Why Fibromyalgia Deserves a Closer Look
Fibromyalgia is one of the most common, yet most misunderstood, chronic pain conditions I see in clinic. It is also a condition I have a fascination with, both because of how frequently it presents and my own keen interest in trying to better understand chronic pain. I actually chose to focus on fibromyalgia as part of my master’s degree research, with some of that research contributing to this body of work. Over time, working with patients and engaging deeply with the research has reinforced one key point. This is not a vague or unexplained condition. It is complex, but it is grounded in real, measurable changes in how the body processes pain.
For many people, the experience of fibromyalgia can be frustrating. You may have been told your scans are normal and your blood work is unremarkable, yet your symptoms are very real. Modern research is helping bridge that gap, showing that fibromyalgia is not about damage in the tissues, but rather a dysregulation in the systems that interpret and respond to sensation. In simple terms, the body is not broken, but it is dysfunctional.
What Is Fibromyalgia Really?
Fibromyalgia is currently understood as a condition of altered pain processing within the nervous system, often described as nociplastic pain (Findeisen et al., 2025). In scientific terms, this refers to pain arising from altered nociception without clear evidence of tissue damage. In other words, the body’s pain system has become overly sensitive, amplifying signals that would normally be non-painful or only mildly uncomfortable.
The Nervous System Turned Up Too High
A central mechanism underpinning fibromyalgia is central sensitisation, where the brain and spinal cord become more responsive to sensory input (Findeisen et al., 2025; Littlejohn & Guymer, 2018). This involves increased activity in pain pathways alongside reduced effectiveness of the body’s natural pain inhibiting systems. In scientific terms, this reflects altered neuroplasticity and dysfunction of descending inhibitory pathways. To put in plainly, the volume dial for pain has been turned up, while the body has lost some of its ability to turn that volume back down.
Neurogenic Inflammation and Why Symptoms Can Feel So Widespread
Littlejohn and Guymer (2018) describe fibromyalgia as involving neurogenic inflammation across the peripheral tissues, spinal cord and brain. This process involves neuropeptides, chemokines and cytokines, along with activation of both the innate and adaptive immune systems. In simple terms, the nerves and immune system start talking to each other in a way that keeps the body sensitive and reactive.
This may help explain why fibromyalgia can cause symptoms beyond pain, including swelling sensations, pins and needles, tenderness, fatigue, poor sleep, cognitive changes and sensitivity to light, sound or chemicals (Littlejohn & Guymer, 2018). This is why fibromyalgia can feel like a whole-body condition rather than just sore muscles.
Brain Chemistry and Pain Amplification
Research shows changes in neurotransmitters, with increased excitatory signalling such as glutamate and reduced inhibitory signalling such as gamma aminobutyric acid (GABA) (Findeisen et al., 2025; Mawla et al., 2021). This reflects an imbalance in excitatory and inhibitory neural pathways, particularly in areas such as the insula, which is involved in pain perception, body awareness and emotional processing. In simple terms, the brain is pressing the accelerator more than the brake, making it easier for pain to be triggered and harder for it to settle.
Stress, Sleep and the Fibromyalgia Loop
Stress physiology is strongly implicated in fibromyalgia. Littlejohn and Guymer (2018) describe the sympathetic nervous system and hypothalamic pituitary adrenal axis as key stress response systems that are activated in fibromyalgia. They also note that stress related pathways may drive neurogenic inflammation through neuropeptides such as substance P. In simple terms, chronic stress can keep the nervous system on high alert, which can then feed into pain, fatigue and sensitivity.
Sleep disturbance is also important. Littlejohn and Guymer (2018) note that disrupted sleep is closely linked with fatigue, cognitive dysfunction and pain. Meaning poor sleep reduces the body’s ability to recover, repair and regulate pain, which can keep the cycle going.
What Can Trigger Fibromyalgia?
Fibromyalgia rarely develops from one single cause. It is better understood as a condition that can emerge when multiple factors accumulate over time. These may include emotional stress, physical trauma, previous pain conditions, infection, sleep disruption, genetic predisposition and immune system dysregulation (Findeisen et al., 2025; Littlejohn & Guymer, 2018). These factors can prime the nervous system until it becomes more sensitive and reactive.
What Keeps It Going?
Once fibromyalgia develops, it can be maintained by a network of reinforcing mechanisms. These include central sensitisation, neurogenic inflammation, immune activation, altered neurotransmitters, sleep disturbance and ongoing stress physiology. The system becomes self-sustaining, meaning symptoms can continue even after the original trigger has passed.
What Does the Acupuncture Research Show?
A randomized controlled trial by Karatay et al. (2018) looked at 75 women with fibromyalgia who received either real acupuncture, sham acupuncture, or a simulated treatment. They had two sessions per week for four weeks. The researchers measured pain, tender points, overall fibromyalgia severity, mood, quality of life, and also looked at blood markers related to pain.
Those who received real acupuncture improved across most outcomes, and these improvements lasted for up to three months. They also showed increased serotonin and reduced substance P, both of which are important in how pain is processed. In this study acupuncture was shown to not only improve symptoms but also appeared to shift some of the underlying chemistry linked to pain.
A separate randomized neuroimaging study by Mawla et al. (2021) involved 76 people with fibromyalgia who received either electroacupuncture or a mock treatment. Alongside pain scores, the researchers used brain imaging to see what was happening in the nervous system. The electroacupuncture group had greater reductions in pain and showed changes in brain connectivity, along with increases in GABA, a calming neurotransmitter. This suggests acupuncture may help by calming overactive pain pathways in the brain.
Di Carlo et al. (2020) studied patients with more severe, treatment resistant fibromyalgia who had not improved with standard medications. They received weekly acupuncture for eight weeks. By the end of treatment, there were significant improvements in overall fibromyalgia severity, body symptoms, nerve related pain features, and pain related thought patterns. Thus, even in more difficult cases, acupuncture appeared to improve both physical symptoms and how patients experience and respond to pain.
Why This Matters Clinically
These studies are useful because they show both symptom outcomes and possible mechanisms. Karatay et al. (2018) showed improvements in pain, fibromyalgia impact, depression and tender points, alongside changes in serotonin and substance P. Mawla et al. (2021) showed pain reduction alongside measurable changes in brain connectivity and GABA. Di Carlo et al. (2020) showed that acupuncture may be useful even in more severe, treatment resistant fibromyalgia.
These studies demonstrate that acupuncture is not simply about “relaxing muscles.” The research suggests it may influence the nervous system, brain chemistry, pain processing, inflammatory signalling and emotional amplification of pain.
Acupuncture and Integrative Care at Como Health Group
At Como Health Group, acupuncture forms part of a broader whole systems approach to fibromyalgia. This aligns with current research because fibromyalgia itself is a whole systems condition involving the nervous system, immune system, stress response, sleep regulation and neurochemical signalling.
The aim is to help calm the overactive pain system, improve regulation and reduce the sensitivity that keeps symptoms active.
Why a Whole Systems Approach Works
Fibromyalgia is not simply a pain condition. It involves altered pain processing, dysfunctional immune pathways, neurogenic inflammation, stress physiology, sleep disruption and changes in neurotransmitter activity. This is why a single intervention is often not enough. A more useful approach is to address several drivers at once.
At Como Health Group, this may include acupuncture, naturopathic support, nutritional strategies, lifestyle modification, sleep support and nervous system regulation, whilst working alongside other health professionals as part of a care team. Rather than trying to fix one part of the problem, we work to address the entire system.
Final Thoughts
Fibromyalgia is a condition of dysregulation rather than damage. While complex, this also means it is modifiable. The research increasingly shows that fibromyalgia involves real changes in the nervous system, immune signalling and pain processing. It also shows that treatments such as acupuncture may help improve symptoms by influencing these same pathways.
In simple terms, the system can learn to settle again, and with the right support, that process can begin.
References
Badanta, B., Álvarez Pérez, I., Bonilla Sierra, P., González Cano Caballero, M., Lucchetti, G., & de Diego Cordero, R. (2024). Complementary and alternative medicine to treat fibromyalgia symptoms: A systematic review. Journal of Pain Research, 17, 1709–1723.
Choi, T. Y., Jun, J. H., Lee, H. W., & Lee, M. S. (2025). Acupuncture for fibromyalgia syndrome: An overview of systematic reviews and meta analyses. Frontiers in Medicine, 12, 1712065. https://doi.org/10.3389/fmed.2025.1712065
Di Carlo, M., Beci, G., & Salaffi, F. (2020). Acupuncture for fibromyalgia: An open label pragmatic study on effects on disease severity, neuropathic pain features, and pain catastrophizing. Evidence Based Complementary and Alternative Medicine, 2020, 9869250. https://doi.org/10.1155/2020/9869250
Findeisen, K., Guymer, E., & Littlejohn, G. (2025). Neuroinflammatory and immunological aspects of fibromyalgia. Brain Sciences, 15(2), 206. https://doi.org/10.3390/brainsci15020206
Karatay, S., Okur, S. C., Uzkeser, H., Yildirim, K., & Akcay, F. (2018). Effects of acupuncture treatment on fibromyalgia symptoms, serotonin, and substance P levels: A randomized sham and placebo controlled clinical trial. Pain Medicine, 19(3), 615–628. https://doi.org/10.1093/pm/pnx263
Littlejohn, G., & Guymer, E. (2018). Neurogenic inflammation in fibromyalgia. Seminars in Immunopathology, 40, 291–300. https://doi.org/10.1007/s00281-018-0672-2
Mawla, I., Ichesco, E., Zöllner, H. J., Edden, R. A. E., Chenevert, T., Buchtel, H., Bretz, M. D., Sloan, H., Kaplan, C. M., Harte, S. E., Mashour, G. A., Clauw, D. J., Napadow, V., & Harris, R. E. (2021). Greater somatosensory afference with acupuncture increases primary somatosensory connectivity and alleviates fibromyalgia pain via insular GABA: A randomized neuroimaging trial. Arthritis & Rheumatology, 73(7), 1318–1328. https://doi.org/10.1002/art.41620
