A side-by-side comparison of the three most evidence-supported medications for fibromyalgia: duloxetine (Cymbalta), pregabalin (Lyrica), and amitriptyline, covering mechanisms, trial data, side effects, and practical prescribing considerations.
How chronic pain changes the brain: structural differences, functional changes in pain processing, the role of the prefrontal cortex, and evidence that some changes reverse with effective treatment.
A comparison of aerobic, strength, and aquatic exercise for fibromyalgia based on systematic review evidence: effect sizes, practical considerations, adherence, and how to choose.
What pain catastrophizing is, the three components (rumination, magnification, helplessness), its relationship to pain outcomes, why it is not blaming the patient, and how it is treated.
An evidence-based explanation of graded exposure for chronic pain and fibromyalgia: the fear-avoidance model, how exposure differs from graded activity, what the trials show, and practical implementation.
What hyperalgesia is, how it differs from allodynia, the spinal cord mechanisms that produce it, its role in fibromyalgia, and opioid-induced hyperalgesia.
What allodynia is, how central sensitization produces it, the types of allodynia found in fibromyalgia, and why understanding the mechanism matters for treatment and self-advocacy.
An explanation of wind-up pain (temporal summation) in chronic pain and fibromyalgia: the spinal cord mechanism, NMDA receptors, how it differs from normal pain processing, and what enhanced wind-up means for treatment.
The history of fibromyalgia tender points, why the 1990 ACR criteria used them, what problems emerged in clinical practice, and how the 2010 and 2016 criteria replaced them with the WPI and SSS.
How fibromyalgia disrupts sleep architecture, why poor sleep amplifies central sensitization, the alpha-delta intrusion finding, and evidence-based approaches to improving sleep in fibromyalgia.