Fibromyalgia and Neuroplastic Pain: What’s the Connection?

How can my pain be neuroplastic when I have an actual diagnosis?

I think fibromyalgia can make the idea of neuroplastic pain especially confusing, particularly if it took you years to get someone to take your symptoms seriously in the first place. Maybe you went through bloodwork, imaging, specialist appointments, and more “everything looks normal” conversations than you ever wanted to have before someone finally gave what you were experiencing a name. So when another person comes along and starts talking about the brain and nervous system, I can understand why your first reaction might be, Absolutely not. We are not doing this again. For a long time, people with fibromyalgia were told some version of “we can’t find anything wrong, so it must be psychological,” and that’s not what I’m saying here.

Fibromyalgia is real. The pain is real. But what modern pain science has learned about fibromyalgia actually gives us a much better explanation for how someone can experience widespread, sometimes debilitating pain without widespread tissue damage to account for it. Increasingly, researchers are looking at what is happening in the pain-processing system itself. And once we understand that, the connection between fibromyalgia and neuroplastic pain starts to make a lot more sense.

Fibromyalgia has changed the way we understand pain

For a long time, our understanding of pain was fairly straightforward: something in the body is damaged, nerves send that information to the brain, and the brain tells you it hurts. That model works pretty well when you step on a nail or sprain your ankle. It becomes much less useful when someone has pain throughout their body for years and testing doesn’t uncover widespread injury or disease that would explain it.

Fibromyalgia is one of the conditions that helped make that impossible to ignore. People can experience widespread pain and tenderness along with fatigue, sleep problems, brain fog, and increased sensitivity to things like touch, sound, or temperature. And today, fibromyalgia is widely considered an example of nociplastic pain—pain involving altered pain processing that cannot be fully explained by ongoing tissue damage or injury to the nerves themselves. Researchers have found differences in the way the nervous system processes and regulates sensory information in fibromyalgia and other nociplastic pain conditions.

If you’ve heard the term central sensitization, this is part of what people are talking about. Essentially, the nervous system has become more sensitive and more responsive. I sometimes think of it like the volume on a speaker being turned way up. The incoming signal doesn’t necessarily have to be enormous for the output to become enormous. Except instead of your neighbor playing music too loudly at 11 p.m., the output might be pain, tenderness, fatigue, or another uncomfortable sensation.

That distinction matters because it gives us a way to understand something that otherwise feels pretty baffling: How can my entire body hurt when no one can find damage throughout my entire body? The answer doesn’t have to be that the pain isn’t real. Pain does not require widespread tissue damage to be real. The nervous system itself can become extraordinarily good at amplifying and producing it.

This is also where I want to distinguish nociplastic pain from the term neuroplastic pain, because they aren’t technically interchangeable. Nociplastic pain is an established pain-science classification. Neuroplastic pain is language commonly used in approaches like Pain Reprocessing Therapy to describe pain that is being generated or maintained through learned neural pathways and the brain’s interpretation of danger. There is plenty of overlap between the ideas, but I wouldn’t say, “You have fibromyalgia, therefore every symptom you experience is definitely neuroplastic.”

Fibromyalgia is still being studied, and there probably isn’t one single mechanism that explains every person’s experience. Researchers continue to investigate central and peripheral nervous-system changes, immune processes, genetics, sleep, stress physiology, and other possible contributors. I don’t think replacing everything is structural with everything is neuroplastic does anyone much good.

What I do think is exciting is that fibromyalgia gives us very good reason to look beyond tissue damage and ask what the nervous system is doing with the information it receives.

And that gives us something to work with.

A sensitive nervous system can also learn what to fear

Imagine you wake up one morning and your legs feel heavy and achy. Before you’ve even gotten out of bed, you think, Oh no. Is today going to be a bad day? You stand up and check. Your legs still hurt. Then you notice your shoulders are sore too, and by breakfast you have a pretty good idea of how you expect the rest of the day to go.

I don’t blame you for that response. If your body has repeatedly blindsided you with pain and fatigue, of course you’re going to pay attention to it. If doing too much has been followed by a horrible flare twenty times, it makes perfect sense that the twenty-first time you consider doing something, your brain goes, Are we sure about this? If exercise, poor sleep, stress, certain movements, or particular sensations have repeatedly been followed by symptoms, your brain has a lot of history to draw from.

The brain is constantly using previous experiences to predict what is likely to happen next. Most of the time, that’s extremely useful. But it also means that pain can become something the brain learns to anticipate and protect against. A sensation appears, and instead of being just a sensation, it comes with everything your brain knows about what happened the last fifty times you felt it. You start checking whether it’s getting worse. You change your plans. Maybe you avoid an activity because you’re afraid of what tomorrow will look like if you do too much today.

Over time, the protection itself can become part of the cycle. Pain creates fear. Fear makes the sensation feel more dangerous and important. The nervous system becomes more vigilant, which makes sensations harder to ignore and can make the brain more likely to produce pain in response to them.

This doesn’t mean you caused your fibromyalgia by being anxious. It doesn’t mean that if you could just relax more, you’d be fine. And it certainly doesn’t mean you should ignore your body and force yourself through every activity that hurts. It means that the way your brain has learned to interpret and respond to sensations may be one part of what is keeping the nervous system sensitized. And learned responses aren’t necessarily permanent.

This is where Pain Reprocessing Therapy starts to become particularly interesting for fibromyalgia.

What does the research tell us?

There is now some early research looking specifically at PRT for fibromyalgia. A 2025 pilot study tested a brief version of Pain Reprocessing Therapy with adults who had fibromyalgia. Participants received three individual telehealth sessions, and researchers found improvements in pain intensity, pain interference, and pain-related fear over the following three months. Among those who completed treatment, 42.3% described themselves as “much improved” or “very much improved” at the three-month follow-up.

I find that really encouraging, but I also want to be clear about what that study can and can’t tell us. It was a small pilot study without a control group, so this is not the same thing as a large randomized controlled trial proving that PRT treats fibromyalgia. It tells us that the approach showed enough promise in this population to justify studying it further, which I think is exciting without needing to turn it into something bigger than it is.

There’s also research on Emotional Awareness and Expression Therapy (EAET), another approach I sometimes incorporate into my work. In a randomized trial of 230 adults with fibromyalgia, researchers compared EAET with cognitive behavioral therapy and fibromyalgia education. EAET performed better than education on several outcomes, including widespread pain, physical functioning, overall symptoms, and the percentage of participants reporting substantial overall improvement. It performed similarly to CBT on many measures and showed some advantages on pain-related outcomes.

I find this research particularly interesting because EAET isn’t simply about calming down or managing stress better. It explores whether emotions, relationships, conflict, and experiences that the nervous system has learned to perceive as threatening may be contributing to symptoms. For one person, that might be an important part of the work. For another, we might spend much more time working directly with fear of sensations, movement, exercise, fatigue, or the possibility of a flare.

That’s why I don’t have a fibromyalgia protocol that I pull out of a drawer and march every client through. Two people can walk into my office—or, more accurately, appear in little boxes on my computer screen—with the exact same diagnosis and have very different patterns keeping their nervous systems on high alert.

I want to understand yours.

Your diagnosis doesn’t have to be the end of the story

A fibromyalgia diagnosis can bring an enormous amount of validation, especially if you spent years wondering what was happening to you or feeling like no one believed how much you were struggling. Finally having someone say, Yes, this is real, and it has a name, can matter. I don’t want to take that away. But I also don’t want the diagnosis to accidentally become a prediction about the rest of your life.

If you’ve been told that your nervous system is sensitized, that can sound like you’ve just been handed another permanent thing that’s wrong with you. I see something hopeful in it instead. The nervous system is plastic. It changes in response to experience. That’s part of how it learns to become more protective in the first place, and it also means those patterns aren’t necessarily set in stone.

We don’t know everything about fibromyalgia, and I don’t think responsible practitioners should pretend that we do. There may be multiple biological processes contributing to it, and appropriate medical care still matters. But we know enough to say that the amount of pain you feel is not simply a measurement of how damaged your body is. We know altered pain processing is an important part of fibromyalgia, and we’re beginning to see promising evidence that treatments targeting pain-related fear, the brain’s interpretation of sensations, and emotional processes can help at least some people with fibromyalgia.

For me, that opens a door.

You don’t have to decide that your fibromyalgia isn’t real to walk through it. You can believe your body and still become curious about whether your brain and nervous system have learned to protect it a little too well.

If you’re wondering whether your symptoms show patterns consistent with neuroplastic pain, my Neuroplastic Symptoms Self-Assessment is a good place to start. You may also want to read What Is Neuroplastic Pain?, or How Do I Know If My Symptoms Are Neuroplastic?

And if you want help looking at your own symptom history and figuring out whether PRT or EAET might make sense for you, I offer a free 15-minute connect call. You don’t need to come into that call already convinced your symptoms are neuroplastic. We can start with the evidence, talk through your particular patterns, and figure out together whether this approach makes sense for you.

Research referenced

Brief Pain Reprocessing Therapy for Fibromyalgia — 2025 pilot study

Emotional Awareness and Expression Therapy, CBT, and Education for Fibromyalgia — randomized controlled trial

⁠Nociplastic Pain: Clinical Features, Risk Factors, and Potential Mechanisms

The Concept of Nociplastic Pain: Where to From Here?