Thanks! I’ll look into whether fibromyalgia is associated with measurable brain differences, how the medical community views its legitimacy, and how treatments like Lyrica are believed to work. I’ll summarize the scientific consensus and highlight any controversies or evolving perspectives.
I’ll get back to you shortly with a clear, well-supported overview.

Fibromyalgia: Neurological Changes, Diagnosis, and Treatment

Neurological Evidence: Fibromyalgia is now understood as a disorder of pain regulation in the central nervous systempubmed.ncbi.nlm.nih.govwww.mayoclinic.org. Research shows people with fibromyalgia process pain differently – for example, brain and spinal cord scans reveal amplified pain signals and altered connectivity in pain-processing regionswww.ncbi.nlm.nih.govarthritis-research.biomedcentral.com. Patients report much higher pain sensitivity (even to normally nonpainful stimuli) – a phenomenon CDC describes as “abnormal pain perception processing”www.cdc.gov. Functional MRI and PET studies have found differences in brain activity (insular, cingulate, thalamus, etc.) and even signs of neuroinflammation (activated glial cells) in fibromyalgiaarthritis-research.biomedcentral.comnews.ki.se. However, experts note it’s unclear if such brain changes cause fibromyalgia or result from chronic pain and related factors (e.g. depression)pmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov. In summary, numerous studies support central sensitization in fibromyalgia – the brain amplifies pain signals – but exactly how this manifests neurologically is still debatedpubmed.ncbi.nlm.nih.govwww.ncbi.nlm.nih.gov.Diagnosis and Consensus: Fibromyalgia was once controversial, but today it is widely recognized as a real syndrome. Major health organizations (CDC, NIH, WHO, etc.) treat it as a legitimate chronic pain condition. The CDC notes that doctors diagnose fibromyalgia through history and exam (using tests mainly to exclude other disorders)www.cdc.govwww.niams.nih.gov. There is no definitive lab or imaging testwww.niams.nih.govmcpress.mayoclinic.org, so diagnosis relies on symptoms criteria: chronic widespread pain (both sides of body, above and below waist) lasting ≥3 months, plus fatigue, sleep and mood issueswww.mayoclinic.orgwww.ncbi.nlm.nih.gov. The American College of Rheumatology (ACR) developed formal criteria (first in 1990 using tender points, updated in 2010/2016 using widespread pain index and symptom severity scores) that are now standard in practice. Under these criteria, fibromyalgia is diagnosed clinically even if a patient has other diseases (RA, lupus, etc. do not exclude the diagnosis)www.cdc.govwww.niams.nih.gov. Prevalence is about 2–3% of people (mostly women)www.ncbi.nlm.nih.gov. While early critics – even some rheumatologists – argued “there is no disease”pmc.ncbi.nlm.nih.gov, today most experts accept fibromyalgia as a central pain syndrome. Medical reviews and guidelines describe it as a central sensitization disorder influenced by genetics and environmentwww.ncbi.nlm.nih.govpubmed.ncbi.nlm.nih.gov. However, stigma remains an issue: surveys find patients often feel misunderstood, and some clinicians still (mistakenly) view it as “all in the head”mcpress.mayoclinic.orgpmc.ncbi.nlm.nih.gov. Overall, current consensus is that fibromyalgia is not a vague catch-all but a recognized syndrome with accepted diagnostic criteria and recommended treatments.Treatment and Medications (Pregabalin): No cure exists, but treatment targets the brain-based pain mechanisms. Non-drug therapies (exercise, cognitive-behavioral therapy, sleep hygiene) are first-line; medications can help with pain and sleep. Key drug classes include certain antidepressants (e.g. duloxetine, milnacipran) and anticonvulsants (gabapentin, pregabalin). For example, Lyrica (pregabalin) is FDA-approved for fibromyalgia (and several neuropathic pain conditions)www.ncbi.nlm.nih.gov. Pregabalin’s mechanism is not disease-specific: it binds to the α2δ subunit of neuronal calcium channels in the central nervous system, reducing release of excitatory neurotransmitterswww.ncbi.nlm.nih.gov. This calms neural hyperexcitability and eases pain signals. Because it acts on general pain pathways, pregabalin also treats diabetic neuropathy, postherpetic neuralgia, seizures, and even anxiety disorderswww.ncbi.nlm.nih.gov. In other words, Lyrica works in fibromyalgia by damping central sensitization, but those same effects underlie its use in other chronic pain and anxiety conditions. Clinically, medications like pregabalin have shown only modest benefit in fibromyalgiawww.ncbi.nlm.nih.gov, highlighting that fibromyalgia’s core is not unique biology but enhanced central pain gain. (Other drugs used in fibromyalgia – SNRIs, TCAs – similarly overlap with treatments for depression and neuropathic pain.)Key Takeaways: Current research indicates fibromyalgia involves real brain-based changes in pain processingwww.mayoclinic.orgnews.ki.se. Medical authorities now recognize it as a legitimate chronic pain syndrome with established criteriawww.cdc.govwww.ncbi.nlm.nih.gov. Diagnosis is based on widespread pain and symptom patterns (no single test)www.niams.nih.govwww.mayoclinic.org. Treatments target the central nervous system (e.g. pregabalin reduces neuronal excitabilitywww.ncbi.nlm.nih.gov), but these treatments act on general pain/modulation pathways – they’re not fibromyalgia-specific. In sum, fibromyalgia is better understood today as a “nociplastic” (central-sensitization) pain disorder with objective neurobiological underpinnings, though some uncertainty remains about the exact mechanismspubmed.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov.Sources: Authoritative reviews and guidelines were used to compile this reportpubmed.ncbi.nlm.nih.govwww.mayoclinic.orgwww.niams.nih.govwww.ncbi.nlm.nih.gov, drawing on recent neuroscience studies and statements from CDC/Mayo/NIH.