When the Body's Pain Volume Is Stuck on High

HMI Blog · Chronic pain & the mind · By Dr Saurabh Kumar, Consultant Neuropsychiatrist · MD (Psychiatry), AIIMS New Delhi · October 2026 · 10-minute read

Here is a sentence most people with fibromyalgia never hear from a doctor: your pain is real, your reports are normal, and both of those things are true at the same time.

That sentence sounds like a riddle until you understand one idea. Pain is not a direct reading of damage in the body. It is the brain’s judgement about danger, and in fibromyalgia that judgement is turned up too high.

In Patna, this condition usually arrives under other names: poore badan mein dard, “nas ki kamzori”, or a file full of normal X-rays, vitamin D injections and calcium tablets. This guide explains fibromyalgia in clear terms, why it sits as much with psychiatry as with rheumatology, and which treatments the evidence supports, including biofeedback and rTMS.

1. What is fibromyalgia?

Fibromyalgia is a long-term condition of widespread body pain, deep tiredness, unrefreshing sleep and poor concentration, caused by the nervous system amplifying pain signals. Muscles and joints are not damaged. Blood tests and scans look normal, yet the pain is genuine and often disabling.

Doctors now call this kind of pain nociplastic pain: pain that comes from changed pain processing, rather than from injury or a damaged nerve. Worldwide, roughly 2 to 3 in every 100 adults live with fibromyalgia, and women are affected more often.

Alongside pain, most people describe a cluster of other symptoms:

• waking tired even after eight hours in bed;
• “fibro fog”: forgetting words, losing track mid-task;
• headaches, jaw pain, an irritable bowel, tingling in hands and feet;
• sensitivity to noise, bright light, cold or perfume.

2. Why does it hurt everywhere? The volume knob

In fibromyalgia, the spinal cord and brain turn up incoming body signals, a process called central sensitisation. A firm handshake, a tight blouse or a long bus ride can register as pain. Poor sleep, stress and low mood turn the volume up further, which is why they matter so much.

Imagine a music system where the volume knob is stuck near maximum. The song has not changed; the speaker has. Brain imaging studies show that people with fibromyalgia process the same pressure as more painful, and that the brain’s own pain-dampening system works less well.

The goal of treatment is to turn the volume down. It rarely reaches zero, but daily life can return.

3. Five beliefs that keep people stuck

4. Is fibromyalgia a psychiatric illness?

Fibromyalgia is not “all in the mind”, but it is a disorder of how the brain processes pain, which places it firmly within a psychiatrist’s expertise. Depression, anxiety and sleep problems are very common alongside it, and the medicines and therapies that help most act on the brain.

The overlap with mental health is striking. A systematic review found that depression was the most common companion of fibromyalgia, with lifetime rates up to 63% in clinic studies. A 2025 analysis of over 347,000 people with chronic pain found the highest rates of depression and anxiety among those with fibromyalgia.

That does not mean depression causes fibromyalgia. Pain, broken sleep and lost roles wear anyone down, and low mood then lowers the pain threshold. Each feeds the other. Breaking that loop is exactly what psychiatric care is designed to do.

I tell patients that fibromyalgia belongs to a family of conditions where the brain and body disagree about danger, alongside migraine and irritable bowel syndrome. A shared mechanism is why many people have two or three of them at once.

5. What must be ruled out first?

Before fibromyalgia is diagnosed, a doctor should check for conditions that can mimic it. Simple tests usually settle this: blood count, thyroid function, inflammation markers, vitamin D, calcium and, where needed, tests for arthritis or muscle disease.

6. Self-check: does this sound like you?

Answer for the last three months. This is a guide to whether an assessment is worthwhile, not a diagnosis.

• I have pain on both sides of my body, above and below the waist
• I wake up tired, however long I sleep
• I struggle to concentrate or find words (“fog”)
• Light pressure or a tight garment can hurt
• I also have headaches, jaw pain or an irritable bowel
• My tests keep coming back normal
• I feel low, anxious or hopeless about the pain

7. How is fibromyalgia treated?

Fibromyalgia is treated with a combination: education, graded exercise, better sleep, psychological therapy, and medicines that calm pain signalling. European (EULAR) guidelines rate exercise as the only treatment with strong evidence; the others help many people and are added in steps.

The EULAR guidelines recommend starting with education and non-drug treatment, then adding therapy for mood and coping, medicines for severe pain or sleep problems, or a full rehabilitation programme when disability is severe. In practice, I think of four pillars:

Please do not start, stop or change any medicine on your own based on this article.

8. Biofeedback and brain stimulation: what is the role?

Biofeedback teaches you to control body signals such as muscle tension and heart rhythm by watching them on a screen. In fibromyalgia, muscle (EMG) biofeedback has some evidence for reducing pain, but results are mixed. It works best as an add-on to exercise, CBT and medicine.

Many people with fibromyalgia hold their shoulders, jaw and back tight all day without knowing it. EMG biofeedback places small sensors on those muscles, shows the tension as a line on a screen, and lets you practise lowering it. Once you can see it, you can learn to release it.

A meta-analysis of seven trials found that biofeedback reduced pain intensity, with the benefit limited to EMG biofeedback; EEG neurofeedback did not show a clear effect. A newer review of trials against sham devices found no consistent short-term benefit over sham. The fair summary: promising for some people, not a cure, and best combined with other treatment.

Where rTMS fits

Repetitive transcranial magnetic stimulation (rTMS) uses magnetic pulses to change activity in brain areas that process pain and mood. European expert guidelines rate high-frequency rTMS as probably effective (Level B) in fibromyalgia, over the motor cortex for quality of life and over the prefrontal cortex for pain. It is non-invasive, needs no anaesthesia, and is considered when medicines and therapy have not been enough.

How the treatments compare

Bars show the relative strength of evidence as summarised in the cited guidelines and reviews, not the size of benefit for any one person.

9. What to expect at Healthy Minds India, Patna

Your first consultation at Healthy Minds India reviews your pain story, sleep, mood and past reports, then builds a step-by-step plan. We do not repeat tests you already have. Treatment may combine medicine, CBT, a movement plan, biofeedback and, where suitable, rTMS.

1. Listen and map. Where it hurts, what eases it, how you sleep, what you have tried.
2. Check the basics. Review your reports; suggest only the tests that are missing.
3. Measure. Short scales for pain impact, sleep, depression and anxiety, so progress is tracked.
4. Plan. A written plan for the next eight to twelve weeks, with your family included if you wish.

Online consultation is available for patients across Bihar and beyond.

10. Frequently asked questions

• Is fibromyalgia a real disease?

  Yes. Fibromyalgia is a recognised chronic pain condition with measurable changes in how the nervous system processes pain. It has formal diagnostic criteria from the American College of Rheumatology and is listed in the WHO’s ICD-11 as chronic primary pain.

• Can a blood test diagnose fibromyalgia?

  No blood test or scan confirms fibromyalgia. A doctor diagnoses it from widespread pain lasting three months or more, with fatigue, sleep and memory problems, after simple tests rule out other diseases.

• Why should I see a psychiatrist for body pain?

  Because fibromyalgia pain is generated by over-sensitive pain processing in the brain and spinal cord. A psychiatrist treats that system along with the sleep, mood and anxiety problems that make pain worse, working alongside your physician.

• Does rTMS help fibromyalgia?

  European guidelines rate high-frequency rTMS as probably effective for fibromyalgia pain and quality of life. It is usually considered when medicines and therapy have not helped enough, and should be planned by a doctor trained in neuromodulation.

• Where can I get fibromyalgia treatment in Patna?

  Healthy Minds India in Patna offers psychiatric assessment and treatment for fibromyalgia, including medicine review, CBT, biofeedback and rTMS where suitable. In-person and online consultations are available for patients across Bihar.

Written by Dr Saurabh Kumar

Dr Saurabh Kumar, Consultant Neuropsychiatrist, Patna · MD (Psychiatry), AIIMS New Delhi · Ex-Assistant Professor, PMCH Patna · Associate Professor and Head of Psychiatry, RDJM Medical College · Certified in Medical Neuroscience (Duke University) and Sleep Neurobiology (University of Michigan) · Research on rTMS for depression, OCD, migraine and other conditions, with about 59 publications. Last reviewed: October 2026

This article is for general education and does not replace a medical consultation. Diagnosis and treatment decisions should be made with a qualified doctor.

References

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