Chronic Pain & Fatigue Care
Fibromyalgia
Our board-certified rheumatologists diagnose and treat fibromyalgia, the widespread muscle pain, exhaustion, and mental fog that so many patients are told is "all in their head." It is a real condition with real mechanisms, and it responds to real treatment. We confirm what is happening, rule out what else it could be, and build a plan that gives you your life back.
What Fibromyalgia Actually Is
Fibromyalgia is a disorder of how your body processes pain. The problem is not in the muscles or the joints themselves. It sits in the nervous system, where the volume knob on pain signals has been turned up and left there. Your brain and spinal cord amplify sensations that should be minor, so a light touch registers as pain and ordinary pressure registers as agony.
This is why the standard tests come back clean. Your blood work looks normal. Your X-rays look normal. There is no swelling to point to and no joint erosion to photograph. That absence of evidence is exactly what leads so many patients to be dismissed for years, sent from one specialist to another, and quietly told the problem is stress or anxiety.
Here is what we want you to hear clearly. Fibromyalgia is a recognized medical condition, not a personality trait and not a failure of willpower. It affects millions of people, it frequently overlaps with autoimmune diseases like lupus and rheumatoid arthritis, and it has effective treatments. The first step is a physician who takes the symptoms seriously and knows what to look for.
How We Diagnose Fibromyalgia
There is no blood test that confirms fibromyalgia. We diagnose it by recognizing the pattern and by carefully ruling out the conditions that mimic it, which is precisely the work a rheumatologist is trained to do.
The evaluation has two halves. First, we look for the characteristic picture: pain that is widespread, present on both sides of the body, above and below the waist, and lasting at least three months, alongside fatigue, unrefreshing sleep, and cognitive difficulty. Second, we run targeted testing to exclude other causes, because fibromyalgia symptoms overlap with several treatable diseases.
| What We Rule Out | Why It Matters |
|---|---|
| Thyroid disease | An underactive thyroid causes fatigue, muscle aches, and fog that closely mimic fibromyalgia, and it is easily corrected once found. |
| Rheumatoid arthritis and lupus | These autoimmune diseases cause pain and exhaustion too, but they damage tissue, so missing them has real consequences. They can also coexist with fibromyalgia. |
| Inflammatory myositis | Autoimmune muscle inflammation causes true muscle weakness, not just pain, and shows up on specific muscle enzyme tests. |
| Vitamin D and B12 deficiency | Both produce diffuse aching and fatigue, and both are simple to test for and simple to correct. |
| Sleep apnea and sleep disorders | Poor sleep quality drives pain sensitivity, and untreated apnea can make fibromyalgia far worse than it needs to be. |
| Anemia and other blood disorders | Low blood counts cause profound fatigue that can be mistaken for the exhaustion of fibromyalgia. |
An important point: a normal blood panel does not mean nothing is wrong. It is part of how we arrive at the diagnosis, not evidence against it. When the pattern fits and other causes are excluded, fibromyalgia is a positive diagnosis, and we say so plainly rather than leaving you without an answer.
What Fibromyalgia Feels Like
Fibromyalgia is more than pain. Patients consistently describe a cluster of symptoms that feed one another, and understanding the whole cluster is what makes treatment work.
Widespread Pain
A deep, constant ache across the body that has lasted months, often described as burning, throbbing, or a feeling of having been hit by a truck. It moves and shifts rather than staying in one joint.
Tenderness to Touch
Pressure that should not hurt does. A hug, a waistband, or a hand on the shoulder can be genuinely painful, because the pain threshold itself has dropped.
Overwhelming Fatigue
Not ordinary tiredness. This is exhaustion that sleep does not fix, where you wake as depleted as when you went to bed and the day feels like walking through water.
Unrefreshing Sleep
Many patients fall asleep but never reach the deep, restorative stages. The sleep problem and the pain problem drive each other, which is why we treat both.
Cognitive Fog
Often called "fibro fog." Trouble concentrating, losing words mid-sentence, forgetting why you walked into a room. It is one of the most distressing symptoms and one of the least discussed.
Headaches and Migraines
Frequent tension headaches and migraines are common companions, along with jaw pain and facial tenderness.
Digestive Symptoms
Irritable bowel symptoms, bloating, and abdominal discomfort overlap heavily with fibromyalgia and share the same heightened nerve sensitivity.
Stiffness and Numbness
Morning stiffness, tingling in the hands and feet, and a sense of swelling in the fingers even when nothing visible is there.
Mood and Anxiety
Living with chronic pain and being disbelieved takes a toll. Depression and anxiety are common and deserve treatment in their own right, not as a dismissal of your pain.
Fibromyalgia Services We Provide
Fibromyalgia does not respond to a single pill. The treatments that work are combinations, tailored to which symptoms dominate for you, and adjusted over time. Here is what we offer.
Comprehensive Evaluation
We take a full history, perform a hands-on exam, and run the blood work needed to exclude thyroid disease, autoimmune conditions, and deficiencies, so you get a real answer rather than a shrug.
Overlap Condition Screening
Fibromyalgia often coexists with lupus, rheumatoid arthritis, and Sjögren's. As rheumatologists, we are the specialists who can identify both and treat each appropriately.
Medication Management
We prescribe and fine-tune the medications proven to help, starting low and adjusting carefully so you get benefit without being flattened by side effects.
Sleep Optimization
Because poor sleep amplifies pain, we address sleep directly, including screening for sleep apnea and treating the unrefreshing sleep that fuels the cycle.
Exercise and Therapy Guidance
Movement is one of the most effective treatments, but only when it is paced correctly. We help you start gently enough to avoid a flare and refer to physical therapy when useful.
Long-Term Follow-Up
Fibromyalgia fluctuates. We track what is working, adjust as your symptoms shift, and stay with you rather than sending you off with a prescription and no plan.
Fibromyalgia Treatment Options We Prescribe and Manage
The best results come from combining approaches rather than relying on any one. We build your plan around the symptoms that are costing you the most, whether that is pain, exhaustion, sleep, or fog. Here are the main tools we use.
- Medications that calm nerve signaling
- Duloxetine, milnacipran, and pregabalin are the therapies specifically studied for fibromyalgia. They work on how pain is processed in the nervous system rather than on inflammation. We start low, increase slowly, and find your effective dose.
- Sleep-directed treatment
- Restorative sleep is not optional in fibromyalgia. Certain medications taken at night improve deep sleep and reduce next-day pain, and we screen for sleep apnea when the picture suggests it.
- Graded exercise and movement
- The evidence here is strong. Gentle aerobic activity, walking, water exercise, and light strength work reduce pain over time. The key is pacing: starting well below what feels possible and building gradually, so you avoid the crash that discourages most people.
- Cognitive behavioral therapy and pain psychology
- This is not a suggestion that your pain is imaginary. CBT is a proven tool for changing how the nervous system responds to pain, improving sleep, and restoring function, and we refer to therapists experienced in chronic pain.
- Treating what travels with it
- We address the overlapping conditions, including depression, anxiety, migraine, irritable bowel symptoms, and vitamin deficiencies, because leaving them untreated keeps the pain amplified.
We will also be honest with you about what does not work. Opioids are not effective for fibromyalgia and can make pain sensitivity worse over time, so we steer toward treatments that have actually been shown to help.
When Should You See a Rheumatologist for Fibromyalgia?
Most fibromyalgia patients spend years without an answer. They are told to lose weight, reduce stress, or simply live with it. If any of the following describe you, an evaluation is worth your time.
- Widespread pain on both sides of the body that has lasted three months or longer
- Exhaustion that sleep does not relieve, no matter how many hours you get
- Waking up feeling as though you never slept
- Difficulty concentrating, finding words, or holding a thought, often called fibro fog
- Tenderness to light pressure or touch across the body
- Normal blood work and imaging despite feeling unmistakably unwell
- Being told repeatedly that nothing is wrong, or that the pain is stress or anxiety
- An existing autoimmune diagnosis alongside pain that treatment has not resolved
- Frequent headaches, irritable bowel symptoms, or numbness with the pain
Next step: call us and we will evaluate you properly. A clear diagnosis is often the turning point, because it finally makes the right treatment possible.
Who Is at Risk, and How You Manage Daily Life
Who Carries the Highest Risk
Fibromyalgia is diagnosed far more often in women, and most commonly in middle age, though it affects men and younger adults as well. A family history raises your risk, which suggests a genetic component. It frequently begins after a triggering event: a physical injury, surgery, an infection, or a period of significant psychological stress. It also occurs at much higher rates in people who already have lupus, rheumatoid arthritis, Sjögren's, or ankylosing spondylitis.
How You Take Back Ground
Pace yourself rather than pushing through good days and crashing after. Keep a consistent sleep schedule and protect it. Move every day, even a little, because inactivity worsens pain over time. Manage stress deliberately, since stress reliably amplifies symptoms. Be patient with medication, which often takes weeks to show benefit. And keep your appointments, because this condition shifts and your plan needs to shift with it.
Why Patients Choose Our Team for Fibromyalgia
We believe you. This matters more here than anywhere else in rheumatology. Our patients arrive after years of being doubted. We start from the assumption that your pain is real, because it is.
We rule things out properly. Fibromyalgia should never be a label applied because a doctor ran out of ideas. We do the work to exclude thyroid disease, autoimmune conditions, and deficiencies first.
We catch overlapping disease. Fibromyalgia often sits alongside lupus or rheumatoid arthritis. As rheumatologists, we are positioned to find both rather than mistaking one for the other.
We treat the whole cluster. Pain, sleep, fatigue, and fog all feed each other. Addressing only one leaves the cycle running, so we build a plan that takes on all of them.
We stay with you. Fibromyalgia is a long-term condition with good stretches and bad ones. We adjust your treatment over time rather than handing you a prescription and a closed door.
Meet the Doctors Who Treat Fibromyalgia
Our physicians are board-certified rheumatologists with deep experience in chronic pain, autoimmune disease, and complex musculoskeletal care.
Gilbert F. Gelfand, M.D.
Dr. Gelfand serves as Clinical Professor of Medicine at USC and Chief of Rheumatology at Rancho Los Amigos Medical Center, and he has cared for patients for more than 30 years.
Tien-I Karleen Su, M.D., FACR
Dr. Su co-founded Amicus Arthritis and Osteoporosis Center and brings more than 10 years of rheumatology practice, with a focus on patient-centered care for complex, long-term conditions.
Susan Mansourian, M.D., FACR
Dr. Mansourian is known for an empathetic, individualized approach, and she helps patients with complex rheumatologic conditions reach their best possible health outcomes.
Branden Ireifej, M.D.
Dr. Ireifej focuses on musculoskeletal and autoimmune conditions and works through an evidence-based approach with patient education and shared decision-making at every step.
Frequently Asked Questions About Fibromyalgia
Is fibromyalgia a real medical condition?
Yes. Fibromyalgia is a recognized disorder of pain processing in the central nervous system. Research has shown measurable differences in how pain signals are amplified in people who have it. The fact that routine blood tests come back normal does not mean the condition is imaginary; it means the problem is in signaling rather than in tissue damage.
Is there a blood test for fibromyalgia?
No single test confirms it. We diagnose fibromyalgia by recognizing the characteristic pattern of widespread pain, fatigue, unrefreshing sleep, and cognitive fog, and by running targeted tests to exclude conditions that mimic it, such as thyroid disease, lupus, and vitamin deficiencies.
Is fibromyalgia an autoimmune disease?
No. It does not involve the immune system attacking your tissue, and it does not damage joints or organs. However, it appears far more often in people who do have autoimmune conditions like lupus or rheumatoid arthritis, which is one reason a rheumatologist is the right specialist to sort it out.
Can fibromyalgia be cured?
There is no cure, but it can be managed well. Many patients achieve substantial and lasting improvement in pain, sleep, energy, and function with the right combination of medication, paced exercise, sleep treatment, and therapy. The goal is getting your life back, and that is realistic.
Does exercise make fibromyalgia worse?
Done wrong, yes. Pushing too hard too soon reliably triggers a flare, which is why so many patients give up on it. Done right, gentle and gradually increasing activity is one of the most effective treatments we have. The skill is in the pacing, and we help you find it.
Do I need a referral to be evaluated?
It depends on your insurance. HMO plans usually require a referral from your primary care doctor, while PPO plans often let you book directly. Call our office and our staff will check your plan with you.
Do you treat patients in Spanish?
Yes. We have Spanish-speaking physicians and staff, and a Spanish-language section on our website.
Schedule an Appointment with a Fibromyalgia Specialist
You are not imagining this, and you are not out of options. Whether you have been searching for an answer for years or you were handed the diagnosis and nothing else, our rheumatologists will take your symptoms seriously, rule out what needs ruling out, and build a plan that actually addresses the pain, the fatigue, and the fog.