It's Not 'All in Your Head'—It's in Your Nervous System

You wake up exhausted despite sleeping for hours. Your muscles ache as if you've run a marathon, but you haven't exercised in weeks. You struggle to remember simple words, and even a gentle hug can feel painful. You've seen multiple doctors, undergone countless tests, and heard the same frustrating conclusion: "Everything looks normal."

Then comes the dismissal: "Maybe it's just stress" or "Have you considered seeing a therapist?"

But you know your pain is real. You're not imagining it, and you're not crazy.

At Whole Health Rheumatology, we understand what you're experiencing. You have fibromyalgia—a real medical condition with measurable changes in your nervous system.

Fibromyalgia Is Real: The Science Behind Your Symptoms

For decades, fibromyalgia was misunderstood and dismissed. Today, there is irrefutable evidence from brain imaging and other techniques that this condition has strong biological underpinnings. Fibromyalgia is not "all in your head"—it's a disorder of how your nervous system processes pain and sensory information.

The hallmark of fibromyalgia is central sensitization, a condition where your brain and spinal cord have turned up the "volume knob" on pain signals. Your nervous system interprets normal sensations as painful (allodynia) and amplifies genuinely painful stimuli (hyperalgesia). Brain imaging studies reveal structural, functional, and neurochemical changes in people with fibromyalgia.

When Fibromyalgia Mimics Other Conditions

One of the most challenging aspects of fibromyalgia is that its symptoms overlap significantly with other medical conditions—making accurate diagnosis essential.

Fibromyalgia and Menopause: Fibromyalgia predominantly affects middle-aged women between 40 and 65, the same population experiencing perimenopause and menopause. Research published in Climacteric found that fibromyalgia and climacteric conditions share common epidemiological and clinical features, with fibromyalgia symptoms often beginning during menopause. Musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties are frequently seen in both conditions. Studies show that 25% of postmenopausal women with fibromyalgia report their symptoms started with menopause, and another 26% report worsening of previous symptoms after menopause. Women with fibromyalgia tend to experience more severe symptoms after menopause, and those with early menopause display greater pain sensitivity than those with later menopause.

Fibromyalgia and Rheumatologic Conditions: The differential diagnosis of fibromyalgia includes rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, spondyloarthropathies, polymyalgia rheumatica, and inflammatory myopathies. Critically, patients with these rheumatologic conditions may also have fibromyalgia—the two can coexist. When fibromyalgia accompanies an inflammatory condition, patients tend to have higher self-rated disease activity scores than their degree of inflammation would suggest, which can lead to overtreatment of the inflammatory condition if fibromyalgia is not recognized.

Other Conditions to Consider: Fibromyalgia symptoms can also overlap with hypothyroidism, hyperthyroidism, hyperparathyroidism, Lyme disease, hepatitis, multiple sclerosis, small fiber neuropathy, and hypermobile Ehlers-Danlos syndrome (hEDS). The prevalence of concomitant hEDS/HSD and fibromyalgia ranges from 68-89% in some studies, highlighting the importance of evaluating for both conditions.

Why a Rheumatologist? Why This Practice?

A rheumatologist typically makes a diagnosis of fibromyalgia—yet here's the reality: most rheumatologists don't treat it. Many rheumatology practices focus exclusively on inflammatory and autoimmune conditions, leaving fibromyalgia patients without a medical home.

At Whole Health Rheumatology, we do things differently.
Dr. Olga Pinkston, a Mayo Clinic-trained rheumatologist has extensive fibromyalgia training that started at the Mayo Clinic Fibromyalgia Treatment Program and continued with additional training in integrative & lifestyle medicine, and pain reprocessing therapy.

We rule out what needs to be ruled out. As a board-certified rheumatologist, Dr. Pinkston has the expertise to distinguish fibromyalgia from inflammatory arthritis, lupus, and other autoimmune conditions—or to identify when both conditions coexist. Fibromyalgia should be considered in patients with other rheumatologic diagnoses who do not respond well to treatment of their primary condition. We ensure you receive the correct diagnosis so you receive the correct treatment.

We address the whole picture. For women in perimenopause or menopause, we evaluate whether hormonal changes are contributing to your symptoms. While menopausal hormone therapy should not be recommended for fibromyalgia alone, recognizing when both conditions coexist allows for more comprehensive care.

The Whole Health Rheumatology Approach

Our treatment strategy includes:

Validation and Education: We validate your experience and help you understand that your pain is real, caused by measurable changes in your nervous system. A Mayo Clinic Proceedings framework for fibromyalgia management emphasizes that education and goal setting are core principles of comprehensive care.
Pain Neuroscience Education: We teach you that "hurt does not equal harm"—that pain in fibromyalgia reflects nervous system amplification rather than tissue damage. Randomized controlled trials have shown that structured pain neuroscience education programs can produce significant improvements, with up to 70% of patients achieving meaningful improvement at one year.
Sleep Restoration: A tired brain is a sensitive brain. We work to rebuild your sleep foundation, which lowers your nervous system's threat level and reduces pain amplification.
Movement and Exercise: Graded aerobic exercise is one of the most effective treatments for fibromyalgia, with moderate-quality evidence showing improvements in quality of life, pain, and physical function.
Cognitive Behavioral Therapy: CBT teaches patients how to change negative thoughts and behaviors, with systematic reviews demonstrating improvements in pain and disability.
Multimodal Integration: The most effective treatment combines education, physical activity, sleep optimization, stress management, and when needed, appropriate medical management.

You Deserve to Be Heard

Fibromyalgia affects 2-8% of the global population, with a strong female predominance. Despite its prevalence, many physicians still fail to recognize the syndrome, leaving patients feeling dismissed and alone.

At Whole Health Rheumatology, we take your symptoms seriously from day one. If you are tired of being told "it's all in your head," schedule your evaluation today.

Dr. Pinkston is the host of the globally top-rated podcast "Mind Your Fibromyalgia"—you can find it on all podcast platforms!