The UK’s National Health Service (NHS) recommends exercise, therapy, and medication as key treatment approaches for fibromyalgia — but the roles of the nervous system and gut–brain axis, important areas emerging from fibromyalgia research, receive surprisingly little attention.

While exercise, talking therapies, and medication are sensible recommendations and supported by evidence, as someone who has lived with fibromyalgia and spent years studying the psychology and neuroscience of chronic pain, omitting the nervous system and the role of diet and inflammation is concerning. 

These omissions matter because they shape how patients understand their illness — and therefore how they attempt to recover.

Fibromyalgia Is Increasingly Understood as a Nervous System Disorder

The NHS overview briefly notes that fibromyalgia may involve “changes in the way the central nervous system processes pain”. That short sentence refers to a major body of research known as central sensitisation.

Central sensitisation describes a state where the brain and spinal cord amplify pain signals. Neural circuits that normally filter sensory input become hyper-responsive, meaning ordinary sensations can be interpreted as pain. Neuroimaging studies have repeatedly shown altered activity in brain regions involved in pain processing in people with fibromyalgia (Adler et al. 2023).  

In simple terms, the nervous system becomes stuck in a high-alert mode (also referred to as fight-or-flight). This perspective explains why fibromyalgia symptoms extend far beyond pain. Fatigue, sleep disturbances, cognitive difficulties, and sensory hypersensitivity are all consistent with a nervous system that has lost its ‘normal’ regulatory balance.

Yet if a newly diagnosed fibromyalgia patient reads the NHS treatment page, they may never encounter this explanation. Instead, they are offered exercise, talking therapies, and antidepressants — useful tools, but not necessarily a conceptual framework for what is happening inside their body. 

Physical activity improves quality of life, cognitive behavioural therapy can help people manage chronic pain, and certain antidepressants may reduce symptoms for some patients. However, by omitting essential information on the nervous system and how to rebalance a system that’s stuck in high-alert mode, the guidance is missing a major piece of the puzzle. Consequently, for the patient, this may perpetuate confusion for the patient. 

When patients don’t understand the nervous system’s role in chronic pain and fatigue, they may interpret symptoms as mysterious, unnecessarily concerning, or irreversible. And that’s not the case.

By following treatment approaches that balance the nervous system away from high-alert states and back into calm, many fibromyalgia symptoms can reduce and even disappear completely. 

The Gut-Brain Axis: Another Emerging Piece of the Puzzle

A further striking omission from the NHS guidance is diet. Food is rarely presented as a meaningful factor in fibromyalgia management within mainstream guidance. Yet research over the past decade increasingly points to connections between gut microbiota, inflammation, and chronic pain.

For example, studies show that the gut microbiome of individuals with fibromyalgia differs significantly from that of healthy controls (Minerbi et al., 2019). Experimental work has even demonstrated that transferring gut microbiota from fibromyalgia patients into mice can induce pain-like symptoms and immune changes in the animals (Cai et al., 2025). This suggests that microbiome alterations may play an active role in the disease process rather than simply reflecting lifestyle differences.

Dietary patterns also appear to influence symptom severity. Research examining the inflammatory potential of diet found that pro-inflammatory diets, including the Western diet, were associated with greater pain and disease severity in fibromyalgia patients (Dragan et al. 2020). Other intervention studies have shown that anti-inflammatory dietary approaches, such as vegan and low-FODMAP diets, can improve fatigue, disability scores, and quality of life in people with fibromyalgia (Lowry et al., 2020).  

While diet is not a one-stop solution for a complex and heterogeneous condition like fibromyalgia, when patients are searching for ways to regain stability, understanding how food influences inflammation, energy metabolism, and the gut–brain axis can be deeply empowering and result in reduced symptom severity. 

The Missing Bridge Between Biology and Behaviour

The irony is that the NHS guidance already includes two elements that align with modern chronic pain science – exercise and psychological therapies – which help regulate the nervous system.

Graded movement can recalibrate threat perception in the body, while cognitive and behavioural therapies can reshape how the brain interprets signals from the body, helping to shift nervous systems in a high alert ‘fight-or-flight’ mode into a calmer, balanced state. These approaches are consistent with what we know about neuroplasticity and pain processing.

However, without explaining the underlying mechanisms, such as the role of the nervous system and the gut–brain axis, these treatments may feel random to patients.

Guidance becomes “try exercise… try therapy… try medication,” instead of, “your nervous system has become sensitised, and these interventions help retrain it.” This distinction is not just semantic. Understanding the underlying mechanism — the all-important, clarifying ‘why’ — transforms passive treatment into active participation in recovery.

Why This Matters for Patients

Fibromyalgia patients often spend years feeling misunderstood. Many are told their symptoms are unexplained, psychosomatic, or simply something they must learn to live with. Yet the science is slowly telling a different story.

Fibromyalgia appears to involve an interaction between:

~ altered pain processing in the nervous system
~ immune and inflammatory signalling
~ gut microbiome changes
~ psychological stress and trauma history

In other words, it is a biopsychosocial condition in the truest sense of the word.

The NHS guidance is not wrong. Exercise, psychological therapy, and certain medications can help — it’s the explanation behind them that feels incomplete. Patients deserve to understand the biological systems involved in their illness, especially when those systems are precisely where recovery strategies can begin.

A More Complete Conversation

Healthcare guidance inevitably simplifies complex science. Public information pages cannot include every nuance of emerging research. Yet fibromyalgia is a condition where the explanation itself is therapeutic. When people understand that their nervous system has become dysregulated — and that they are not mysteriously, irreversibly broken — hope enters the conversation.

And when we start discussing inflammation, diet, the gut–brain axis, and nervous system regulation alongside conventional treatments, we move closer to something that patients have been asking for for a long time: not just symptom management, but understanding.

References: 

Adler et al. (2023). Functional Magnetic Resonance Imaging Changes and Increased Muscle Pressure in Fibromyalgia: Insights from Prominent Theories of Pain and Muscle Imaging. 

Cai et al. (2025). The Gut Microbiota Promotes Pain in Fibromyalgia. Neuron, 113(13). 

Dragan et al. (2020). Dietary Patterns and Interventions to Alleviate Chronic Pain. Nutrients, 12(9). 

Lowry et al. (2020). Dietary Interventions in the Management of Fibromyalgia: A Systematic Review and Best-Evidence Synthesis. Nutrients, 12(9). 

Minerbi et al. (2019). Altered Microbiome Composition in Individuals with Fibromyalgia. Pain, 160(11). 

NHS. (2022). Fibromyalgia treatment. https://www.nhs.uk/conditions/
fibromyalgia/treatment/