Fibromyalgia.
What is fibromyalgia?
Fibromyalgia, or Fibromyalgia Syndrome (FMS), is a chronic condition characterised by widespread pain in the muscles, ligaments and tendons, accompanied by fatigue — affecting approximately 90% of patients — sleep disturbances, and cognitive difficulties. Unlike most pain conditions, fibromyalgia produces no detectable inflammation or tissue damage. It is now understood as a disorder of pain processing and perception — the way the brain and nervous system amplify and modulate pain signals — placing it firmly within the category of nociplastic pain, alongside complex regional pain syndrome and central sensitisation syndromes.
Fibromyalgia affects approximately 2 to 4% of the Australian population, with a significantly higher prevalence in women than men. It most commonly develops between the ages of 30 and 60, though it can occur at any age. It frequently coexists with other conditions including ME/CFS, irritable bowel syndrome, headaches and migraines, temporomandibular disorder and depression and anxiety — reflecting the shared central sensitisation mechanism across these conditions.
What causes fibromyalgia?
The exact cause is unknown, but fibromyalgia is understood to involve a combination of genetic susceptibility, central nervous system sensitisation, and triggering factors including physical or emotional trauma, infections, and prolonged psychological stress. The sensitised nervous system amplifies pain signals so that stimuli that would not normally be painful — light touch, mild pressure, temperature changes — are perceived as painful. This is called allodynia and central sensitisation, and it is the defining neurobiological feature of fibromyalgia.
Research has demonstrated consistent neurobiological abnormalities in fibromyalgia — altered brain connectivity, reduced descending pain inhibition, elevated substance P in the cerebrospinal fluid, and abnormal dopamine processing. These findings validate fibromyalgia as a genuine neurobiological condition and have helped to shift the clinical approach from symptom management toward mechanism-directed treatment.
What are the symptoms?
Widespread musculoskeletal pain — by definition present in all four quadrants of the body for more than three months — is the defining feature. The pain is typically described as aching, burning, stiffness or heaviness and varies in intensity and location over time.
Fatigue — often profound and disproportionate to activity level, not relieved by sleep — affects approximately 90% of patients and is one of the most disabling features. Sleep disturbance — non-restorative sleep, frequent waking, restless legs — both results from and perpetuates the central sensitisation that drives pain. The bidirectional relationship between sleep and pain is one of the most important treatment targets in fibromyalgia.
Cognitive difficulties — commonly called "fibro fog" — include difficulty with concentration, memory, word-finding and processing speed. Heightened sensitivity to light, sound, smell and temperature is common. Mood disturbance including depression and anxiety affects the majority of patients with fibromyalgia.
How is fibromyalgia diagnosed?
The diagnosis of fibromyalgia is clinical — there is no definitive laboratory or imaging test. The 2016 American College of Rheumatology criteria require widespread pain in multiple body regions, symptom severity including fatigue, sleep disturbance and cognitive symptoms, and symptom duration of at least three months, in the absence of another condition that would explain the pain. The previous requirement for tender point examination has been replaced by the current widespread pain index and symptom severity scale.
Fibromyalgia is frequently misdiagnosed or significantly delayed — the average time from symptom onset to diagnosis is several years. It is often diagnosed by exclusion after other conditions have been ruled out, though fibromyalgia is not a diagnosis of exclusion in the modern clinical framework — the positive symptom pattern is sufficient for diagnosis when present.
How can physiotherapy help?
Physiotherapy plays a pivotal role in managing and alleviating symptoms of fibromyalgia through a modern pain neuroscience approach that directly targets the central sensitisation driving symptoms.
Pain neuroscience education is the most important and most distinctively modern component of fibromyalgia physiotherapy. Understanding that fibromyalgia reflects nervous system sensitisation — not ongoing tissue damage — is both clinically accurate and therapeutically powerful. Multiple systematic reviews confirm that pain neuroscience education reduces pain, fatigue, catastrophising and fear-avoidance in fibromyalgia, often producing rapid improvements that persist over time. Yulia's certification in the Biopsychosocial Reframed Chronic Pain Treatment Model is directly relevant here.
Manual therapy — gentle joint mobilisation and soft tissue techniques — provides short-term pain relief through neurophysiological mechanisms and facilitates participation in the active exercise program. Myofascial release of the tender areas and trigger point dry needling can reduce localised pain and muscle tension.
Dry needling of widespread myofascial trigger points — which are a consistent finding in fibromyalgia and contribute significantly to the pain load — can produce meaningful symptom reduction as part of a broader treatment program.
Pacing and activity management — structured approaches to distributing activity across the day to avoid the boom-bust cycle of overdoing activity on good days and crashing on bad days — is a fundamental self-management skill. The boom-bust cycle is one of the most common patterns in fibromyalgia and is directly amenable to physiotherapy guidance.
Clinical Pilates provides an excellent controlled exercise environment for fibromyalgia — the low-impact, body-awareness emphasis with precise load adjustment allows meaningful exercise participation even on symptomatic days. The small group environment also provides the social connection that is beneficial for fibromyalgia outcomes.
How can exercise physiology help?
Exercise is one of the most robustly evidence-based treatments for fibromyalgia — and this is not intuitive for patients who find that activity increases their pain in the short term. The evidence shows clearly that regular, appropriately dosed exercise reduces pain sensitivity, improves fatigue, enhances sleep quality and reduces the psychological burden of fibromyalgia over time, even when individual exercise sessions temporarily worsen symptoms.
The key is exercise prescription calibrated to the individual's current capacity and tolerance — too much too fast reliably produces a flare, while too little produces no benefit. Exercise physiology provides the specific expertise to design, progress and monitor an exercise program that navigates this carefully, building exercise capacity progressively over weeks and months while managing the symptom variability that is inherent to fibromyalgia.
Both aerobic exercise and progressive resistance training have strong evidence in fibromyalgia. Aerobic exercise — walking, pool-based exercise, cycling — reduces central sensitisation through endogenous pain inhibitory mechanisms activated by aerobic effort. Progressive resistance training reduces pain, fatigue and depression while improving physical function. The combination produces better outcomes than either alone.
Eligible patients can access exercise physiology through a Medicare GPCCMP (previously CDMP or EPC) with GP referral — fibromyalgia is an eligible chronic condition. This significantly reduces the out-of-pocket cost and is worth discussing with your GP.
For NDIS participants with fibromyalgia, physiotherapy and exercise physiology are claimable under therapeutic and capacity building supports respectively. See our NDIS physiotherapy page for more detail.
The importance of a multidisciplinary approach
Combining physiotherapy, exercise physiology, medication, psychological support and lifestyle changes provides the most comprehensive approach to managing fibromyalgia. Pain psychology — including cognitive behavioural therapy and acceptance and commitment therapy — addresses the catastrophising, fear-avoidance and mood disturbance that perpetuate central sensitisation. We work collaboratively with referring GPs, rheumatologists and psychologists to ensure coordinated care.
Our physiotherapists Yulia Khasyanova and Mauricio Bara and Exercise Physiologist Ash O'Regan all have experience in fibromyalgia and complex chronic pain conditions and are members of the Australian Physiotherapy Association. Yulia's certification in the Biopsychosocial Reframed Chronic Pain Treatment Model and specialist experience in complex pain conditions makes her particularly well suited to fibromyalgia presentations.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Fibromyalgia, or Fibromyalgia Syndrome (FMS), is a chronic condition characterised by widespread pain in the muscles, ligaments and tendons, accompanied by fatigue — affecting approximately 90% of patients — sleep disturbances, and cognitive difficulties. Unlike most pain conditions, fibromyalgia produces no detectable inflammation or tissue damage. It is now understood as a disorder of pain processing and perception — the way the brain and nervous system amplify and modulate pain signals — placing it firmly within the category of nociplastic pain, alongside complex regional pain syndrome and central sensitisation syndromes.
Fibromyalgia affects approximately 2 to 4% of the Australian population, with a significantly higher prevalence in women than men. It most commonly develops between the ages of 30 and 60, though it can occur at any age. It frequently coexists with other conditions including ME/CFS, irritable bowel syndrome, headaches and migraines, temporomandibular disorder and depression and anxiety — reflecting the shared central sensitisation mechanism across these conditions.
What causes fibromyalgia?
The exact cause is unknown, but fibromyalgia is understood to involve a combination of genetic susceptibility, central nervous system sensitisation, and triggering factors including physical or emotional trauma, infections, and prolonged psychological stress. The sensitised nervous system amplifies pain signals so that stimuli that would not normally be painful — light touch, mild pressure, temperature changes — are perceived as painful. This is called allodynia and central sensitisation, and it is the defining neurobiological feature of fibromyalgia.
Research has demonstrated consistent neurobiological abnormalities in fibromyalgia — altered brain connectivity, reduced descending pain inhibition, elevated substance P in the cerebrospinal fluid, and abnormal dopamine processing. These findings validate fibromyalgia as a genuine neurobiological condition and have helped to shift the clinical approach from symptom management toward mechanism-directed treatment.
What are the symptoms?
Widespread musculoskeletal pain — by definition present in all four quadrants of the body for more than three months — is the defining feature. The pain is typically described as aching, burning, stiffness or heaviness and varies in intensity and location over time.
Fatigue — often profound and disproportionate to activity level, not relieved by sleep — affects approximately 90% of patients and is one of the most disabling features. Sleep disturbance — non-restorative sleep, frequent waking, restless legs — both results from and perpetuates the central sensitisation that drives pain. The bidirectional relationship between sleep and pain is one of the most important treatment targets in fibromyalgia.
Cognitive difficulties — commonly called "fibro fog" — include difficulty with concentration, memory, word-finding and processing speed. Heightened sensitivity to light, sound, smell and temperature is common. Mood disturbance including depression and anxiety affects the majority of patients with fibromyalgia.
How is fibromyalgia diagnosed?
The diagnosis of fibromyalgia is clinical — there is no definitive laboratory or imaging test. The 2016 American College of Rheumatology criteria require widespread pain in multiple body regions, symptom severity including fatigue, sleep disturbance and cognitive symptoms, and symptom duration of at least three months, in the absence of another condition that would explain the pain. The previous requirement for tender point examination has been replaced by the current widespread pain index and symptom severity scale.
Fibromyalgia is frequently misdiagnosed or significantly delayed — the average time from symptom onset to diagnosis is several years. It is often diagnosed by exclusion after other conditions have been ruled out, though fibromyalgia is not a diagnosis of exclusion in the modern clinical framework — the positive symptom pattern is sufficient for diagnosis when present.
How can physiotherapy help?
Physiotherapy plays a pivotal role in managing and alleviating symptoms of fibromyalgia through a modern pain neuroscience approach that directly targets the central sensitisation driving symptoms.
Pain neuroscience education is the most important and most distinctively modern component of fibromyalgia physiotherapy. Understanding that fibromyalgia reflects nervous system sensitisation — not ongoing tissue damage — is both clinically accurate and therapeutically powerful. Multiple systematic reviews confirm that pain neuroscience education reduces pain, fatigue, catastrophising and fear-avoidance in fibromyalgia, often producing rapid improvements that persist over time. Yulia's certification in the Biopsychosocial Reframed Chronic Pain Treatment Model is directly relevant here.
Manual therapy — gentle joint mobilisation and soft tissue techniques — provides short-term pain relief through neurophysiological mechanisms and facilitates participation in the active exercise program. Myofascial release of the tender areas and trigger point dry needling can reduce localised pain and muscle tension.
Dry needling of widespread myofascial trigger points — which are a consistent finding in fibromyalgia and contribute significantly to the pain load — can produce meaningful symptom reduction as part of a broader treatment program.
Pacing and activity management — structured approaches to distributing activity across the day to avoid the boom-bust cycle of overdoing activity on good days and crashing on bad days — is a fundamental self-management skill. The boom-bust cycle is one of the most common patterns in fibromyalgia and is directly amenable to physiotherapy guidance.
Clinical Pilates provides an excellent controlled exercise environment for fibromyalgia — the low-impact, body-awareness emphasis with precise load adjustment allows meaningful exercise participation even on symptomatic days. The small group environment also provides the social connection that is beneficial for fibromyalgia outcomes.
How can exercise physiology help?
Exercise is one of the most robustly evidence-based treatments for fibromyalgia — and this is not intuitive for patients who find that activity increases their pain in the short term. The evidence shows clearly that regular, appropriately dosed exercise reduces pain sensitivity, improves fatigue, enhances sleep quality and reduces the psychological burden of fibromyalgia over time, even when individual exercise sessions temporarily worsen symptoms.
The key is exercise prescription calibrated to the individual's current capacity and tolerance — too much too fast reliably produces a flare, while too little produces no benefit. Exercise physiology provides the specific expertise to design, progress and monitor an exercise program that navigates this carefully, building exercise capacity progressively over weeks and months while managing the symptom variability that is inherent to fibromyalgia.
Both aerobic exercise and progressive resistance training have strong evidence in fibromyalgia. Aerobic exercise — walking, pool-based exercise, cycling — reduces central sensitisation through endogenous pain inhibitory mechanisms activated by aerobic effort. Progressive resistance training reduces pain, fatigue and depression while improving physical function. The combination produces better outcomes than either alone.
Eligible patients can access exercise physiology through a Medicare GPCCMP (previously CDMP or EPC) with GP referral — fibromyalgia is an eligible chronic condition. This significantly reduces the out-of-pocket cost and is worth discussing with your GP.
For NDIS participants with fibromyalgia, physiotherapy and exercise physiology are claimable under therapeutic and capacity building supports respectively. See our NDIS physiotherapy page for more detail.
The importance of a multidisciplinary approach
Combining physiotherapy, exercise physiology, medication, psychological support and lifestyle changes provides the most comprehensive approach to managing fibromyalgia. Pain psychology — including cognitive behavioural therapy and acceptance and commitment therapy — addresses the catastrophising, fear-avoidance and mood disturbance that perpetuate central sensitisation. We work collaboratively with referring GPs, rheumatologists and psychologists to ensure coordinated care.
Our physiotherapists Yulia Khasyanova and Mauricio Bara and Exercise Physiologist Ash O'Regan all have experience in fibromyalgia and complex chronic pain conditions and are members of the Australian Physiotherapy Association. Yulia's certification in the Biopsychosocial Reframed Chronic Pain Treatment Model and specialist experience in complex pain conditions makes her particularly well suited to fibromyalgia presentations.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
