Among the non-pharmacologic interventions doctors can offer to patients with fibromyalgia include addressing psychological wellness, anxiety and sleep issues. Cognitive behavioral therapy, also known as CBT, is recommended as a first-line behavioral intervention for fibromyalgia in U.S. and international guidelines, with benefits observed across diverse patient populations.1 Although patients may sometimes interpret the recommendation to engage in CBT treatment as a way of the doctor saying, “it’s all in your head,” there is evidence clinicians can point to showing the effectiveness of this therapy.
Because the availability of providers trained in CBT methodologies is limited in many cities and towns across the country, Dr. Kaplan made note of a smartphone application called Stanza that can provide the therapy through a digital interface.
Neuromodulation—including transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), transcranial random noise stimulation (tRNS) and transcutaneous vagus nerve stimulation (tVNS)—can also be used as a treatment for fibromyalgia, though further research is needed to refine protocols and confirm long-term benefits.
Dr. Kaplan ended his lecture cycling through a few frequently asked questions he receives: Does he test for small fiber neuropathy with a skin biopsy? (Not typically unless there is a co-occurring autoimmune disease like Sjogren’s.) Does he use low-dose naltrexone as a treatment? (Sometimes.) Where can patients go for additional resources? (He highly recommends painguide.com.)
Drug Therapies
The second speaker was Yvonne Lee, MD, the Helen Myers McLoraine Professor of Rheumatology at the Feinberg School of Medicine at Northwestern University in Chicago, and her task was to discuss pharmacologic therapies for pain. Similar to Dr. Kaplan, D. Lee teased apart nociplastic pain from nociceptive pain, which is pain that arises from actual or threatened damage to body tissue caused by activation of pain-sensing nerve fibers, and neuropathic pain, which is defined as pain caused by damage or dysfunction of the nervous system itself that leads to abnormal pain signaling.
Dr. Lee noted that suzetrigine, a Nav1.8 inhibitor, was approved by the Food and Drug Administration (FDA) in January 2025 as a new, non-opioid treatment for moderate to severe acute pain. The medication works by selectively inhibiting the Nav1.8 voltage-gated sodium channel, which is a significant factor in transmitting pain signals. Although patients may bring up the idea of this therapy after hearing about it in the news, Dr. Lee explained there is currently no data on how Nav1.8 inhibitors may work in rheumatic diseases, and she believes they are unlikely to help with nociplastic pain such as that seen with fibromyalgia.
