Fibromyalgia (FMS) is one of the most common chronic pain conditions, with more than 5 million sufferers in the U.S. Yet despite its ubiquity, it can be a long and frustrating road to diagnosis and treatment.

The pain of fibromyalgia is not like what you feel when you have a toothache or stub your toe. It’s chronic (lasts a long time—at least 3 months, or even longer), widespread (felt all over the body, but can also be concentrated in specific areas), and usually accompanied by tenderness (even light pressure can cause intense pain). Many people live with the pain caused by fibromyalgia for years before finally being diagnosed.

The symptoms can be different in every sufferer, they feel worse on some days and better on others, and they are also affected by stress or physical activity. Put these factors together, and it’s easy to see why fibromyalgia is so hard to diagnose.

Signs and symptoms

Pain related

  • Deep muscle pain, soreness
  • Stiffness in the morning
  • Flu-like aches
  • Radiating pain
  • Sensitivity to even a light touch

Other symptoms

  • Sleep problems
  • Fatigue
  • Trouble with thinking clearly, also known as “fibro fog”
  • Difficulty performing everyday tasks
  • Anxiety and stress
  • Depression
  • Migraines


Cognitive behavioral therapy (CBT) is a commonly used and well-researched non-drug treatment for fibromyalgia. While CBT is a psychological treatment, it’s also used to treat a host of physical ailments—so don’t make the mistake of thinking that a recommendation of therapy is a suggestion that your illness is “all in your head.”

What is cognitive behavioral therapy?

CBT is usually a short-term therapy, the goal of which is to change how you think about certain things, as well as your responses to them. For instance, research shows that many FMS sufferers do something known as “catastrophizing,” meaning they believe things are much worse than they really are. They say things like, “My pain is so horrible, and I know it will never get better.”

If that sounds like you, it’s possible that believing this can stop you from seeking out treatments that may in fact make you feel better. CBT can help you change your belief so you might instead say, “My pain might be bad, but I can find ways to make it better.”

Of course, changing how you think will not miraculously cure your illness, but it can improve your behaviors and responses, which can in turn lead to effective treatment and symptom management.

CBT often involves “homework” assignments as part of your sessions. You may also be encouraged to schedule an appointment every few months after your sessions have ended, just to check in and help you stay on track.

CBT as a treatment for fibromyalgia

Research shows that CBT can help improve the symptoms of FMS, especially when combined with other treatment types and is tailored to the patient’s specific needs. A 2010 meta-analysis of psychological treatments for fibromyalgia showed that CBT was the most effective. Many studies have found CBT to be effective as part of a program involving exercise and education (both patient and family). Others have looked at its effectiveness when combined with drug treatment, and they, too, have shown CBT to be beneficial. Still others found that CBT had a positive effect on multiple FMS symptoms, including insomnia, sleep quality, depression and anxiety, emotional distress, cognitive function (especially attention), alertness, daily function, exercise tolerance and general quality of life.

Reviews of research into CBT for FMS, however, suggest that some CBT practitioners rely more on behavioral interventions, so the specifics of treatment will vary from one therapist to another.

CBT can also be used to help you modify the activities trigger pain or other symptoms, find ways to exercise without causing a flare up, practice healthier sleep habits, adhere to your treatment plan, and pace yourself better.

In some studies, many people undergoing CBT have not only shown improvement during the course of their sessions, but have successfully maintained their progress afterwards. Preliminary research also suggests that CBT may actually lead to a physical change in how certain pain receptors (nociceptors) respond to stimuli, leading to a decrease in the amount of pain you feel. However, it’s still early days, and more research is needed to confirm these findings.