Fibromyalgia

What is fibromyalgia?

Fibromyalgia is a chronic condition characterised by widespread musculoskeletal pain lasting longer than three months, alongside fatigue, non-restorative sleep, and difficulty with concentration and memory^1,2. It is among the most common chronic pain conditions, affecting an estimated 2-4% of adults globally, with women currently diagnosed more often than men^3,4. In Australia, where roughly one in five adults lives with chronic pain, fibromyalgia is part of a significant and under-recognised burden on the health system⁵.

The World Health Organization's ICD-11 classifies fibromyalgia as a chronic primary pain condition⁶. The current scientific understanding is that fibromyalgia is a nociplastic pain condition: pain that arises from changes in how the central nervous system processes pain signals, rather than from identifiable tissue damage or nerve injury^7,1. This is why standard scans and blood tests are usually normal in fibromyalgia, and why diagnosis can take years. The 2016 revised diagnostic criteria are based on the distribution of widespread pain and the symptoms that travel with it, rather than on imaging or laboratory findings².

Fibromyalgia is real

If you have been told your fibromyalgia symptoms are not real, or that they are "just" stress, that is not consistent with current evidence. Fibromyalgia is recognised by the World Health Organization, has formal diagnostic criteria, and involves identifiable changes in central nervous system pain processing observable on functional imaging^6,7,1. It is not in your head, or more precisely, it is in your nervous system, which is part of your body.

Fibromyalgia is harder to diagnose than many other conditions because no single blood test or scan confirms it. Diagnosis comes from a careful history and physical examination by a clinician familiar with the condition. If you have not yet had a formal diagnosis and you suspect fibromyalgia, a GP referral to a rheumatologist, pain physician or pain-trained physiotherapist is a reasonable next step.

What current evidence says about fibromyalgia care

The most widely cited current guideline for fibromyalgia management is the 2017 revised EULAR recommendations⁸. These, alongside Australian guidance from the RACGP and the Australian Pain Society, recommend a multimodal approach in which non-pharmacological treatments (particularly graded exercise, education and psychological support) are first-line care^8,9,10.

The evidence base for medication in fibromyalgia is modest. Some medications help some patients, but no single drug is reliably effective for most, and the EULAR guideline gives most medications a "weak for" recommendation at best⁸. This is the opposite of what many patients have been told historically. The strongest evidence sits with aerobic and strengthening exercise, cognitive behavioural therapy, and patient education^8,11,12.

A 2017 Cochrane review of aerobic exercise for fibromyalgia concluded that regular aerobic exercise probably improves quality of life, reduces pain and increases physical function compared with no exercise¹¹. A 2018 systematic review and meta-analysis of cognitive behavioural therapies found small but consistent reductions in pain, distress and disability in people with fibromyalgia^12,13. The implication across guidelines is consistent: what you do every day (moving, sleeping, managing stress, staying connected) matters at least as much as anything in a pill bottle.

How Pain Coach is built for fibromyalgia

Pain Coach is a chronic pain tracking app designed to be used with your physiotherapist or pain clinician. For fibromyalgia, the daily check-in captures pain alongside the five lifestyle factors most consistently linked to symptom severity (sleep, exercise, nutrition, stress and social connection) in under two minutes a day.

Many people with fibromyalgia find their symptoms fluctuate in ways that are hard to remember between appointments. A bad week can blur into all the others. Tracking gives you and your clinician something concrete to work from. Over a few weeks, patterns often emerge: how your sleep tracks with your pain, what a sustainable exercise dose actually looks like, which kinds of weeks leave you flaring. Your clinician sees the same data, so appointments can focus on what you've actually experienced rather than what you remember from the past fortnight.

Pain Coach doesn't promise a cure. Fibromyalgia is a long-term condition, and most evidence-based improvements are gradual, built through consistent, graded self-management with clinical support^8,10. The aim is clarity, fewer surprises, and steady progress on what you can change.

The five lifestyle factors and fibromyalgia

Each of the five factors Pain Coach tracks has a meaningful evidence base in fibromyalgia, and they influence symptoms in ways that interact. Poor sleep makes pain worse, which makes exercise harder, which worsens mood, which disrupts sleep. Tracking them together is more useful than tracking any one alone^8,14.

• Exercise and movement. Aerobic and resistance exercise have the strongest evidence base of any intervention in fibromyalgia^11,8,15. The key word is graded. Starting too hard is the single most common reason people with fibromyalgia abandon exercise, and it is why so many have a bad history with it. Current guidelines recommend starting well below what feels possible and increasing slowly, sometimes over months⁸. Pain Coach shows your clinician what you actually sustained, not what you intended.
• Sleep. Non-restorative sleep is one of the defining features of fibromyalgia and a strong driver of next-day symptom severity^16,17. Sleep and pain reinforce each other through shared central nervous system pathways. Tracking sleep duration, quality and waking pain together is one of the most informative things you can do.
• Stress. Persistent stress, fear of activity and unhelpful beliefs about pain can amplify how the central nervous system processes pain signals^18,19. In fibromyalgia, where the underlying mechanism is altered central pain processing, this matters especially. Psychological support, particularly cognitive behavioural therapy, has consistent evidence for reducing fibromyalgia symptoms^12,13.
• Social connection. Isolation and loneliness independently worsen chronic pain outcomes, and social pain shares neural pathways with physical pain^20,21. Fibromyalgia can be isolating, particularly when those around you don't understand the condition. Small, regular contact with people you trust tends to correlate with better days.
• Nutrition. Diet has a smaller but emerging evidence base in chronic musculoskeletal pain, including fibromyalgia²². Eating regularly and well supports energy, mood and recovery. Pain Coach tracks plant intake, whole-food intake and added sugar so your clinician can see the pattern; it does not prescribe a specific diet.

Find a fibromyalgia physiotherapist in Australia

Pain Coach Connect lists verified Australian physiotherapists who work with fibromyalgia, with telehealth and in-person consultations available. Telehealth is particularly useful in fibromyalgia, where travel and fatigue can themselves trigger flares. Many participating clinics accept Medicare Chronic Disease Management (CDM) plan referrals.

• Sydney
• Melbourne
• Brisbane
• Gold Coast
• All regions