What Actually Causes Fibromyalgia? The Mitochondrial, Mast Cell, and Small Fiber Neuropathy Mechanisms Standard Treatment Misses — Frequently asked questions about fibromyalgia

Is fibromyalgia a real disease or "all in my head"? Fibromyalgia is a real, organic, mechanistically definable condition. The "all in your head" framing reflects the historical limitations of the diagnostic workup that fibromyalgia patients are given. When the workup looks only for the diseases the workup was designed to detect, and does not find them, the alternative explanation that the symptoms have a different mechanistic basis was historically dismissed. The research literature has moved past this framing. Mitochondrial dysfunction, mast cell activation, small fiber neuropathy, and gut-brain axis dysfunction are all objectively documented in fibromyalgia populations. The disease has a substrate. The substrate is in a layer the standard workup does not measure. Why don't Lyrica and Cymbalta work for me? The most common reason is that the dominant driver in your case is producing peripheral input into central sensitization that the medications do not address. The medications reduce central amplification. They do not reduce the input. When the input continues, the response is partial. The framework above identifies four upstream drivers. Addressing the dominant driver in your specific case, alongside the central medications, typically produces meaningfully better response than the medications alone. Can fibromyalgia be cured? Cure is not the right framing. Substantial improve