 317–320.

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