Widespread pain
Fibromyalgia
Widespread pain, fatigue and poor sleep for 3+ months may be fibromyalgia. Gulf Coast Pain & Spine in Houston: 2016 criteria, approved drugs, what works.
Fibromyalgia is a condition of widespread pain, fatigue, unrefreshing sleep and trouble concentrating that lasts 3 months or more, caused by a nervous system that amplifies pain signals rather than by damage to muscles or joints. It affects about 2 to 4 percent of adults, mostly women. There is no injection or surgery for fibromyalgia, and opioids make it worse. Gulf Coast Pain & Spine confirms the diagnosis, checks for conditions that mimic or overlap with it, treats any separate pain sources that injections can help, and coordinates the medication, exercise, sleep and psychology plan that works.
Key facts
| What it is | A chronic pain-processing disorder (central sensitization) with pain in all four quadrants of the body plus fatigue, poor sleep and cognitive symptoms |
|---|---|
| Most common causes | No single cause; often follows physical or emotional stress, infection, injury or another chronic pain condition; runs in families; more common with rheumatoid arthritis, lupus and spinal pain |
| Typical course | Waxes and wanes over years; does not damage joints, muscles or nerves; most people improve function substantially with exercise, sleep repair and the right medication, though symptoms rarely vanish completely |
| See a specialist when | Widespread pain has lasted 3 months, the diagnosis is uncertain, or a treatment plan has never been organized |
| Treatments we offer | Diagnosis confirmation and overlap screening, medication management (duloxetine, milnacipran, pregabalin), a graded exercise plan with PT, referral for CBT and sleep evaluation, targeted treatment of separate pain generators |
When to get emergency care
Fibromyalgia itself is not dangerous, but these symptoms are not fibromyalgia and need prompt medical care:
- Joint swelling, redness or warmth, or morning stiffness lasting more than an hour (inflammatory arthritis)
- Muscle weakness (not just pain), such as trouble rising from a chair or lifting the arms, or dark urine (muscle disease)
- Unexplained weight loss, fevers, night sweats, or new lumps
- A new rash, mouth ulcers, or hair loss with joint pain (lupus and related conditions)
- Numbness spreading up the legs, loss of bowel or bladder control, or new severe headache
- Thoughts of harming yourself. Call or text 988 (Suicide and Crisis Lifeline) any time
Fibromyalgia can coexist with any of these conditions; a fibromyalgia diagnosis should never stop a new symptom from being evaluated.
What fibromyalgia is
Fibromyalgia is the clearest example of a nervous system that has become sensitized. Brain-imaging and spinal-fluid studies show that people with fibromyalgia process pain signals differently: pressure that others find mildly uncomfortable registers as painful, pain spreads and lingers, and the systems that normally dampen pain are underactive. Muscles, joints and nerves are structurally normal, which is why blood tests, X-rays and MRIs come back clean and why some patients have been told the pain is not real. It is real; it is generated in the pain-processing system rather than in the tissues.
The same amplification affects other signals, which explains the fatigue, non-restorative sleep, "fibro fog" (trouble with memory and concentration), headaches, irritable bowel and bladder symptoms, sensitivity to noise, light and temperature, and mood symptoms that travel with the pain. Fibromyalgia affects about 2 to 4 percent of adults, women about twice as often as men, and most often begins between 30 and 55. Gulf Coast Pain & Spine sees fibromyalgia patients in Houston, Webster and Pearland (opening November 2026).
What causes it
No single cause has been found. The current understanding is that a genetic tendency (fibromyalgia clusters in families) is triggered by a stressor: a physical injury or accident, an infection, surgery, a period of severe psychological stress, or years of another painful condition such as rheumatoid arthritis, lupus, osteoarthritis or chronic low back pain. Poor sleep both results from and worsens it. Fibromyalgia is not an autoimmune disease, not an infection, and not caused by inflammation, which is why anti-inflammatory drugs and steroids do little for it.
Symptoms, and the 2016 criteria
The American College of Rheumatology's 2016 revised criteria replaced the older tender-point exam. Fibromyalgia is diagnosed when all of the following are present:
- Generalized pain in at least 4 of 5 body regions (left upper, right upper, left lower, right lower, and the spine/chest/abdomen region), so that pain is truly widespread rather than in one or two areas.
- Symptoms at a similar level for at least 3 months.
- A widespread pain index (WPI) of 7 or more with a symptom severity score (SSS) of 5 or more, or a WPI of 4 to 6 with an SSS of 9 or more. The WPI counts painful body areas (0 to 19); the SSS grades fatigue, waking unrefreshed and cognitive symptoms (each 0 to 3) plus headache, abdominal pain and depression (0 to 3), for a total of 0 to 12.
- The diagnosis stands regardless of other diagnoses. Having rheumatoid arthritis or spinal stenosis does not exclude fibromyalgia, and vice versa.
These questionnaires take about five minutes and are part of the first visit. Typical symptoms beyond pain: waking as tired as you went to bed, fatigue that worsens with modest activity, trouble finding words or following what someone is saying, stiffness in the morning, headaches, irritable bowel symptoms, numbness or tingling without a nerve pattern, and heightened sensitivity to cold, noise and light.
Look-alikes and overlaps that must be checked: hypothyroidism (fatigue, aches, weight gain), inflammatory arthritis such as rheumatoid arthritis or psoriatic arthritis (swollen joints, prolonged morning stiffness), polymyalgia rheumatica in people over 50 (shoulder and hip girdle stiffness, high inflammatory markers), lupus and Sjogren's syndrome, obstructive sleep apnea (snoring, witnessed pauses, morning headaches), vitamin D deficiency, statin-related muscle pain, and depression presenting mainly as body pain. Several of these can coexist with fibromyalgia, and treating them changes the picture.
How we diagnose it
Fibromyalgia is diagnosed by history, questionnaire and exam; there is no confirming test. The workup exists to exclude the look-alikes above and to find separate, treatable pain sources:
- The ACR 2016 questionnaires (WPI and SSS), scored at the visit and repeated at follow-ups to track change.
- Examination of the joints for swelling and range of motion, muscles for true weakness, the spine and large joints for local pain generators (facet joints, sacroiliac joints, hips, shoulders), and skin for rash.
- A limited blood panel: complete blood count, ESR and CRP (inflammation markers, normal in fibromyalgia), thyroid function (TSH), a metabolic panel, creatine kinase if there is weakness, and vitamin D. Antibody tests such as ANA and rheumatoid factor are ordered only when the exam suggests inflammatory disease, because false positives are common and lead to unnecessary worry.
- Sleep apnea screening with a short questionnaire (STOP-Bang); a home sleep study is arranged when the score is high. Untreated apnea makes fibromyalgia unmanageable.
- Mood screening (PHQ-9, GAD-7), because depression and anxiety are present in about half of patients and change the medication choice.
Imaging is not needed for fibromyalgia. It is ordered only when the exam points to a separate problem in the spine or a joint that we would treat differently. Rheumatology referral is arranged when inflammatory disease is a real possibility.
Treatment options, in order
An honest statement first. Injections, nerve blocks, radiofrequency ablation and spinal cord stimulation do not treat fibromyalgia, and opioids are ineffective for it and worsen sensitization, sleep and function over time; major guidelines (EULAR, ACR, CDC) recommend against them. A pain clinic's role in fibromyalgia is different from its role in a facet joint or a pinched nerve: we confirm the diagnosis, treat the separate pain generators that many fibromyalgia patients also have (a painful facet joint, an arthritic knee, a trapped nerve), manage medication carefully, and organize the exercise, sleep and psychology plan that the evidence supports. The treatments with the strongest evidence, in order of effect, are exercise, cognitive behavioral therapy, and a small group of medications.
- Education and pacing
Understanding that the pain is amplified rather than a sign of damage reduces fear and allows activity. Pacing means steady daily activity rather than boom-and-bust cycles.
- Graded aerobic exercise
The single most effective treatment. Start at a level you can do without a flare (often 5 to 10 minutes of walking, cycling or warm-water exercise), increase by about 10 percent per week toward 30 minutes most days, and add gentle strength training. Tai chi and yoga have good trial evidence. Physical therapy helps build the program safely; a flare in the first weeks is expected and is not damage. Learn more →
- Sleep repair
Fixed wake time, no screens before bed, treatment of sleep apnea if present, and a bedtime medication that helps sleep when needed (low-dose amitriptyline or cyclobenzaprine). Improving sleep lowers pain within weeks.
- Cognitive behavioral therapy (CBT)
CBT for chronic pain, delivered in person or online, improves pain, function and mood in trials and is recommended by every major guideline. We refer to pain psychologists and coordinate the plan.
- Medication
Three drugs are FDA-approved for fibromyalgia: duloxetine (60 mg daily), milnacipran (100 to 200 mg per day in two doses), and pregabalin (300 to 450 mg per day). Each reduces pain meaningfully in about one in three to one in four patients; duloxetine or milnacipran suit patients with fatigue or low mood, pregabalin suits those with prominent sleep and anxiety symptoms. Low-dose amitriptyline at night is inexpensive and effective. Gabapentin and cyclobenzaprine are alternatives. NSAIDs and acetaminophen do little on their own. Opioids, including tramadol long-term, and benzodiazepines are not part of the plan. Learn more →
- Treat the separate pain generators
Many fibromyalgia patients also have a specific problem that responds to targeted care, such as facet joint pain, knee osteoarthritis, or myofascial trigger points in the neck and shoulders. These are treated on their own merits (diagnostic blocks, joint injections, trigger point injections) with the understanding that they address one source, not the fibromyalgia itself. Learn more →
What you can do now
- Walk for 10 minutes today, and add one minute every few days. Consistency beats intensity.
- Anchor your wake time seven days a week; it is the most powerful single sleep change.
- Warm water helps. Warm baths, a heated pool, or a warm shower before stretching reduce stiffness.
- Track three things for two weeks before your visit: hours slept, minutes of activity, and average pain (0 to 10). Patterns become obvious.
- Ask about sleep apnea if you snore, wake gasping or wake with a headache.
- Simplify the medication list. Bring every bottle; fibromyalgia patients often accumulate drugs that are no longer helping.
New patients can start at new patient information; physicians can use the referral page.
Frequently asked questions
Is fibromyalgia a real disease?
Yes. It is recognized by the American College of Rheumatology, the World Health Organization and the FDA (which has approved three drugs for it). Research shows measurable differences in how the brain and spinal cord process pain in fibromyalgia. Normal tests reflect the fact that the problem is in pain processing, not in the tissues.
Why won't a pain clinic give me injections for fibromyalgia?
Because there is nothing to inject. Injections treat a specific inflamed joint or irritated nerve; fibromyalgia pain is generated centrally and widespread injections do not change it and expose you to steroid side effects. If you also have a specific pain source, such as a facet joint or an arthritic knee, that can and should be treated on its own.
Why not opioids?
Opioids do not work for fibromyalgia in trials, and long-term use worsens pain sensitivity (opioid-induced hyperalgesia), sleep, fatigue and mood, the very things fibromyalgia already damages. EULAR, the ACR and the CDC all recommend against them. Tapering off opioids, done gradually with support, usually improves fibromyalgia symptoms.
Will exercise make my pain worse?
In the first two to three weeks, often yes, slightly. That is why the program starts below your current limit and increases slowly. After that period, most patients find pain, sleep and energy improve, and trials consistently show aerobic exercise is the most effective treatment available. Flares from exercise are not injuries.
Which medication should I try first?
It depends on your main symptom. Fatigue and low mood favor duloxetine or milnacipran; sleep and anxiety favor pregabalin or bedtime amitriptyline. Each needs 6 to 8 weeks at a full dose. About one in three patients gets a meaningful response to any one drug, so switching or combining is common.
Does fibromyalgia get worse over time or cause disability?
It does not damage joints, muscles or nerves and does not shorten life. Symptoms fluctuate over years, often worsening with stress, poor sleep or inactivity and improving with a consistent program. Most people who follow an exercise, sleep and medication plan regain substantial function.
Can I have fibromyalgia and another condition like arthritis or a spine problem?
Yes, and it is common. The 2016 criteria specifically allow the diagnosis alongside other conditions. Part of our job is to sort out which symptoms come from which condition, because the treatments differ.
Sources
- 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria (opens in new tab) — Wolfe F et al., Seminars in Arthritis and Rheumatism 2016 (PubMed)
- Fibromyalgia (opens in new tab) — American College of Rheumatology
- Fibromyalgia (opens in new tab) — National Institute of Arthritis and Musculoskeletal and Skin Diseases
- EULAR revised recommendations for the management of fibromyalgia (opens in new tab) — Macfarlane GJ et al., Annals of the Rheumatic Diseases 2017 (PubMed)
- CDC Clinical Practice Guideline for Prescribing Opioids for Pain, 2022 (opens in new tab) — Centers for Disease Control and Prevention
Request an appointment
Call (832) 916-2075 or request an appointment online. New patients are welcome; the team confirms insurance and referral requirements before scheduling.