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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Yes, for assessment and a treatment plan. The symptom pattern is assessed by video, blood tests arranged to rule out look-alikes, and a graded activity, sleep and medication plan agreed; a hot swollen joint, progressive weakness or unexplained weight loss go to in-person care.
- What it is: a disorder of pain processing, with the nervous system's volume control stuck high; fibromyalgia affects about 1 in 20 people to some degree, women about twice as often as men, usually from 25 to 55, often after an infection, injury or severe stress.
- Diagnosis: widespread pain on both sides, above and below the waist, for at least 3 months, with fatigue, unrefreshing sleep and poor concentration; no blood test or scan proves fibromyalgia, and normal results are typical rather than suspicious.
- What works: graded exercise has the most consistent evidence of any fibromyalgia treatment, built up in small weekly steps from below bad-day capacity; cognitive behavioural therapy, sleep treatment and low-dose amitriptyline or duloxetine help some people.
- What does not: ordinary painkillers generally work poorly for fibromyalgia, and opioids can worsen pain sensitivity over time; fibromyalgia is not degenerative, and most people improve meaningfully with the right combination.
- Emergency: fibromyalgia itself is never an emergency; a hot, swollen joint with fever, sudden weakness or chest pain is something else and means 112 or an emergency department.
Widespread pain with exhaustion fits fibromyalgia, but some symptoms point away from it and need faster care: a hot, swollen joint with fever (call 112 or go to an emergency department: possible joint infection), progressive muscle weakness, unexplained weight loss or fevers, or new morning stiffness lasting over an hour in your joints. Those need in-person or urgent assessment, not a routine appointment.
Can an online doctor help with fibromyalgia?
Yes. Fibromyalgia is diagnosed from your history and symptom pattern, not from a scan or a single test, so a video consultation can often provide enough information to assess it, organise the blood tests that rule out look-alike conditions, and start an evidence-based management plan.[1] Some findings still need in-person examination, and the doctor tells you plainly when they do.
How an online consultation helps with fibromyalgia
- A doctor who starts from “this is real”: Fibromyalgia is a recognised disorder of pain processing, not imagined and not a label for “we found nothing”. Being believed is not a courtesy here; it is the foundation the whole plan is built on.
- The rule-outs, done properly: Thyroid problems, inflammatory arthritis, polymyalgia rheumatica and vitamin D deficiency can all mimic fibromyalgia. The doctor explains which blood tests you need and how to arrange them locally, then reviews the results with you.
- A plan with evidence behind it: Graded activity, sleep repair and talking therapies carry the strongest evidence.[2] You leave with concrete first steps, not a leaflet.
- Medication without overpromise: Where medicines are worth a trial, the doctor is honest about the modest benefit to expect, sets a review date, and stops what is not working.
What the doctor checks in an online fibromyalgia consultation
The assessment is unhurried on purpose, because the diagnosis lives in the details. The doctor will typically check:
- The pain map and its duration: pain on both sides, above and below the waist, present for over three months is the core pattern of fibromyalgia.[1]
- Sleep, fatigue and fog: unrefreshing sleep, waking exhausted, and the concentration and memory problems many patients describe as “fibro fog”.
- Joint check by video and photo: visible swelling, redness or heat in joints points away from fibromyalgia and towards arthritis, which changes the pathway entirely.
- Mimic screening: thyroid symptoms, morning stiffness duration, rashes, weight change, medication causes (statins can cause muscle aches), menopause status, and, in over-50s, the shoulder-and-hip girdle stiffness of polymyalgia rheumatica.
- Mood and stress load: depression and anxiety commonly travel with fibromyalgia; they are treated alongside it, never used to dismiss it.
- Flare pattern and pacing: the boom-and-bust cycle (overdoing good days, crashing for days after) that keeps many people stuck.
- What you have already tried: medicines, supplements, therapies, and what each actually did.
How is fibromyalgia diagnosed?
Fibromyalgia is diagnosed clinically: widespread pain on both sides of the body lasting over three months, together with fatigue, unrefreshing sleep and often cognitive symptoms, once examination shows no inflamed joints and basic blood tests exclude look-alikes.[1] There is no confirmatory scan or antibody, which is exactly why the journey to diagnosis is often long.
Honesty matters here: many people with fibromyalgia see several doctors over several years before the condition is named, and many arrive at this page carrying a folder of normal results and a quiet fear that nobody believes them. Normal tests do not mean nothing is wrong. They mean the problem is not inflammation or tissue damage: current evidence understands fibromyalgia as amplified pain processing in the nervous system, a volume-control problem rather than a damage problem.[3] Getting the name right is genuinely useful: it ends the escalating hunt for hidden damage, protects you from unnecessary procedures, and points treatment at the mechanisms that actually respond.
The usual rule-out blood tests are a blood count, inflammatory markers (CRP and ESR), thyroid function, vitamin D, calcium and sometimes a muscle enzyme (CK). The doctor explains which you need, how to arrange them locally, and reviews the results with you; unexpected findings redirect the pathway, for example to arthritis assessment if inflammation shows up.
What actually helps fibromyalgia?
The strongest evidence in fibromyalgia is for things you do, supported rather than replaced by things you take. European guidance puts graded exercise first, with talking therapies and stress-focused approaches close behind, and medication as a selective add-on rather than the core.[2] None of this is quick, and the doctor will not pretend otherwise; improvement is measured in months of small gains that compound.
Graded activity: the treatment with the best evidence
Exercise is the only intervention with consistent evidence for improving pain, function and wellbeing in fibromyalgia.[2][4] The word that matters is graded: start below what you can manage on a bad day, increase by small steps weekly, and hold the line on good days rather than bingeing on them. Walking, warm-water exercise, cycling and gentle strength work all count. Expect a temporary increase in ache when you begin; that is the nervous system recalibrating, not damage.
Sleep, stress and talking therapies
Unrefreshing sleep amplifies next-day pain, and pain then wrecks sleep, so the cycle is attacked deliberately: fixed wake time, wind-down routine, caffeine cut-off, and screens out of the bedroom. Cognitive behavioural therapy (CBT) has good evidence for reducing the distress and disability of fibromyalgia, and mind-body approaches such as tai chi, yoga and mindfulness have supporting evidence too.[2] Choosing CBT is not an admission the pain is psychological; it is using the best-studied tool for turning down a sensitised alarm system.
Medication: honest expectations
No medicine is approved specifically for fibromyalgia in Europe, and the honest summary of the evidence is: modest benefit, for some people, usually partial.[2] Where a trial makes sense, options include low-dose amitriptyline at night or duloxetine where low mood and pain overlap, prescribed with a clear review date and stopped if not clearly helping.[5] Ordinary painkillers, including paracetamol and anti-inflammatories, generally work poorly for fibromyalgia pain. Opioids are not prescribed through online consultations, do not work for fibromyalgia, and tend to worsen it over time; pregabalin and similar medicines are controlled in several countries and are likewise not prescribed online.[2]
Which fibromyalgia care might the doctor recommend?
This is the decision framework the doctors use, aligned with cited European guidance:[1][2]
Swipe sideways to compare →
| Presentation | Likely first step | Suitable for online care? | When referral or in-person care is needed |
|---|---|---|---|
| Widespread pain over three months with fatigue and unrefreshing sleep, no joint swelling | Structured assessment, rule-out bloods arranged, graded activity and sleep plan | Usually yes | Abnormal blood results or an atypical picture |
| Widespread pain plus swollen joints or morning stiffness over 30 minutes | Bloods plus rheumatology referral for possible inflammatory arthritis | Assessment and referral | Specialist confirmation; early treatment protects joints |
| Over 50 with new stiffness of both shoulders and hips | Prompt inflammatory-marker bloods for suspected polymyalgia rheumatica | Yes to organise; bloods done locally | New headache, jaw or scalp pain, or visual change: emergency care |
| Established fibromyalgia in a flare | Review triggers, sleep and pacing; adjust the plan and any medication trial | Usually yes | Symptoms that break the usual pattern |
| Pain with fever, weight loss, weakness, or a hot swollen joint | In-person assessment today; 112 for a hot swollen joint with fever | No | These features point away from fibromyalgia |
Not sure which row is you? A doctor can tell you in one consultation.
See available times →Living with fibromyalgia between flares
Flares happen: after poor sleep, stress spikes, infections, weather swings or no identifiable reason at all. A written flare plan helps more than improvisation: drop to your baseline activity rather than zero, protect sleep fiercely for a few days, use heat and gentle movement, and resist the urge to catch everything up the moment you improve. Pacing is the discipline of spending energy evenly, and it beats the boom-and-bust cycle that turns one bad day into a bad week. At work, small adjustments (movement breaks, task rotation, flexibility around the worst hours) often keep people productive; the doctor can advise how to frame that conversation. If low mood deepens, say so in the consultation, because treating it improves pain too; and if you ever have thoughts of harming yourself, call 112 rather than waiting for any appointment.
When it might be something else
Fibromyalgia shares symptoms with conditions that need different treatment, which is why the rule-outs matter. Joint swelling with prolonged morning stiffness points to inflammatory arthritis. New shoulder-and-hip girdle stiffness in over-50s suggests polymyalgia rheumatica, covered on the musculoskeletal pain page, and responds dramatically to the right treatment. Pain centred on one region behaves differently too: persistent back pain has its own assessment pathway. Thyroid disease, vitamin D deficiency and medication side effects round out the list, and all are checkable.
When fibromyalgia is treated online, and when you need in-person care
Treated online: first assessments of widespread pain, including organising rule-out blood tests; building and adjusting the management plan (graded activity, sleep, pacing, stress); considered medication trials with honest expectations and firm review dates; flare reviews; and second opinions when you suspect fibromyalgia but nobody has said the word.
In-person care: suspected inflammatory arthritis or polymyalgia rheumatica goes for bloods and specialist assessment; a hot, swollen joint with fever means 112 or an emergency department now, because septic arthritis cannot wait; progressive weakness, unexplained weight loss or fevers need in-person examination; severe or treatment-resistant fibromyalgia can be referred to pain-management programmes where available; and a mental-health crisis needs urgent care today, not a routine slot.
When to get in-person care
Call 112 now for a hot, swollen joint with fever or shivering (possible septic arthritis), chest pain or breathlessness, sudden weakness or numbness, or if you are having thoughts of harming yourself. Arrange urgent in-person review for progressive muscle weakness, unexplained weight loss or fevers with widespread pain, or, in over-50s, new severe girdle stiffness with headache, jaw pain or visual change.
How Mobi Doctor works
- Book a time that suits you: open daily 7am–11pm CET. You can see a doctor over video, usually within 15 minutes. No subscription, exact price up front.
- Speak to a licensed doctor about fibromyalgia: a private video call: you describe what you feel, the doctor asks what matters, and you agree the right plan together.
- Leave with your plan: everything agreed before you hang up: your plan, and a prescription to use at a pharmacy near you where medication is clinically right for you. If your doctor decides you need to be seen in person, you get a full refund.
No sign-up needed
Not sure it’s fibromyalgia? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
Tap the body — an area or a point — to browse symptoms anywhere
Similar symptoms, different condition? Musculoskeletal Pain can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about fibromyalgia
What is fibromyalgia, and is it a real condition?
Fibromyalgia is a recognised long-term condition, listed in international disease classifications, in which the nervous system amplifies pain signals like a volume control stuck high, producing widespread pain, exhaustion, unrefreshing sleep and poor concentration. Normal scans and blood tests are typical and do not mean the pain is imagined; fibromyalgia affects about 1 in 20 people to some degree.
What causes fibromyalgia?
The cause of fibromyalgia is not fully known, but it involves changes in how the brain and spinal cord process pain, with lower pain thresholds, disturbed deep sleep and altered stress hormones. It often starts after a trigger such as a viral infection, an injury or surgery, childbirth, or a period of severe physical or emotional stress, runs in families, and is commoner in people with rheumatoid arthritis, lupus or irritable bowel syndrome.
What are the symptoms of fibromyalgia?
Fibromyalgia causes widespread aching, burning or stabbing pain on both sides of the body and above and below the waist for at least three months, with exhaustion that sleep does not fix, waking unrefreshed, poor memory and concentration (fibro fog), stiffness in the morning, headaches, irritable bowel, tingling, sensitivity to cold, noise and light, and low mood or anxiety. Symptoms fluctuate in flares.
How is fibromyalgia diagnosed?
Fibromyalgia is diagnosed from the symptom pattern: widespread pain for at least three months with fatigue, unrefreshing sleep and cognitive symptoms, using a standard questionnaire, once blood tests have excluded conditions that mimic it. Tender-point counting is no longer required. The doctor checks the joints and muscles on video for swelling or weakness, which point away from fibromyalgia, and arranges the tests.
What blood tests are done for suspected fibromyalgia?
Tests do not diagnose fibromyalgia; they exclude conditions that mimic it. The usual set is a blood count, inflammatory markers (CRP and ESR), thyroid function, vitamin D, calcium, iron stores, blood sugar and sometimes creatine kinase for muscle and a coeliac screen. The doctor explains which you need and where to have them taken, and a normal set supports the diagnosis of fibromyalgia.
Can an online doctor prescribe fibromyalgia medication in Europe?
Sometimes, and only after a consultation. No medicine is licensed specifically for fibromyalgia in Europe; where a trial is sensible, options such as low-dose amitriptyline for sleep and pain or duloxetine for pain and mood can be prescribed, for use at a pharmacy near you, with a review of benefit and side effects. Opioids and other controlled medicines are not prescribed online.
Does exercise really help fibromyalgia, even when it hurts?
Yes; graded exercise has the most consistent evidence of any fibromyalgia treatment. The key is starting below your bad-day capacity, perhaps five minutes of walking or gentle water exercise, and increasing very gradually each week, so the nervous system adapts without triggering flares. Some extra ache at the start is expected and settles; crashing after a big day means the step was too large.
Why are opioids and strong painkillers not used for fibromyalgia?
Because they fail at both jobs: evidence shows opioids do not relieve fibromyalgia pain well, and long-term use can increase pain sensitivity while adding dependence, constipation and drowsiness. They are also not prescribed through online consultations at all. Treatments that act on the nervous system's pain processing, such as graded exercise, sleep repair, cognitive behavioural therapy and selected antidepressants, do more.
Can fibromyalgia get better, and does it ever go away?
Yes, meaningfully. Fibromyalgia is not degenerative: it does not damage joints or muscles, and symptoms can improve substantially with the right combination of graded activity, sleep work, stress treatment and selective medication. Most people continue to have some symptoms that wax and wane over years, and a minority become symptom-free; the difference between unmanaged and well-managed fibromyalgia is often large.
What can I do at home to manage fibromyalgia?
At home, manage fibromyalgia by pacing activity across the day rather than boom and bust, building exercise up in tiny steps, keep a regular sleep and wake time with no screens in the last hour, using warmth, gentle stretching and relaxation for pain, limiting caffeine and alcohol, and keeping a simple diary of sleep, activity and pain to spot the patterns behind flares. Plan rest before big events, not only after.
How can I prevent fibromyalgia flares?
Fibromyalgia cannot be prevented, but flares can be reduced: steady pacing, protected sleep, graded rather than sudden exercise, early treatment of infections and stress, warm clothing in cold weather, planning recovery time after travel or busy periods, staying on treatment that helps rather than stopping when well, and reviewing the plan with the doctor when a flare lasts more than a couple of weeks.
Could it be something other than fibromyalgia?
Yes, and that is why blood tests and a careful history come first. An underactive thyroid, vitamin D deficiency, polymyalgia rheumatica in people over 60, early rheumatoid arthritis, lupus, sleep apnoea, depression and long-term effects of a viral infection can all mimic fibromyalgia. Swollen joints, muscle weakness, fever, weight loss or morning stiffness over an hour point away from fibromyalgia.
Is fibromyalgia different in pregnancy or in older people?
In pregnancy, fibromyalgia symptoms often worsen in the last months and after the birth, and some medicines, including duloxetine and amitriptyline, are reviewed with the doctor before conception, so a non-drug plan matters more. In older people, new widespread pain and stiffness is more often polymyalgia rheumatica, thyroid disease or vitamin D deficiency than fibromyalgia, so those are tested first.
- Chronic pain (primary and secondary) in over 16s: assessment and management (NG193), NICE, National Institute for Health and Care Excellence, 2021.
- EULAR revised recommendations for the management of fibromyalgia, EULAR, Annals of the Rheumatic Diseases, 2017.
- Fibromyalgia, HSE, Health Service Executive (Ireland), reviewed 2023.
- Aerobic exercise for adults with fibromyalgia, Cochrane Review, Cochrane, 2017.
- Amitriptyline for fibromyalgia in adults, Cochrane Review, Cochrane, 2015.
- Fibromyalgia, NHS, National Health Service (UK), reviewed October 2022.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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