Prof. Dr. Mehmet Şenoğlu — Brain, Nerve and Spine Surgery
Some of the patients who come to my office with widespread body pain arrive after a long search. They have several MRIs in hand, reports from several different departments, and all of them say the same sentence: “No significant pathology was found.”
In some of these patients, the picture is not due to the spine or to nerve compression — it is fibromyalgia.
Let me state one thing clearly from the outset: fibromyalgia is not the field of my own specialty but primarily that of Physical Medicine and Rehabilitation and Rheumatology. However, as a spine surgeon I encounter these patients often, and because correctly recognizing this picture — which is frequently mistaken for a “lumbar disc herniation” — prevents both unnecessary tests and unnecessary operations, I wanted to write this article.
In this article, I will tell you less about what fibromyalgia is and more about what makes things worse. Because my clinical experience shows this: in this condition, avoiding mistakes often makes more difference than adding a new treatment.
Briefly: What Is Fibromyalgia?
Fibromyalgia is a chronic syndrome that runs with widespread musculoskeletal pain, fatigue, sleep disturbance, and difficulty concentrating.
The fundamental point to understand is this: in fibromyalgia, the problem is not damage in the muscles or joints. The problem is that the central nervous system perceives pain signals far more strongly than normal. I explain this to my patients like so: the “volume control” of the pain system has been turned up too high; even a stimulus that would normally go entirely unnoticed is felt as pain.
This is why tests are generally normal. And the tests being normal does not mean your pain is not real. I particularly want to underline this, because it is the point at which these patients are most hurt.
1. Staying Inactive (The Most Common and Most Harmful Mistake)
This is the cruelest paradox of fibromyalgia: pain pushes you toward inactivity, and inactivity increases pain.
The process that begins with “I’m in pain, let me rest” turns within weeks into muscle weakness, joint stiffness, loss of fitness, and more pain. Then moving becomes even harder, and the cycle feeds itself.
The correct approach: Regular, mild-to-moderate exercise is one of the most evidence-supported pillars of fibromyalgia treatment. Gentle activities such as walking, swimming, in-water exercise, yoga, and tai chi are recommended.
2. Saying “I Feel Good Today” and Exhausting Yourself
This is the trap I call the “good day — bad day” cycle among my patients, and it is extremely common.
You have a good day. You feel energetic. You try to do all the accumulated tasks that day: cleaning the house, shopping, visits… And the next day you cannot get out of bed. This “flare” pushes you back into inactivity.
The correct approach: Pacing — managing your tempo. Distribute your energy evenly across the day and the week. Even on a good day, stay slightly below what you planned. The aim is not peaks and troughs but a steady line.
3. Overdoing the Exercise
The exact opposite of the previous point is also a mistake. Movement is beneficial, but starting a heavy program in the eagerness to “recover quickly” most often results in a serious flare, and the patient then gives up on exercise entirely.
The correct approach: Start very slowly — sometimes even a 5-minute walk a day is a sufficient beginning. Increase the duration and intensity very gradually, over weeks. It is best to start under the guidance of a physiotherapist.
4. Neglecting Sleep Routine
In fibromyalgia, sleep is not an optional matter; it is at the center of treatment. Poor-quality sleep increases pain, and increased pain disrupts sleep. This is one of the condition’s strongest vicious circles.
What should not be done: Irregular bed and wake times, phone/television in bed, caffeine late in the evening, a heavy meal late at night, long daytime naps.
The correct approach: Going to bed and getting up at the same time every day, a dark and cool room, using the bedroom only for sleep.
5. Leaving Stress Unmanaged
Stress is one of the strongest triggers of fibromyalgia. In a tense body, the muscles remain constantly contracted, sleep is disrupted, and the pain threshold drops.
The correct approach: Breathing exercises, mindfulness practices, relaxation techniques. Cognitive behavioral therapy (CBT) is an approach whose effectiveness has been demonstrated in fibromyalgia, and receiving psychological support in no way means that your pain is imaginary.
6. Saying “Yes” to Everything
This is a characteristic I see very often in people with fibromyalgia. Because the condition is invisible from the outside, most patients feel pressure to prove themselves or not to disappoint anyone, and they say “yes” to every request.
The result: exhaustion and a flare.
The correct approach: Learn to say “no.” This is not a weakness but a part of managing the condition. Your energy is a limited resource, and you must decide where to spend it.
7. Withdrawing Completely From Social Life
Pain and fatigue push a person toward withdrawal. However, isolation deepens depression and anxiety — and these directly increase the perception of pain.
The correct approach: Limiting intense and noisy environments is reasonable, but do not cut off social contact entirely. From what I have observed in my clinic, keeping up short meetings with understanding company makes a marked difference.
8. Smoking and Excessive Alcohol
Smoking: It impairs tissue nutrition, lowers sleep quality, and increases the perception of pain. Quitting is particularly recommended in fibromyalgia.
Alcohol: Although it may seem relaxing in the short term, it disrupts sleep architecture — meaning you sleep but do not feel rested. It can also interact with certain medications.
9. Following Strict Diets on Your Own
I need to be careful with this item, because there is a great deal of exaggeration about it online.
The truth is this: There is no diet proven to cure fibromyalgia. Some patients report feeling better when they reduce processed foods, refined sugar, or excessive caffeine; this is a personal observation and it is valuable.
However, what you should not do: Start strict, restrictive diets on your own because you read about them online. Unnecessary restrictions can lead to nutritional deficiencies, weight loss, and new problems. Furthermore, living with a constant list of “forbidden foods” is a source of stress in itself.
The correct approach: Eating a balanced diet, avoiding excessive caffeine, and — if you want to make changes — planning them with a doctor or dietitian.
10. Going From Doctor to Doctor and Having Unnecessary Tests
This is one of the situations that saddens me most in my clinic. The patient goes from department to department for years, has dozens of tests, and receives the answer “there’s nothing wrong” every time. In the end they are worn down both financially and emotionally.
Here I particularly want to emphasize: findings can appear on the spine MRIs of people with fibromyalgia — disc protrusions, wear, and so on. These are most often the normal traces of age and do not explain the patient’s widespread pain. Having surgery on the basis of these findings does not solve the problem, because the source of the pain is not there.
The correct approach: After the diagnosis is made, working regularly and continuously with a doctor who sets up a treatment plan suited to you. Patiently sustaining the plan that works, rather than constantly seeking new ones.
11. Managing Medications on Your Own
What should not be done: Stopping medications abruptly when you feel better, increasing the dose on your own when you feel worse, using someone else’s medication, using painkillers long-term and without supervision.
I would particularly draw attention to this point: fibromyalgia pain responds only to a limited extent to classic painkillers, because the problem is not in the tissue but in the perception of pain. This is why increasing the dose generally does not help and raises the risk of side effects.
The correct approach: Make changes to your medications only together with your doctor.
12. Falling for Products and Methods That Promise a “Definitive Cure”
Chronic conditions that cannot be fully resolved are, unfortunately, open to exploitation. Miracle cures, herbal mixtures, and expensive devices that “completely eliminate fibromyalgia” will frequently come your way.
The honest answer: There is no “definitive cure” proven to eliminate fibromyalgia entirely. But the good news is this: with the right plan — exercise, sleep routine, stress management, medication where needed, and psychological support — a significant proportion of patients can markedly reduce their symptoms and maintain a good quality of life.
The greatest risk you need to avoid: Trusting these products and abandoning treatment whose effectiveness has been demonstrated.
In Addition: Things to Watch For in Daily Life
- Do not stay in the same position for long periods — neither sit for a long time nor stand for a long time. Change position, take breaks.
- Avoid repetitive, straining tasks — heavy cleaning, long gardening sessions, and repetitive handwork should be done in stages, not all at once.
- Give yourself room during sudden weather changes — many patients report that their complaints increase in cold and damp weather.
- Do not carry heavy loads.
- Limit noisy, crowded, and long-lasting environments.
A Useful Suggestion: Keep a Pain Diary
In fibromyalgia, triggers vary from person to person. A simple diary — what you did, what you ate, how you slept, and your pain level — reveals your own personal triggers within a few weeks.
This makes things easier both for you and for your doctor, and it personalizes the treatment.
For Which Symptoms Should a Doctor Definitely Be Consulted?
Even if you have a diagnosis of fibromyalgia, the following situations may be the sign of a new problem and must be assessed:
- Progressive loss of strength in an arm or leg
- Disruption of bladder or bowel control (emergency)
- Sharp numbness spreading along a specific nerve pathway
- Fever, night sweats, and unexplained weight loss
- Swelling, redness, and warmth in the joints
- A marked change in the character of your symptoms
- Newly appearing severe headache or neurological findings
Having a diagnosis of fibromyalgia does not mean you will not develop another illness. Do not dismiss a new and different complaint as “it’s the fibromyalgia again.”
Frequently Asked Questions
Below, I have gathered the most frequently asked questions on this subject along with brief answers. These answers are for general information; the information that applies to your specific situation is the one given by the doctor who examines you.
What should people with fibromyalgia not do?
The main ones: staying inactive, exhausting yourself on good days, overdoing exercise, neglecting your sleep routine, leaving stress unmanaged, saying “yes” to everything, withdrawing from social life, smoking and excessive alcohol, following strict diets on your own, chasing unnecessary tests, managing medications on your own, and turning to products that promise a “definitive cure.”
Should I exercise with fibromyalgia, or should I rest?
You should exercise — this is one of the most evidence-supported pillars of treatment. However, it must be mild-to-moderate and gradual. Walking, swimming, in-water exercise, and yoga are suitable. Prolonged inactivity increases pain and fatigue.
Which department’s field is fibromyalgia?
It is primarily the field of Physical Medicine and Rehabilitation and Rheumatology. Treatment is generally carried out in a multidisciplinary way; support from a physiotherapist, a psychologist, and, when needed, a dietitian may be involved. The role of neurosurgery here is to distinguish whether the pain originates from the spine or the nerves.
Which foods should I avoid with fibromyalgia?
There is no diet proven to cure fibromyalgia. Some patients report relief when they reduce processed foods, refined sugar, and excessive caffeine. However, do not start strict, restrictive diets on your own; if you want to make changes, plan them with a doctor or dietitian.
Is fibromyalgia pain confused with lumbar disc herniation pain?
Yes, frequently. Fibromyalgia pain is widespread — it is present simultaneously in many regions of the body. Lumbar disc herniation pain, on the other hand, follows a specific nerve pathway and is generally one-sided. Incidental findings can appear on an MRI; surgery based on those findings does not relieve fibromyalgia pain.
Does fibromyalgia go away completely?
There is no treatment proven to eliminate it completely; however, “remission” — long periods in which symptoms are greatly reduced — is possible. A significant proportion of patients who patiently follow the right plan experience marked improvement and maintain a good quality of life.
Does receiving psychological support for fibromyalgia mean my pain is imaginary?
Absolutely not. Fibromyalgia pain is real and rests on a measurable nervous system mechanism. Psychological support, particularly cognitive behavioral therapy, is an effective part of treatment because it develops skills for coping with pain.
Why is having constant tests harmful?
Because it wears you down both financially and emotionally, and it increases the risk of unnecessary treatment and surgery based on incidental findings. After the diagnosis is made, the right approach is to patiently sustain the treatment plan that works and to be reassessed only for new or different symptoms.
Disclaimer (Legal Notice)
The information contained in this article has been prepared for general informational purposes only and in no way replaces a medical examination, diagnosis, or treatment. The diagnosis of fibromyalgia, the treatment plan, the exercise program, and the use of medication vary greatly from person to person and can only be determined by a doctor who evaluates you. Do not make changes to your medications on your own, and do not begin restrictive diets without consulting your doctor or a dietitian. Even if you have a diagnosis of fibromyalgia, in situations such as progressive loss of strength, disruption of bladder-bowel control, fever, unexplained weight loss, or a marked change in the character of your symptoms, consult a doctor without delay.