Fibromyalgia and fatigue

Fatigue is one of the most common and debilitating symptoms of fibromyalgia—a chronic condition characterized by widespread pain, tenderness, and a host of other symptoms. 

Here's a breakdown of how fatigue relates to fibromyalgia and what can help manage it:

---

🧠 Why Fatigue Happens in Fibromyalgia

1. Sleep Disturbances

   • Many people with fibromyalgia experience non-restorative sleep, insomnia, or sleep disorders like restless leg syndrome or sleep apnea.

   • Even after a full night's sleep, you may wake up feeling unrefreshed.

2. Chronic Pain

   • Ongoing pain can disrupt sleep and drain energy throughout the day, especially when the body is in a constant state of stress or tension.

3. Central Sensitization

   • Fibromyalgia is linked to abnormalities in how the brain processes pain and sensory signals. This increased nervous system sensitivity can lead to cognitive fatigue ("fibro fog") and physical exhaustion.

4. Immune System Dysregulation

   • Some theories suggest the immune system may be in a low-grade, chronic inflammatory state, contributing to persistent fatigue.

5. Coexisting Conditions

   • Conditions such as depression, anxiety, thyroid disorders, or chronic fatigue syndrome (CFS/ME) often overlap and can compound fatigue.

---

🛠️ Ways to Manage Fatigue

✅ Lifestyle Adjustments

• Sleep hygiene: Set a regular bedtime, avoid screens at night, and make your sleep environment calming.

• Gentle exercise: Activities like walking, yoga, or tai chi can improve energy and reduce pain over time.

• Pacing: Practice energy conservation—balance activity and rest to avoid flare-ups.

✅ Nutrition

• Anti-inflammatory diet: Emphasize whole foods, omega-3s, and avoid processed sugar and refined carbs.

• Stay hydrated and avoid alcohol, caffeine, and artificial sweeteners that may worsen fatigue in some people.

✅ Mind-Body Approaches

• Meditation, mindfulness, and deep breathing help calm the nervous system.

• Cognitive Behavioral Therapy (CBT) can reduce the mental load and help manage the emotional aspects of chronic illness.

✅ Medications & Supplements

• Some people benefit from:

  • Low-dose antidepressants (e.g., amitriptyline or duloxetine)

  • Sleep aids (used cautiously)

  • Supplements like magnesium, CoQ10, vitamin D, and B vitamins (check with your doctor first)

---

📌 When to Talk to a Doctor

• If fatigue severely interferes with daily life or worsens despite lifestyle changes, speak with a provider about personalized treatments or underlying conditions that may need addressing.

How to use Tiger Balm correctly for fibromyalgia pain (and other pain)

🐯  Using Tiger Balm correctly helps ensure you get the maximum relief from pain while minimizing any skin irritation or side effects. 

Here's a quick, clear guide:

🧴 How to Use Tiger Balm

1. Choose the Right Type

• White Tiger Balm: Cooling, better for headaches, migraines, nasal congestion, and general aches.

• Red Tiger Balm: Warming, better for muscle pain, joint pain, and backaches.

---

✅ Application Instructions

1. Clean the Area
   Wash and dry the skin where you’ll apply it.

2. Take a Small Amount
   Scoop a pea-sized amount with your finger or a cotton swab.

3. Rub It In
   Gently massage into the affected area using circular motions for 1–2 minutes until absorbed.

4. Wash Hands Thoroughly
   Especially important to avoid accidental contact with eyes, mouth, or other sensitive areas.

---

💡 Where to Apply (Common Uses)

Condition	Where to Apply	Notes
Headache	Temples, forehead, back of neck	Avoid eyes; use White Balm
Muscle/joint pain	Affected muscle or joint area	Use Red Balm for deeper pain
Back pain	Lower or upper back area	Massage deeply
Congestion	Chest or under nose (lightly)	Use White Balm only

⚠️ Precautions

• Do not apply to broken, irritated, or sensitive skin

• Avoid sun exposure after applying Red Balm (it can irritate skin)

• Use up to 3–4 times per day

• Not for children under 2

• Avoid bandaging tightly over the balm unless advised

---

🕒 When to Expect Results

• You should feel cooling or warming sensations within minutes.

• Pain relief typically lasts a few hours.

• For chronic pain, consistent use over several days may help more.

You may be interested in these articles:

• Tiger balm and other topical pain relief
• Natural Treatments for Fibromyalgia
• Traditional Chinese Medicine and Fibromyalgia

The connection between Fibromyalgia and the Butterfly

The butterfly is often used as a symbol for fibromyalgia, and this connection is both poetic and powerful. Here's a breakdown of the symbolism and why it resonates with people who live with the condition:

---

🦋 Why the Butterfly?

1. Delicacy and Sensitivity

   • Butterflies are delicate creatures—just like people with fibromyalgia often feel in their own bodies. The condition involves chronic pain, fatigue, and extreme sensitivity, especially to touch, sound, and even temperature. The butterfly represents this fragility.

2. Transformation and Survival

   • A butterfly goes through a full transformation—from caterpillar to chrysalis to butterfly. This mirrors the journey many people with fibromyalgia go through, often after a long period of struggle, change, and learning to live differently. It’s a symbol of resilience and metamorphosis.

3. Invisible but Real

   • Just like a butterfly can flutter by without notice, fibromyalgia is often an invisible illness. On the outside, a person may look fine, but they’re enduring constant pain, fatigue, or cognitive fog. The butterfly serves as a gentle reminder that you can’t always see someone’s pain.

4. Beauty and Hope

   • Butterflies are also symbols of hope, beauty, and freedom. For many, it’s an uplifting symbol that reminds them to find moments of peace and joy, even when living with chronic pain.

---

Fibromyalgia Awareness

• The butterfly is commonly featured in fibromyalgia awareness campaigns, often in purple (the official awareness color).

• You’ll see butterfly logos on ribbons, tattoos, jewelry, and merchandise used to promote awareness and advocacy.

I'd love to hear what the butterfly means to you if you have fibromyalgia. Do you like it as a symbol?

Immune System Clues to Fibromyalgia Pain: A New Study on Autoantibodies

This new Evidence Links Immune Antibodies to Pain in Fibromyalgia

A recent study published in PAIN investigated the presence and effects of specific antibodies in individuals with fibromyalgia syndrome (FMS) and post-acute COVID-19 syndrome (PACS), commonly known as long COVID.

Key Findings:

1. Shared Antibodies: Both FMS and PACS patients were found to have elevated levels of IgG autoantibodies targeting satellite glial cells (SGCs). SGCs are supportive cells in the nervous system that play a role in modulating pain.

2. Differing Effects: While these antibodies are present in both conditions, only the IgG from FMS patients was found to be pronociceptive—meaning it can enhance pain perception. In contrast, the IgG from PACS patients did not exhibit this pain-enhancing effect.

Implications:

• The presence of these autoantibodies in both conditions suggests a potential autoimmune component in their development.

• The pronociceptive nature of FMS IgG indicates that these antibodies may contribute directly to the chronic pain experienced by FMS patients. ScienceDirect

• Understanding these mechanisms could lead to targeted therapies that address the specific immune responses involved in FMS and PACS.

This research highlights the importance of the immune system's role in chronic pain conditions and opens avenues for further studies into autoimmune contributions to diseases like fibromyalgia and long COVID.

📌 Why It Matters for People with Fibromyalgia:

1. Possible Cause of Pain Identified

• This supports the idea that fibromyalgia isn’t “just in your head” — your immune system may be playing a direct role in causing the pain.

• This moves fibromyalgia closer to being seen as a biological, autoimmune-linked condition.

2. Better Diagnosis in the Future

• If these antibodies can be reliably tested for, doctors might be able to diagnose fibromyalgia more accurately with a blood test instead of relying only on symptoms.

3. New Treatment Possibilities

• Treatments could be developed to block or reduce these harmful antibodies, potentially reducing pain for people with fibromyalgia.

• This could include therapies similar to those used in autoimmune diseases, like immunotherapy.

4. More Recognition and Validation

• This kind of research adds scientific legitimacy to fibromyalgia, which many patients have long sought.

• It helps push back against stigma or disbelief about the condition.

---

🧠 Bottom Line:

For people with fibromyalgia, this study suggests that your pain may partly be caused by your own immune system misfiring — and that there may be real biological targets for future treatments.

SOURCE

Post acute COVID-19 syndrome and fibromyalgia syndrome are associated with anti-satellite glial cell IgG serum autoantibodies but only fibromyalgia syndrome serum-IgG is pronociceptive

The causes of Fibromyalgia - latest theories (2025)

Fibromyalgia is a complex and poorly understood condition characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, cognitive issues ("fibro fog"), and other symptoms. Its exact cause remains unknown, but recent research has advanced our understanding. As of 2025, here are the most recent and emerging insights into possible causes and contributing factors of fibromyalgia:

---

1. Central Nervous System Dysregulation

• Central sensitization: A key theory is that the central nervous system (CNS) becomes hypersensitive, amplifying pain signals. This may involve altered neurotransmitter levels (e.g., increased substance P, decreased serotonin and norepinephrine).

• Brain imaging studies show abnormal pain processing and connectivity in regions related to pain and emotion.

2. Small Fiber Neuropathy

• Recent studies have found that many people with fibromyalgia have damage to small nerve fibers, which could explain pain and sensory abnormalities.

• This provides potential overlap with other neuropathic conditions and may offer new diagnostic avenues.

3. Mitochondrial Dysfunction and Oxidative Stress

• Evidence suggests impaired energy metabolism and increased oxidative stress in fibromyalgia patients.

• This might contribute to fatigue and muscle pain.

4. Immune System and Inflammation

• Low-grade systemic inflammation and altered cytokine profiles have been observed.

• Some research suggests fibromyalgia may involve neuroinflammation, especially in the brain and spinal cord.

5. Gut Microbiome Imbalance

• Newer studies indicate significant differences in the gut microbiota of people with fibromyalgia.

• This supports a gut-brain axis connection, potentially affecting inflammation, pain perception, and mood.

6. Infections and Viral Triggers

• Post-infectious fibromyalgia is increasingly recognized, particularly following infections like:

  • Epstein-Barr virus

  • Lyme disease

  • COVID-19 (some long COVID symptoms closely resemble fibromyalgia)

7. Trauma and Stress

• Physical or emotional trauma, including adverse childhood experiences, is a known risk factor.

• Chronic stress affects the hypothalamic-pituitary-adrenal (HPA) axis, which regulates pain and stress responses.

8. Genetic and Epigenetic Factors

• Genetic predisposition plays a role, especially in serotoninergic and catecholaminergic systems.

• Emerging research is exploring how epigenetic modifications (e.g., DNA methylation) may influence symptom development.

---

Takeaway:

Fibromyalgia is likely a multifactorial syndrome involving a combination of:

• Neurological dysregulation

• Immune and metabolic dysfunction

• Environmental triggers

• Genetic susceptibility

Ongoing research continues to explore biomarkers for diagnosis and more effective treatments. Find out more about these biomarkers here.

Related articles you may be interested in:

Findings Link Gut Bacteria and Fibromyalgia

Upper Trapezius Changes Linked to Fibromyalgia

Identifying Fibromyalgia Biomarkers discovered

Serotoninergic and catecholaminergic systems in Fibromyalgia

Here's a simple explanation of the serotoninergic and catecholaminergic systems:

---

🧠 Serotoninergic System

• This system involves the brain chemical serotonin.

• Serotonin helps regulate:

  • Mood (it’s sometimes called the “feel-good” chemical)

  • Sleep

  • Appetite

  • Pain perception

Think of serotonin as a calming, balancing chemical that helps you feel stable and content. In fibromyalgia, low levels of serotonin may make you more sensitive to pain and more likely to feel tired or anxious.

---

⚡ Catecholaminergic System

• This system involves chemicals called catecholamines, mainly:

  • Dopamine

  • Norepinephrine (noradrenaline)

  • Epinephrine (adrenaline)

These chemicals help control:

• Alertness and energy

• Mood

• Response to stress

• Attention and focus

They are like your brain’s “go” signals — helping you feel awake, motivated, and able to handle stress. In fibromyalgia, problems in this system may contribute to:

• Fatigue

• Brain fog

• Mood swings

• Heightened pain response

---

🧩 Why This Matters in Fibromyalgia

Both of these systems help regulate how your brain and body handle pain, stress, and energy. If they aren’t working properly, it can lead to:

• Feeling more pain from things that shouldn’t hurt

• Trouble sleeping

• Feeling drained or foggy

• Mood problems like anxiety or depression

Researchers think that imbalances in these systems may be part of why people develop fibromyalgia.

Upper Trapezius Changes Linked to Fibromyalgia

This study reveals that muscle changes in Fibromyalgia can be seen in ultrasounds and that upper trapezius changes are linked to Fibromyalgia.

Fibromyalgia (FM) is a long-term condition that causes widespread muscle pain, fatigue, sleep problems, and memory issues. It affects about 2–3% of people globally. The exact causes of FM are still not well understood, but both genetic and environmental factors seem to contribute. 

Recent research suggests that central sensitization—a condition where the nervous system becomes overly sensitive to pain—plays a role in FM.

In the past, FM has been diagnosed using tender points on the body. Studies have shown that muscles in these areas may have poor blood flow and signs of damage related to low oxygen levels. One muscle often affected is the upper trapezius (the muscle along the back of the neck and shoulders).

* Trapezius muscle * Original by sv:Användare:Chrizz

Use of Ultrasound in FM:
Ultrasound is a safe and noninvasive tool used to examine muscles. Newer methods like blob analysis can give more detailed images of muscle structure. Blob analysis looks at clusters of similar signals (called "blobs") in the muscle, helping to detect structural changes that might not be visible with standard imaging.

While blob analysis has been used to study other muscle conditions, it hasn’t been used before to assess muscles in FM patients. 

This study aims to fill that gap by examining the upper trapezius muscle using B-mode ultrasound and blob analysis in FM patients compared to healthy individuals.

Methods:
The study included 34 women with FM and 34 healthy women. Participants were evaluated using several scales to measure pain, fatigue, mental health, and quality of life. 

Ultrasound images of the upper trapezius muscle were taken and analyzed using blob analysis software to measure blob size, count, and brightness (echointensity).

Key Findings:

• FM patients had larger and more numerous blobs in the upper trapezius muscle compared to healthy individuals.

• Higher echointensity (brighter muscle areas) was found in FM patients.

• Blob size and count were linked to higher pain, fatigue, and central sensitization scores.

• These structural muscle changes could help explain ongoing pain and sensitivity in FM.

Conclusion:
This study is the first to use blob analysis with ultrasound to examine muscle changes in FM. 

The results suggest that FM is associated with measurable structural muscle changes, particularly in areas of pain. This technique may offer a more objective way to assess FM and understand its underlying mechanisms.

Source:

Structural changes in the upper trapezius muscle of fibromyalgia patients identified by quantitative ultrasonography: a cross-sectional study
Observational Research | Open access | Published: 22 April 2025

Identifying Fibromyalgia Biomarkers discovered

In a breakthrough effort to improve diagnosis, researchers have turned to cutting-edge tools like gene expression analysis and machine learning. By examining patterns in how genes are activated in fibromyalgia patients, the study identified three key genes that could serve as reliable biomarkers for diagnosis. 

SUMMARY 

---

🧬 What Was Done?

Scientists studied gene activity from people with fibromyalgia and healthy individuals.

They used a smart computer program to find key differences.

---

💡 What They Found:

Three genes were different in people with fibromyalgia:

• DYRK3

• RGS17

• ARHGEF37

These genes affect:
🧠 Brain function
⚡ Cell communication
🧪 Body balance (like ion levels)

---

🧠 Why It Matters:

These genes can help diagnose fibromyalgia more accurately using a simple test in the future.

---

🧪 How Good Is It?

The computer model was tested and worked over 80% accurately in both training and testing groups.

✅ Training accuracy: 83%
✅ Testing accuracy: 82%

---

🏥 What This Means for Patients:

• Faster, more accurate diagnosis

• Less guessing and more targeted care

• A step closer to better treatment

Fibromyalgia is a Functional Pain Syndrome

Until recently, I hadn't heard of the term FPS, which stands for Functional Pain Syndrome. So I looked it up, and here's what I found:

When someone is in pain but doctors can’t find a clear physical cause, it’s often called functional pain. The diagnosis depends on where the pain is felt — for example, in the stomach for people with Irritable Bowel Syndrome (IBS) or in the muscles and joints for those with Fibromyalgia (FM).

Experts are now changing how they think about FPS. Instead of seeing each chronic pain condition as separate, they’re starting to group them under a broader idea called Central Sensitivity Syndrome (CSS). This means that the brain and nervous system are more sensitive to pain signals.

Fibromyalgia is one type of FPS.

Fibromyalgia is a type of Functional Pain Syndrome, which means it causes real pain even though doctors can't find a clear injury or damage in the body.

In my opinion, it would be very helpful if doctors could tell us something about a brand-new pain we are experiencing - is it caused by Fibromyalgia or by something else? Is it just fibromyalgia that just feels different or is showing up in a new area? Is it relted to something completely different and not fibromyalgia? But fibro does not seem to work like that. It is not clear cut and cannot be seen in any blood tests or xrays etc. 

People with fibromyalgia often feel pain from things that wouldn’t bother most people — like a light touch. This is likely because their nervous system has become overly sensitive, a process known as central sensitization.

What is perceived as touch in an individual from the general population is perceived as pain in individuals suffering from FM. This is probably due to their central sensitization.  

Dr David Crabtree & Dr Praveen Ganty 

Central sensitization means the brain and spinal cord react too strongly to pain signals. This happens because of a complicated mix of chemicals in the body that either increase or decrease pain. This might also explain why people with fibromyalgia often feel tired, have memory issues, and struggle with sleep and mood problems.

How does knowing all this help me (I can here you asking)

Knowing that fibromyalgia is a Functional Pain Syndrome can be really comforting and helpful, especially when you're trying to make sense of what’s going on with your body.

It means:

💡 Your pain is real.
Even if tests come back normal, what you’re feeling isn’t "in your head." Your nervous system is just working differently and that’s something good doctors now understand better.

🧭 You’re not alone.
There are many others living with the same condition. It has a name, it has patterns, and there are communities and support out there.

🌱 There are ways to feel better.
Once doctors know what’s really going on, they can focus on treatments that actually help like managing stress, improving sleep, gentle movement, and sometimes medications that calm the nervous system.

❤️ It’s not your fault.
You didn’t cause this. Your brain and body are reacting in a certain way, and now that there’s a clearer understanding of why, you can be kinder to yourself and more hopeful moving forward.

These sources go into more depth if you want to explore the science or treatment options further: 

1. Mayo Clinic Proceedings – “Fibromyalgia: Understanding the Pathogenesis”
   https://www.mayoclinicproceedings.org/article/S0025-6196(15)00243-8/fulltext

2. ScienceDirect – “Neurobiology of central sensitization”
   https://www.sciencedirect.com/science/article/pii/S0306452216302366

3. Verywell Health – “Understanding Central Sensitivity Syndromes”
   https://www.verywellhealth.com/central-sensitivity-syndromes-716160

4. Cleveland Clinic Journal of Medicine (CCJM) – “Fibromyalgia and Central Sensitization Syndrome”
   https://www.ccjm.org/content/90/4/245

5. Common Functional Pain Syndromes                        https://www.bjaed.org/article/S2058-5349(17)30034-3/fulltext

How do doctors tell if it's fibromyalgia or another condition?​

So how do doctors differentiate fibromyalgia from other conditions since fibromyalgia shares symptoms with many other conditions like chronic fatigue syndrome, rheumatoid arthritis, and lupus. 

Here's how doctors usually differentiate fibromyalgia from other diagnoses:​

🩺 1. Patient History & Symptoms

Doctors start by listening to your story:

• Widespread pain (on both sides of the body, above and below the waist)

• Fatigue

• Sleep disturbances

• Cognitive issues ("fibro fog")

• Sensitivity to touch (allodynia), light, sound, or temperature

They’ll also ask:

• How long symptoms have lasted (typically 3+ months)

• If symptoms are persistent or come and go

---

✅ 2. American College of Rheumatology (ACR) Criteria

Instead of the old "tender point" test, doctors now often use these criteria:

• Widespread Pain Index (WPI): Scores how many areas of the body hurt

• Symptom Severity Scale (SSS): Assesses fatigue, cognitive symptoms, and unrefreshing sleep

• A diagnosis is supported if the WPI and SSS scores meet a certain threshold, without another disorder explaining the symptoms.

---

🧪 3. Rule Out Other Conditions

There’s no lab test for fibromyalgia, so doctors order blood work to rule out other possible causes, such as:

• Thyroid disorders

• Vitamin deficiencies (like B12 or D)

• Autoimmune diseases (e.g. lupus, rheumatoid arthritis)

• Anemia

• Infections

---

🤯 4. No Inflammation or Tissue Damage

Fibromyalgia pain doesn’t come from inflammation or joint damage (unlike arthritis or lupus), and imaging usually shows no structural problems. If a patient has pain but normal blood tests and imaging, it supports a fibro diagnosis.

---

🧬 5. Central Sensitization

Doctors consider whether pain may be amplified by the central nervous system. Fibromyalgia is a central sensitivity syndrome, meaning the brain and nerves are overly reactive to sensory input.

---

💡 Bonus: Common Mistaken Diagnoses

Sometimes fibromyalgia is confused with:

• Chronic Fatigue Syndrome (CFS/ME)

• Lyme disease

• Depression or anxiety disorders

• Myofascial pain syndrome

• Multiple sclerosis (MS)

So careful differential diagnosis is key.

I hope this clears up some of the questions you have about why fibromyalgia is diagnosed and not another condition. Of course you can have Fibromyalgia and other diseases as well. 😕 I personally have autoimmune conditions and osteoarthritis as well as Fibro. 

You may also find the following articles interesting:

• How can a doctor diagnose Fibromyalgia which includes why you may find it difficult to get a diagnosis. 
• 14 reasons it may NOT be Fibromyalgia
• 2010 set of criteria for diagnosing Fibromyalgia. 

Treatment options for sleep disorders common in Fibromyalgia

Here is a breakdown of treatments specifically for sleep disorders, especially as it relates to fibromyalgia and a list of reliable sources that support the information.

🛌 General Treatment Options:

1. Sleep Hygiene Practices

• Keep a consistent sleep schedule

• Avoid screens 1-2 hours before bed

• Make the bedroom dark, cool, and quiet

• Use the bed only for sleep and intimacy

• Limit caffeine and alcohol

2. Medications

• Low-dose tricyclic antidepressants (e.g., amitriptyline) – often used to improve deep sleep

• Cyclobenzaprine – a muscle relaxant that can improve sleep

• Pregabalin (Lyrica) / Gabapentin – help with nerve pain and sleep

• Melatonin – natural sleep hormone to help regulate circadian rhythm

• Zolpidem (Ambien) or other sleep aids – sometimes used short-term

3. Supplements

• Magnesium – may help relax muscles and support better sleep

• 5-HTP – can improve serotonin, potentially aiding mood and sleep

• Valerian root – herbal remedy used for sleep

• CBD – anecdotal support for pain relief and relaxation

4. Cognitive Behavioral Therapy for Insomnia (CBT-I)

• One of the most effective long-term treatments for sleep issues

• Helps break cycles of negative sleep habits and anxiety about sleep

5. Treating Co-Existing Conditions

• Sleep apnea: use of CPAP machines

• RLS: iron supplementation or medications like pramipexole

• Managing depression and anxiety, which often impact sleep

6. Gentle Exercise

• Light stretching, yoga, or walking daily can improve sleep quality

• Avoid intense workouts late in the evening

7. Relaxation Techniques

• Guided meditation, breathing exercises, or progressive muscle relaxation before bed

• Apps like Calm or Insight Timer can help

🛌 Specific Treatment Options for Insomnia can be found here

🔬 Scientific & Medical Sources:

1. National Institutes of Health (NIH)

   • Cognitive Behavioral Therapy for Insomnia (CBT-I)
     NIH recognizes CBT-I as a highly effective, evidence-based treatment for chronic insomnia.

2. American College of Rheumatology

   • Recommends low-dose tricyclic antidepressants (e.g., amitriptyline) and muscle relaxants like cyclobenzaprine to help with pain and sleep in fibromyalgia patients.

3. National Sleep Foundation

   • Sleep Hygiene Tips and info on how habits affect insomnia.

4. Mayo Clinic

   • Melatonin and other sleep supplements, info on prescription sleep aids, and managing insomnia in chronic conditions.

5. Journal of Clinical Sleep Medicine (JCSM)

   • Research articles on effectiveness of CBT-I and concerns about long-term use of prescription sleep medications.

6. Arthritis Foundation

   • Articles on fibromyalgia and sleep, emphasizing the need for a combined approach: meds, lifestyle, and therapy.

---

📚 Peer-Reviewed Research Examples:

• Osorio et al. (2015), “The effectiveness of CBT-I in patients with fibromyalgia: A meta-analysis” – Sleep Medicine Reviews

  Found CBT-I improves both sleep and pain levels in fibromyalgia patients.

• Choy, E. (2015) “The role of sleep in pain and fibromyalgia” – Nature Reviews Rheumatology

  Discusses how sleep disruption worsens fibromyalgia symptoms and how restoring sleep improves quality of life.