What Actually Causes Fibromyalgia? The Mitochondrial, Mast Cell, and Small Fiber Neuropathy Mechanisms Standard Treatment Misses — The patterns that suggest the framework applies

Fibromyalgia cases that benefit most from a Host Capacity Model approach share specific features: inadequate response to first-line treatments (pregabalin, duloxetine, gabapentin, milnacipran); side effects from standard treatments that outweigh benefits; profound post-exertional fatigue suggesting Driver 1; concurrent MCAS-spectrum symptoms suggesting Driver 2; burning or shooting pain quality (not just dull aching) suggesting Driver 3; concurrent gastrointestinal symptoms suggesting Driver 4; pattern of multiple overlapping syndromes (fibromyalgia + IBS + migraine + POTS + hEDS-spectrum hypermobility); onset or worsening following identifiable triggers (infection, surgery, severe stress, antibiotic course); family history of similar overlapping syndromes; and a sense from the patient that the standard medical model has not captured what is happening in their body.