Fibromyalgia
Widespread pain that is real, physiological, and treatable — by a practice that understands central sensitization.
Fibromyalgia is a symptom. The source is the answer.
Fibromyalgia is characterized by widespread musculoskeletal pain, profound fatigue, unrefreshing sleep, and cognitive difficulty often described as “fibro fog.” For decades, patients were told the pain was in their heads. It is not.
Fibromyalgia is fundamentally a disorder of central sensitization — the nervous system amplifies pain signaling, so that ordinary sensations register as painful and painful ones become severe. The problem isn’t the tissue. The problem is the volume control.
This explains why treatments aimed only at muscles and joints so often disappoint, and why opioids are especially poor choices — they can worsen pain sensitivity over time. It also explains why treatments that act on the central nervous system, including ketamine, can be effective. Understanding the mechanism is the beginning of treating it properly.
Consider what this means practically. If the amplifier is turned up, then the input matters less than the gain. A patient with fibromyalgia can have genuinely severe pain from tissue that looks entirely normal on every scan — and every clinician who orders another test to “find something” is looking in the wrong place.
But there is a critical corollary, and it is one the field routinely gets wrong. Fibromyalgia does not make a patient immune to ordinary, treatable, structural pain. Many patients carry the diagnosis and an arthritic facet joint, a torn disc, or an injured sacroiliac joint that nobody investigated — because once the label was applied, the search stopped. We look. Frequently, we find something treatable.
Fibromyalgia is not a diagnosis of exclusion or a label for unexplained pain. It is a specific disorder of pain processing — and it responds to treatment aimed at the right target.
What can cause fibromyalgia
Below are the conditions we most commonly identify and treat. Many patients have more than one contributing source at the same time — which is precisely why careful diagnosis matters.
Core Features
Widespread Musculoskeletal Pain
Pain on both sides of the body, above and below the waist, persisting for months. It may migrate, vary in intensity, and worsen with stress, weather, or poor sleep.
Allodynia & Hyperalgesia
Ordinary touch or pressure registers as painful, and painful stimuli feel far worse than they should — hallmarks of an amplified pain-processing system.
Profound Fatigue & Unrefreshing Sleep
Sleep architecture is disrupted, so patients wake unrested. Poor sleep amplifies pain, and pain disrupts sleep — a cycle that must be broken from both directions.
Cognitive Dysfunction ("Fibro Fog")
Difficulty with concentration, word-finding, and short-term memory — a well-documented feature, not a character flaw.
Mechanisms & Contributors
Central Sensitization
The core mechanism. Persistent amplification of pain signaling within the central nervous system, involving changes in how the spinal cord and brain process sensory input.
Post-Traumatic & Post-Infectious Onset
Fibromyalgia frequently begins after physical trauma, surgery, infection, or significant psychological stress — events that can prime the nervous system toward sensitization.
Coexisting Structural Pain Generators
Many patients have fibromyalgia and a treatable structural problem — an arthritic facet joint, a disc, an SI joint. Treating the structural source can meaningfully lower the overall pain burden. Assuming everything is “just fibromyalgia” leaves real, fixable pain untreated.
Related Conditions
Irritable bowel syndrome, migraine, temporomandibular disorder, restless legs, and mood disorders frequently coexist — reflecting shared mechanisms of sensitization.
What Fibromyalgia Is Not
Not Psychological
Distress and depression can accompany chronic pain, as they accompany any serious illness. They are not the cause of fibromyalgia.
Not Inflammatory Arthritis
Fibromyalgia does not damage joints. But it can coexist with rheumatoid or psoriatic arthritis, and distinguishing the two determines treatment.
Not a Wastebasket Diagnosis
It is a specific disorder with specific criteria. Applying it carelessly to any unexplained pain does patients real harm by ending the search for a treatable cause.
Not Untreatable
This is the most damaging myth. Fibromyalgia responds to treatment aimed at central sensitization, sleep, movement, and any coexisting structural pain.
What Makes Fibromyalgia Worse — and Better
Non-Restorative Sleep
Disrupted sleep architecture amplifies central sensitization directly. Restoring sleep is among the most effective interventions available, and it should be treated as a primary target rather than an afterthought.
Stress & Nervous System Arousal
Sustained sympathetic arousal lowers pain thresholds. This is physiology, not weakness — and it is why nervous-system-directed treatment works where tissue-directed treatment fails.
Boom-and-Bust Activity Cycles
Overexertion on good days followed by collapse is one of the most common patterns and one of the most damaging. Carefully graded, consistent activity is the antidote.
Metabolic Health, Weight & Nutrition
Metabolic dysfunction and inflammation influence pain sensitivity, sleep, and energy. Our team includes a double board-certified internal and obesity medicine physician for precisely this reason.
Getting the Diagnosis Right
Why Over-Diagnosis Harms Patients
Applying the fibromyalgia label to any unexplained pain ends the search for a treatable cause. Patients then live for years with an arthritic joint or an injured disc that was never investigated. Accurate diagnosis protects patients in both directions.
Conditions That Mimic Fibromyalgia
Thyroid disease, inflammatory arthritis, polymyalgia rheumatica, sleep apnea, and certain medication effects can all produce widespread pain and fatigue. Each requires entirely different treatment, and each is identifiable.
Fibromyalgia With a Structural Pain Generator
This combination is common and routinely missed. A patient can have genuine fibromyalgia and a facet joint that will respond beautifully to a medial branch block. We look for both.
When the Diagnosis Changes the Plan
Recognizing central sensitization as the driver reframes everything: it explains why tissue-directed treatment disappointed, why opioids made things worse, and why nervous-system-directed treatment can succeed.
When to seek urgent evaluation
Fibromyalgia itself is not a medical emergency, but new or changing symptoms deserve evaluation rather than attribution to a prior diagnosis. Seek prompt care for: new focal weakness or numbness; joint swelling, redness, and fever; unexplained weight loss; or severe, sudden pain unlike your usual pattern. Call 911 for chest pain, difficulty breathing, or signs of stroke.
Diagnosis is a procedure, not a guess
Imaging alone rarely provides the answer. Findings of degeneration are extraordinarily common in people with no pain whatsoever — so an abnormal image doesn’t prove we’ve found the culprit. Conversely, some of the most treatable causes may not appear on imaging at all.
So we build the diagnosis from several converging sources:
01 — A genuinely thorough history and physical examination
Fibromyalgia is a clinical diagnosis based on widespread pain, symptom duration, and associated features — and on a careful search for anything else that could explain the picture. Our visits are longer than the industry norm precisely because this takes time.
02 — Ruling out and identifying coexisting conditions
Thyroid disease, inflammatory arthritis, and other conditions can mimic or accompany fibromyalgia. We identify them rather than assume.
03 — Virtual MSK Movement Assessment
Objective, wearable-free measurement of movement, range, and compensation — establishing a functional baseline and tracking real improvement, which matters enormously in a condition where subjective pain scores fluctuate.
04 — Identifying treatable structural pain generators
Crucially, we look for the arthritic facet joint, the SI joint, or the disc that may be contributing. Patients labeled “fibromyalgia” often have a coexisting, entirely treatable source of pain that no one ever looked for.
This is the difference between treating a picture and treating a patient. We confirm the source before committing you to a therapeutic procedure.
Precise, non-opioid, physician-performed care
Once we know the source, treatment can be targeted. Every procedure is performed personally by Dr. Joshi, using low-dose imaging, non-opioid sedation when appropriate, and hand-selected medications and products. We do not delegate procedures, and we do not use opioids as a treatment strategy.
Ketamine Infusion Therapy
Ketamine acts on the NMDA receptor to reduce central sensitization — the core mechanism of fibromyalgia. For appropriate patients, it can meaningfully lower the amplified pain response.
Dr. Joshi built the nation’s first surgery-center-based outpatient ketamine infusion program roughly two decades ago, with surgical-grade safety infrastructure. Thousands of infusions later, it remains a cornerstone of our approach to centrally-mediated pain.
Treatment of Coexisting Structural Pain
When a facet joint, SI joint, or disc is contributing, treating it precisely can substantially reduce total pain burden — often to the surprise of patients told their pain was “all fibromyalgia.”
Trigger Point Injections
For focal myofascial pain that layers on top of widespread sensitization, precise injections can relieve specific pain generators and improve function.
Sleep Optimization
Restorative sleep reduces central sensitization. Addressing sleep is not adjunctive — it is a primary intervention.
Graded Movement & Rehabilitation
Progressive, carefully dosed movement retrains the nervous system’s threat response. Our multi-disciplinary team builds this into the plan, because too much too fast flares symptoms and too little perpetuates them.
Nutrition, Metabolic & Whole-Person Care
Metabolic health, weight, and nutrition influence inflammation, sleep, and pain. Our team includes a double board-certified internal and obesity medicine physician for exactly this reason.
Why We Don't Use Opioids
Opioids are a poor treatment for fibromyalgia and can worsen it through opioid-induced hyperalgesia — increasing pain sensitivity in a condition already defined by amplified pain signaling.
Dr. Joshi has never prescribed OxyContin or oxycodone in more than three decades of practice. He predicted the opioid epidemic in the late 1990s, more than a decade before the CDC acknowledged it.
Diagnostic Blocks to Find Treatable Pain
When a specific joint or nerve appears to contribute, a diagnostic block answers the question definitively. Finding and treating a real structural pain generator in a fibromyalgia patient can transform their overall pain burden.
Non-Opioid Medication Strategy
Certain medications that act on the central nervous system’s pain processing have a legitimate role. We use them thoughtfully and in conjunction with everything else — never as the entire plan.
Whole-Person, Multi-Disciplinary Care
Fibromyalgia sits at the intersection of pain, sleep, movement, metabolism, and mood. Our multi-disciplinary team — spanning interventional pain, chiropractic and musculoskeletal care, obesity and lifestyle medicine, and behavioral support — addresses them together rather than sequentially.
We don't rush to implant
A spinal cord stimulator is a legitimate tool for the right patient at the right time. But it’s an implant, and we treat it as a genuine last resort — not an early default reached for after a couple of quick attempts. First we find the root cause, address it, and rehabilitate it. Only when the better options are truly exhausted do we consider going there.
The same procedure is not the same procedure
Two practices can list the same procedure on a website and deliver profoundly different experiences, risks, and outcomes. Here is what changes when the details are done right.
Performed personally by Dr. Joshi
Never delegated to a technician, resident, or rotating staff. You’re treated by the physician who developed and teaches the technique — and in image-guided procedures, the difference between physicians is measured in millimeters.
Dramatically less radiation
Pulsed, low-dose imaging and a few precisely targeted spot images instead of continuous live X-ray. Based on our own procedural dose data, this reduces radiation exposure by at least 50% — and often far more — versus conventional continuous fluoroscopy, with no compromise in accuracy. For conditions treated repeatedly over years, that difference compounds.
Non-opioid sedation
When sedation is used, we use ketamine-based sedation, not fentanyl. Opioid sedation exposes you to unnecessary opioids, can complicate workplace drug testing, and can actually increase pain sensitivity. Ketamine can do the opposite.
Smaller needles, tissue-sparing lesions
Precision means we don’t need to be destructive to be effective — smaller-gauge needles and lower-temperature, longer-duration ablation that spares the healthy tissue around the target.
We actually numb you first
Thorough local anesthesia of skin and underlying tissue before the procedure begins. It takes an extra minute. We take it.
Independent, and obsessive about quality
Nearly four out of five U.S. physicians now answer to a corporate owner. We’re physician-owned, so our only incentive is your outcome. What a practice refuses to do tells you as much as what it offers.
Fibromyalgia, answered
Yes. It is a well-characterized disorder of central pain processing, with measurable differences in how the nervous system amplifies pain signals. The idea that it is imaginary has caused profound harm and delayed treatment for countless patients.
Because fibromyalgia is not a disease of tissue damage — it is a disorder of how the nervous system processes signals. Blood tests and scans look at tissue. They are essential for excluding other conditions, but a normal result does not mean nothing is wrong.
Absolutely, and this is one of the most important things we look for. Many patients labeled “fibromyalgia” also have an arthritic facet joint, an SI joint problem, or a disc — a real, treatable pain generator that no one investigated because the label ended the search.
Because they make fibromyalgia worse. Opioids can cause opioid-induced hyperalgesia, increasing sensitivity to pain in a condition whose central problem is already amplified pain signaling. Dr. Joshi has never prescribed OxyContin or oxycodone in three decades of practice.
Ketamine acts on the NMDA receptor, a key player in central sensitization. By reducing that amplification, it can lower pain in patients whose nervous systems have turned the volume up. We built America’s first surgery-center-based outpatient ketamine program. Individual results vary.
Too much, too fast, will. Carefully graded, progressive movement does the opposite — it retrains the nervous system’s threat response and improves pain, sleep, and function over time. The dosing is the skill.
Clinically. It is based on widespread pain of sufficient duration, associated symptoms such as fatigue and cognitive difficulty, and the careful exclusion of other conditions that could explain the picture. There is no blood test that confirms it, and no scan that reveals it.
This is the right instinct, applied correctly. Fibromyalgia is a real cause. But you should absolutely be evaluated for coexisting, treatable structural pain generators — an arthritic joint, a disc, an SI joint — because the label too often ends a search that should have continued.
Considerably. In a condition where subjective pain scores fluctuate day to day, objective functional data gives us a genuine baseline and lets us measure whether you are truly improving — rather than relying on impressions during a fifteen-minute visit.
It is not a degenerative disease and does not damage joints or tissue. Symptoms fluctuate, often considerably, and can improve substantially with treatment aimed at sleep, movement, central sensitization, and any coexisting structural pain.
Because central sensitization is modulated by the state of the nervous system. Stress, poor sleep, and barometric change all influence pain thresholds. This is physiology, not imagination — and it is a clue to where treatment should be aimed.
Longer than you’re used to. We take a thorough history, examine you carefully, review prior workup, look specifically for coexisting treatable structural pain generators, and establish an objective functional baseline with the Virtual MSK Movement Assessment. Then we build a plan across sleep, movement, central sensitization, and metabolic health.
Find out what's actually causing your pain.
A precise diagnosis is the beginning of a real solution. Let’s find your pain generator — and treat it.
This page is provided for general educational purposes and does not constitute medical advice, diagnosis, or treatment, nor does it create a physician-patient relationship. Individual results vary, and no specific outcome is promised or guaranteed. Radiation-reduction figures reflect National Pain Centers’ own procedural dose data compared with conventional continuous-fluoroscopy technique. Certain regenerative therapies are considered emerging or investigational and are not FDA-approved for all uses. Always consult a qualified physician regarding your medical condition. If you are experiencing a medical emergency, call 911.