Fibromyalgia: symptoms, diagnosis and interventional treatment

Fibromyalgia is one of the most common conditions in pain medicine practice and, at the same time, one of the most misunderstood. Many patients arrive after years of pain, with normal test results and no clear diagnosis, having seen multiple specialists without finding a convincing explanation or a treatment that truly works.

This is no coincidence: fibromyalgia does not show up on an X-ray or in a blood test. Its diagnosis is clinical and its management requires a specific approach that goes beyond a routine painkiller. In this article I explain what it is, how it is correctly diagnosed and what interventional pain medicine can do when other approaches have not been enough.

What exactly is fibromyalgia?

For many years it was thought that fibromyalgia was mainly a psychological condition or that it was "all in the head." We now know that this is incorrect. Current scientific evidence shows that in fibromyalgia there is central sensitization: the central nervous system —the brain and spinal cord— processes pain signals in an amplified way. Stimuli that would not normally cause pain are perceived as painful, and painful stimuli are perceived with far greater intensity than they should be.

This explains why the pain is widespread, why it appears without obvious tissue injury and why conventional anti-inflammatories have a limited effect: there is no inflammation to treat, but rather an alteration in the neurological processing of pain.

Symptoms: beyond the pain

The main symptom is widespread pain — in muscles, joints and soft tissues, in multiple regions of the body simultaneously. But fibromyalgia is much more than pain:

The combination and intensity of these symptoms varies widely between patients. Some have predominant pain, others fatigue, others brain fog. This also explains why diagnosis takes so long: there is no single profile and the symptoms overlap with many other conditions.

How is it diagnosed?

There is no blood test or imaging study that confirms fibromyalgia. The diagnosis is clinical, based on the American College of Rheumatology (ACR) criteria of 2010, updated in 2016:

• Widespread Pain Index (WPI): the number of body areas with pain in the past week, from a list of 19 specific regions.
• Symptom Severity scale (SS): assessment of fatigue, unrefreshing sleep and cognitive symptoms, plus general somatic symptoms.
• Duration: the symptoms must have been present at a similar level for at least 3 months.
• Exclusion of other causes: studies to rule out inflammatory, thyroid, rheumatological or other conditions that could explain the symptoms.

It is important to note that fibromyalgia can coexist with other conditions. A patient can have fibromyalgia and rheumatoid arthritis at the same time. Diagnosing one does not rule out the other.

Treatment: why the conventional approach has limits

The standard treatment of fibromyalgia includes medications such as dual antidepressants (duloxetine, milnacipran) or anticonvulsants (pregabalin, gabapentin), along with aerobic exercise and cognitive behavioral therapy. These approaches are evidence-based and are the right starting point.

However, a significant proportion of patients do not get sufficient relief from this management. The pain persists, quality of life remains compromised and the cycle of frustration continues. That is where the interventional approach can make a real difference.

The role of interventional pain medicine

Interventional pain medicine does not replace conventional treatment in fibromyalgia — it complements and expands it. The goal is to act on the specific mechanisms that sustain central sensitization and the pain cycle.

The interventional options that may be indicated according to each patient's profile include:

• Pulsed radiofrequency on trigger points: deactivates myofascial pain foci that feed the sensitization cycle. It is minimally invasive and does not destroy nerve tissue.
• Diagnostic-therapeutic nerve blocks: identify and treat specific pain foci that amplify central sensitization.
• Spinal cord stimulation: in cases of severe refractory fibromyalgia, it directly modulates central pain perception at the spinal level. It is reversible and adjustable.
• Individualized multimodal plan: a combination of interventional procedures with pharmacological optimization and non-pharmacological strategies, designed specifically for each case.

The key lies in individualization. Not all patients with fibromyalgia are candidates for the same procedures. The first consultation serves precisely to assess the complete clinical profile, understand which mechanisms predominate in that patient and define the most appropriate plan.

When should you see a pain specialist?

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