Fibromyalgia can cause widespread pain, fatigue, sleep disruption, brain fog, sensitivity, headaches, stiffness, and overlapping chronic pain symptoms.
This video explains how fibromyalgia may involve nervous system sensitivity, widespread pain, fatigue, sleep, brain fog, and coordinated care.
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I’m Dr. Jason Siefferman and medical director of Manhattan Pain Medicine.
Fibromyalgia is a widely misunderstood diagnosis. At its core, it means that the central nervous system is sensitized and pain is being perceived as more intense than it really should be. This often occurs after a physical trauma such as a brain injury, car accident, neck injury, something like that. But we also see it with cancer pain, with multiple sclerosis, with other neurologic system issues.
If someone comes in and we notice that there is some diffuse hypersensitivity that fits the picture of fibromyalgia, we first want to make sure that there’s not some other primary process actually driving that—masquerading as fibromyalgia, getting misdiagnosed as fibromyalgia. One of the bigger problems, one of the bigger issues we encounter is that many patients are labeled with fibromyalgia when it’s not actually fibromyalgia. And of course, when it’s mislabeled, the wrong treatments are given and the patients don’t find relief.
So when a patient comes to us with fibromyalgia who hasn’t had relief, which is why they’re coming to us, we generally do the work of figuring out what is the actual, or what are the actual primary underlying diagnoses that are causing this pain.
Within the spectrum of underlying conditions, we look for autoimmune—something like rheumatoid arthritis, Sjögren’s, psoriatic arthritis. These are often seronegative, meaning the patient may have had a rheumatologic blood workup and nothing showed up. Seronegative means it doesn’t show up in the blood. They may have a systemic post-infectious inflammatory process—something like post-COVID, chronic Lyme, chronic Epstein-Barr. This is something that also goes unnoticed, unchecked with labs frequently. There may be some mast cell activation syndrome. We’ve seen patients with just hypermobility who are told they have fibromyalgia, but in fact, they’re really just hypermobile and that’s what’s driving the sensitization. They may have some craniocervical instability or Chiari malformation that’s causing sensitization of their nervous system globally, and that wasn’t identified and wasn’t treated.
So they continue to have pain and then often side effects from the medications given for fibromyalgia, along with the frustration of not finding relief and being told it’s in their head. Know that if you have been told you have fibromyalgia, we’ll make sure. And if you suspect you may have fibromyalgia, we’ll make sure. And whatever it is you have, we’ll find the appropriate treatment and get you on that path so that you can have some relief.
Fibromyalgia is a chronic pain condition associated with widespread pain, tenderness, fatigue, sleep problems, cognitive symptoms, and heightened sensitivity. It is not considered an inflammatory or autoimmune disease, but it can coexist with autoimmune, rheumatic, neurologic, headache, pelvic, hypermobility, and central pain conditions.
Many patients describe aching, burning, stiffness, brain fog, poor sleep, sensory sensitivity, headaches, or pain that flares without a clear structural injury. Because fibromyalgia can overlap with many other conditions, careful evaluation is important before assuming that every symptom is caused by fibromyalgia alone.
At Manhattan Pain Medicine, evaluation begins by identifying whether symptoms appear centralized, neuropathic, inflammatory, musculoskeletal, autonomic, headache-related, pelvic, hypermobility-related, psychological, or mixed.
For patients looking for fibromyalgia treatment in Manhattan, MPM uses a diagnosis-first approach to understand pain distribution, fatigue, sleep, brain fog, sensitivity, flares, prior testing, and overlapping diagnoses.
Care may include medication management, pain psychology, biofeedback, acupuncture, Feldenkrais, weight support when relevant, movement pacing, sleep-focused strategies, and selected advanced options only when clinically appropriate.
Jason W. Siefferman, MD
Medical Director | Interventional Pain Management | Headache Medicine
Luis Aranguren, MD
Interventional Pain Management
Adam Rosenberg, PA-C
Board-Certified Physician Assistant
Jordan Shankle, PA-C
Board-Certified Physician Assistant
Nino Mikaberidze, MD
Director of Rheumatology & Internal Medicine
Deborah Barbiere, Psy.D., L.Ac.
Pain Psychology
Fibromyalgia is often misunderstood because patients may have severe symptoms even when imaging, bloodwork, or localized structural testing does not fully explain the pain. This does not mean the pain is imagined, exaggerated, or a sign of weakness. Fibromyalgia is commonly understood as involving altered pain processing and nervous system sensitivity.
At the same time, fibromyalgia should not be used as a default explanation before other relevant causes are considered. Widespread pain, fatigue, stiffness, headaches, numbness, tingling, pelvic pain, abdominal symptoms, and brain fog can also overlap with autoimmune-related pain, undifferentiated connective tissue disease, arthritis joint pain, peripheral neuropathy, headache and migraine, MCAS-like symptoms, POTS, EDS, hypermobility spectrum disorder, post-COVID pain, and central pain syndromes. MPM evaluates these possibilities carefully so care is precise and validating.
Fibromyalgia can intersect with many MPM Zones of Expertise, with strongest relevance to Complex Chronic Pain, Psychology of Pain, Autonomic Dysfunction, Musculoskeletal issues, Headache, Hypermobility, Pelvic Pain, and Autoimmune and Inflammatory concerns. This matters because patients rarely present with widespread pain alone. They may also have migraines, pelvic pain, abdominal symptoms, joint stiffness, fatigue, dysautonomia, hypermobility, autoimmune-like symptoms, or sensory sensitivity.
MPM uses the Zones of Expertise framework to evaluate whether symptoms appear centralized, musculoskeletal, headache-related, pelvic, autonomic, inflammatory, hypermobility-related, neuropathic, or mixed. For some patients, fibromyalgia is the primary diagnosis. For others, fibromyalgia-like symptoms coexist with another condition that also needs targeted care.
I cannot say enough good things about Manhattan Pain Medicine. From the moment I walked in, I felt truly cared for and taken seriously. Dr. Nino Mikaberidze, Director of Rheumatology, is exceptional — knowledgeable, compassionate, and incredibly thorough. She takes the time to listen, explains every...
The best care I've received as a chronic pain patient. I traveled from out of state to visit Manhattan Pain Medicine because I could not find knowledgeable doctors in my hometown for my hypermobility, and Ehlers-Danlos syndrome symptoms and comorbidities. Let me tell you, it was worth every travel e...
I was injured in a bicycle accident over 8 years ago. I’ve suffered throughout the years since my accident with nothing seeming to work. PT, Yoga, lifestyle changes, NOTHNG! I finally made an appointment with Dr Kane and I’m feeling an improvement in my life. I no longer stay up all night in pain, a...
One of the best experiences, if not the best, I have ever had at the doctor’s office. From the front desk to the nurses to the PA assisting the doctor this was a great experience. Dr.Nino actually listened to me and came up with a game plan. Would recommend this practice to as many people as I could...
I have very unique & severe nerve pain from CRPS which has no known specific cure. Dr. Siefferman has a huge tool box, far greater than the other 23 Drs. I have seen. He saved me from jumping off a bridge and continues to help me with both treatments and advice. Dr. S. is in a different league!
After two years of searching and feeling lost and let down, I finally found real help at Manhattan Pain Medicine. With Dr. Siefferman, Adam Rosenberg, Dr. Mikaberidze, and the whole team, I feel heard, supported and understood. Every symptom is being considered and I’m finally getting answers with m...
Why is Dr Dr. Tayyaba Ahmed one of the top pevic Floor specialists - 1- She wants to know a full history of what led the patient to get to this point. 2 - She listens intensley to the patient 3- She does not rush you 4- Extremely skilled at giving pelvic floor injections 5- I thank my luck stars she...
The staff was friendly and helpful. Dr. Siefferman was thoughtful, listened, asked questions and proposed simple safe ways to come to further conclusions regarding my pain and discomfort. The office staff including Dr. Siefferman is responsive even after the initial in-person visit. Very pleased.
Dr. Siefferman is a brilliant provider. While my pain is still a work in progress, Dr Siefferman always gives me options and explains his reasoning behind things. He listens to my feedback and concerns. I never feel rushed; and am grateful he works to meet me where I am. I highly recommend him.
What a great find! They listen to me, I listen to them and the diagnosis is made and a plan developed to develop an approach to treat all of my chronic pain. I wish I could have discovered this type of treatment sooner. This doctor and group give me hope.
Fibromyalgia is a chronic condition associated with widespread pain, tenderness, fatigue, sleep disruption, cognitive symptoms, and heightened sensitivity. Patients may describe pain throughout the body, muscle and joint stiffness, brain fog, poor sleep, tingling, headaches, or sensitivity to light, sound, odors, touch, or temperature. Fibromyalgia is real and often involves nervous system sensitivity and altered pain processing. It is not considered an inflammatory or autoimmune disease, but it can coexist with autoimmune, rheumatic, neurologic, headache, pelvic, hypermobility, and central pain conditions.
Fibromyalgia may feel like aching, burning, throbbing, stiffness, tenderness, muscle soreness, joint pain, or widespread sensitivity. Some patients feel exhausted even after sleeping. Others experience brain fog, headaches, numbness, tingling, digestive symptoms, pelvic pain, poor exercise tolerance, or flares after stress, poor sleep, illness, weather changes, or overactivity. Symptoms can vary from day to day. Because widespread pain and fatigue can have many causes, evaluation should include other possible contributors, including inflammatory disease, neuropathy, headache disorders, autonomic dysfunction, sleep disorders, endocrine conditions, and musculoskeletal pain.
Fibromyalgia is not currently classified as an inflammatory or autoimmune disease. The American College of Rheumatology states that fibromyalgia is not an inflammatory or autoimmune disease and that research suggests the nervous system is involved. However, fibromyalgia can coexist with autoimmune or rheumatic conditions such as rheumatoid arthritis, lupus, Sjogren’s syndrome, undifferentiated connective tissue disease, or autoimmune-related pain. This distinction matters because autoimmune inflammation and fibromyalgia are treated differently. MPM evaluates both possibilities so symptoms are not dismissed, mislabeled, or over-attributed to one diagnosis.
Fibromyalgia diagnosis is based on symptoms, medical history, physical examination, pain distribution, fatigue, sleep problems, cognitive symptoms, and evaluation for other possible causes. There is no single lab or imaging test that confirms fibromyalgia. Clinicians may use bloodwork, imaging, sleep evaluation, neurologic assessment, rheumatology review, or other testing to rule out conditions that can cause similar symptoms. These may include autoimmune disease, inflammatory arthritis, thyroid disease, neuropathy, vitamin deficiency, sleep disorders, infection, medication effects, and other pain conditions. Diagnosis should validate the symptoms while still looking carefully for treatable overlaps.
Fibromyalgia treatment is usually multimodal. Options may include movement therapy, graded activity, sleep support, medication management, pain psychology, behavioral therapy, biofeedback, acupuncture, Feldenkrais, stress regulation, pacing strategies, and self-management support. Some medications may target pain processing, sleep, mood, or nerve-related symptoms when appropriate. The treatment plan should be individualized because no single approach works for every patient. MPM also evaluates overlapping pain generators, such as migraine, pelvic pain, neuropathy, hypermobility, musculoskeletal strain, or autoimmune-related symptoms, so targeted care can be added when needed.
Yes. Fibromyalgia can overlap with headache and migraine, pelvic pain, POTS, MCAS-like symptoms, EDS, hypermobility spectrum disorder, peripheral neuropathy, post-COVID pain, central pain syndromes, and autoimmune-related symptoms. These overlaps should be evaluated carefully rather than assumed. For example, a patient with widespread pain and migraines may need headache-focused treatment. A patient with pelvic pain may need pelvic pain evaluation. A patient with dizziness and tachycardia may need autonomic assessment. MPM’s role is to identify how these symptoms fit together and build a coordinated plan.
Yes. Pain psychology can help fibromyalgia by supporting nervous system regulation, coping, sleep, stress management, pacing, fear of movement, flare planning, and function. It does not mean the pain is imagined, exaggerated, or purely emotional. Fibromyalgia pain is real and often involves changes in how the nervous system processes pain and threat. Pain psychology can help patients understand pain patterns, reduce symptom fear, communicate more clearly, build self-management tools, and stay engaged with daily function while medical and movement-based care continue.
There is no known cure for fibromyalgia, but symptoms can often be managed with a coordinated, individualized plan. NIAMS states that there is no cure, and treatment typically includes movement therapies, psychological and behavioral therapy, and medications. The goal is to reduce symptom burden, improve function, support sleep, manage flares, and address overlapping conditions when present. Improvement is often gradual and may require adjustments over time. MPM avoids promising cure or complete relief, but supports patients through diagnosis-first evaluation and practical care planning.
Before care begins, our team helps patients understand the practical side of treatment, including insurance verification, out-of-network benefits, cost-share estimates, self-pay options, and billing questions. We believe patients should have as much clarity as possible before moving forward.
Fibromyalgia is a chronic pain condition associated with widespread pain, fatigue, sleep problems, cognitive symptoms, tenderness, and heightened sensitivity. Patients may describe feeling as though the whole body hurts, even when imaging or local tissue testing does not explain the intensity of symptoms.
Fibromyalgia is real. It is not imagined, exaggerated, or a sign of weakness. It is commonly understood as involving changes in how the nervous system processes pain and sensory information. This can make pain feel amplified, widespread, or triggered by normal activities, poor sleep, stress, illness, weather changes, or sensory input.
Fibromyalgia can cause aching, burning, throbbing, stiffness, tenderness, muscle soreness, joint pain, and sensitivity to touch. Many patients also experience fatigue, poor sleep, brain fog, headaches, numbness, tingling, pelvic pain, abdominal symptoms, dizziness, or sensitivity to light, sound, odors, and temperature.
Symptoms may flare and improve. A patient may feel worse after overactivity, stress, poor sleep, infection, hormonal changes, travel, or emotional strain. Others may wake up already exhausted or feel that movement helps slightly but too much activity causes a flare. These patterns can be difficult to manage without a structured plan.
Central sensitization refers to increased sensitivity in the nervous system. In this state, pain signals may be amplified, last longer, spread more widely, or continue after tissues have healed. Fibromyalgia is often discussed within this broader nervous system framework.
This does not mean the body should not be evaluated. Central sensitization can coexist with local pain generators. A patient may have fibromyalgia and migraine, pelvic pain, arthritis joint pain, hypermobility, tendinopathy, peripheral neuropathy, autoimmune-related pain, or post-COVID pain. A diagnosis-first approach asks which symptoms are primarily centralized and which may need targeted treatment.
Fibromyalgia is not classified as an autoimmune or inflammatory disease. It is generally understood as involving the nervous system rather than primary inflammation or autoimmunity.
However, fibromyalgia can coexist with autoimmune or rheumatic conditions. Some patients with rheumatoid arthritis, lupus, Sjogren’s syndrome, undifferentiated connective tissue disease, or autoimmune-related pain may also develop fibromyalgia-like widespread sensitivity. This can complicate diagnosis because pain may remain high even when inflammation is controlled. MPM evaluates both inflammatory and centralized contributors so treatment is not oversimplified.
There is no single lab test or imaging study that confirms fibromyalgia. Diagnosis is based on the symptom pattern, pain distribution, fatigue, sleep disturbance, cognitive symptoms, tenderness, duration, and evaluation for other possible causes.
Evaluation may include review of bloodwork, inflammatory markers, thyroid function, vitamin levels, neurologic symptoms, autoimmune history, sleep quality, medication effects, prior injuries, imaging, and specialist notes. This helps avoid using fibromyalgia as a default label before other relevant causes are considered.
Fibromyalgia treatment is usually multimodal. Treatment may include movement-based care, psychological and behavioral support, medication management, and other strategies aimed at reducing symptoms and improving overall function.
Movement is often important, but it must be paced carefully. Many patients have learned that pushing too hard can trigger flares. A plan may include gentle graded activity, mobility work, Feldenkrais, physical therapy coordination, pacing strategies, and gradual strengthening when tolerated.
Medication management may target pain processing, sleep, nerve-related symptoms, mood-related pain burden, or flare patterns. Acupuncture may be considered as part of a broader chronic pain plan. Biofeedback can help patients understand how breathing, muscle tension, stress physiology, and autonomic activation interact with symptoms. Pain psychology can support coping, sleep, pacing, fear of movement, and nervous system regulation.
Some patients ask about ketamine therapy, lidocaine and ketamine infusions, botulinum toxin, or regenerative medicine. These are not standard treatments for fibromyalgia as a whole. They may be considered only when a specific symptom pattern or overlapping condition supports their use. For example, botulinum toxin may be relevant for selected headache or muscle-related patterns, not generalized fibromyalgia. Regenerative medicine should not be described as treating fibromyalgia directly.
MPM’s approach is to match treatment to the diagnosis and pain drivers. The care plan may look different for a patient with fibromyalgia and migraine than for a patient with fibromyalgia and pelvic pain, hypermobility, autoimmune overlap, or peripheral neuropathy.
Patients should seek timely medical evaluation for new neurologic deficits, fever, unexplained weight loss, inflammatory joint swelling, chest pain, shortness of breath, new severe headache, cancer history with new pain, progressive weakness, bowel or bladder changes, or rapidly worsening symptoms. These symptoms should not be assumed to be fibromyalgia without evaluation.
MPM approaches fibromyalgia through a diagnosis-first, coordinated model. The evaluation considers central sensitization, widespread pain, sleep, fatigue, brain fog, musculoskeletal pain, headache and migraine, pelvic pain, autonomic symptoms, hypermobility, autoimmune-related pain, peripheral neuropathy, MCAS-like symptoms, post-COVID pain, and emotional burden.
For patients looking for fibromyalgia treatment in Manhattan, MPM offers a careful, validating approach to widespread pain and chronic symptom overlap. The goal is to clarify the pain pattern, identify treatable contributors, support nervous system regulation, improve function where possible, and build a coordinated plan that respects the reality and complexity of fibromyalgia.
