Fibromyalgia
Also known as: Fibromyalgia Syndrome, FM
A chronic pain condition causing widespread musculoskeletal pain, fatigue, and cognitive difficulty. Diagnosed clinically and managed with a combination of medication and lifestyle strategies.
Key Facts
- Affects 2-4% of the population, predominantly women
- Not caused by joint inflammation or damage — it's a disorder of pain processing
- Often coexists with other conditions like IBS, migraines, and TMJ
- Frequently misdiagnosed as inflammatory arthritis or dismissed entirely
- Exercise is one of the most effective treatments, despite being counterintuitive
What is fibromyalgia?
Fibromyalgia is a chronic condition characterized by widespread musculoskeletal pain, fatigue, sleep disturbance, and cognitive difficulties often called “fibro fog.” It’s a disorder of pain processing — the central nervous system amplifies pain signals, making normal sensations feel painful.
Fibromyalgia is one of the most commonly misunderstood conditions in rheumatology. It’s frequently misdiagnosed as inflammatory arthritis, or dismissed entirely. Dr. Fellows has a particular clinical interest in fibromyalgia and regularly educates other physicians on recognizing and treating it effectively.
Symptoms
- Widespread pain affecting both sides of the body, above and below the waist
- Fatigue that doesn't improve with rest
- Unrefreshing sleep — waking up tired regardless of hours slept
- Cognitive difficulty (concentration, memory, mental clarity)
- Headaches, often tension-type or migraine
- Irritable bowel symptoms
- Sensitivity to temperature, noise, and bright lights
- Numbness or tingling in hands and feet
How we diagnose it
- Symptom assessment — Widespread pain present for at least three months, accompanied by fatigue, unrefreshing sleep, and/or cognitive symptoms
- Physical exam — Tender points and diffuse tenderness without joint swelling or inflammation
- Ruling out mimics — Blood work to exclude thyroid disease, inflammatory arthritis, lupus, and other conditions that can present similarly
- Musculoskeletal ultrasound — Used when needed to rule out underlying inflammatory arthritis that may coexist with or mimic fibromyalgia
How we treat it
- Medications — Duloxetine (Cymbalta), milnacipran (Savella), pregabalin (Lyrica), and low-dose tricyclic antidepressants for pain and sleep
- Exercise — Regular low-impact aerobic exercise is one of the most evidence-supported interventions
- Sleep optimization — Addressing sleep quality is critical; poor sleep directly worsens pain
- Cognitive behavioral approaches — Evidence supports CBT for chronic pain management
- Setting realistic expectations — Fibromyalgia is manageable but not curable. The goal is functional improvement, not complete pain elimination.
At Synergy Rheumatology
Dr. Fellows takes fibromyalgia seriously as a clinical diagnosis — not a wastebasket term. We use ultrasound to rule out inflammatory conditions that may coexist, ensure the diagnosis is accurate, and build a treatment plan focused on function and quality of life.
Have questions about fibromyalgia?
Schedule an appointment to discuss your symptoms, diagnosis, or treatment options with Dr. Fellows.