Fibromyalgia and Anxiety: When Central Sensitization and Hypervigilance Stack

Most clients who land on this page have already been told some version of “you seem anxious.” Maybe by a walk-in physician who saw the widespread pain, the sleep disruption, the fatigue and the worry, and concluded the picture was psychiatric. Maybe by a partner or family member who watched years of inconsistent diagnoses and started believing the quiet implication that this is all stress. Maybe by you, in the long stretches where the pain seems worse on the days you are most worried. The neurobiology is more honest than that framing. Fibromyalgia is a defined rheumatologic condition with documented central nervous system changes. Anxiety travels with it at rates well above the general population, not because the pain is fake, but because the systems involved overlap. This page maps that overlap and where hypnotherapy realistically fits inside a rheumatology-led plan.

Why anxiety and fibromyalgia overlap

Anxiety prevalence in fibromyalgia populations runs roughly two to three times the general population baseline, with lifetime anxiety disorder rates approaching sixty percent in some clinical samples. That is a signal, not a coincidence. The systems involved (central pain processing, autonomic balance, HPA axis regulation, sleep architecture, attentional processing of bodily sensation) overlap heavily between the two conditions. When one system shifts, the others tend to follow. So a client diagnosed with fibromyalgia who develops increasing anxiety over the course of the illness is not adding a separate condition on top of the original. They are watching the same dysregulation propagate across related systems.

The pattern I see most often in my hypnotherapy practice is bidirectional. Anxiety amplifies pain perception through hypervigilance and autonomic arousal, both of which are documented amplifiers of central sensitization. Chronic widespread pain in turn drives anxiety because the body is constantly producing threat signals that the nervous system has to process. Sleep disruption, which is a defining feature of fibromyalgia, lowers the threshold for both pain perception and anxiety. Once the loop is running, it self-reinforces. Single-layer treatment often plateaus because the unaddressed layer keeps re-amplifying the layer being treated. The same closed-loop pattern shows up in other comorbidity presentations covered in the broader comorbidity hub, and the chronic pain version sits in the related chronic pain comorbidity pattern.

The depression-fibromyalgia comorbidity is also extremely common and has a related but distinct signature. Depression in fibromyalgia tends to present with low energy, anhedonia, and the gradual narrowing of life that chronic illness produces. Anxiety in fibromyalgia tends to present with hypervigilance, anticipatory worry about flares, sleep-onset rumination and the 3am wake pattern, and a pervasive sense that the body is unsafe. Many clients have both, in which case the work has to address both. The bidirectional pattern this page focuses on is the anxiety side, because the central sensitization mechanism aligns particularly cleanly with what hypnotherapy can address.

The validating piece I want to lead with: clients with fibromyalgia are often dismissed as anxious. The dismissal is wrong on the science. The neurobiology of fibromyalgia is documented in functional imaging, quantitative sensory testing, and autonomic measurement. Anxiety accompanies the picture as a related dysregulation, not as the cause of the pain. Anyone telling you the pain is “just anxiety” is misreading both conditions. Anyone telling you the pain has nothing to do with the anxiety is missing the central sensitization mechanism that ties them together. The honest answer is that both layers are real and they are entangled.

This page is for clients with diagnosed fibromyalgia who also experience significant anxiety. If you have not yet been worked up, the first step is rheumatology referral, not adjunct work. The masking section near the end of this page covers the differential diagnoses that need to be excluded before assuming the picture is fibromyalgia plus anxiety comorbidity rather than something else.

Central sensitization is the shared mechanism

Fibromyalgia is one of the canonical central sensitization conditions. The defining features are chronic widespread pain (typically present for at least three months, on both sides of the body, above and below the waist), hyperalgesia (a lower threshold for pain), and allodynia (pain from stimuli that would not normally be painful, like light touch or a tight waistband). The peripheral tissues often look unremarkable on imaging. Bloodwork is typically normal aside from ruling out other conditions. The dysregulation lives in how the central nervous system processes pain signals, which is why peripheral interventions alone often produce limited benefit.

The mechanism that drives this central amplification involves several converging factors. Repeated pain signalling rewires central pain processing through neuroplastic changes, where pathways that fire together strengthen their connections. Descending pain modulation systems, which normally dampen pain signals at the spinal cord and brainstem level, become less effective. Hypervigilance to bodily sensations directs top-down attention onto pain pathways, which amplifies their gain. The result is a nervous system that is louder than the peripheral input would predict.

Anxiety overlays cleanly onto this picture. The hypervigilance that amplifies pain processing also amplifies threat processing in general. Clients with fibromyalgia and anxiety often describe a persistent background sense that something is wrong, attentional pull toward bodily sensations and external threats, and a body that does not down-regulate easily. The same neural circuits that maintain central pain amplification (limbic-prefrontal-autonomic loops) maintain anxious arousal. What looks like two separate conditions is, mechanistically, related dysregulation in overlapping systems.

Sleep disruption is a feature of both conditions and amplifies the loop. Fibromyalgia produces characteristic sleep architecture disruption, particularly in slow-wave (deep) sleep. Anxiety drives sleep-onset difficulty and the 3am wake-up pattern, where cortisol rises in the second half of the night and pulls the sleeper into wakefulness with anxious thoughts. The cortisol awakening response is real and well documented; in clients with elevated baseline arousal, the rise can pull sleep apart 3-5 hours earlier than intended. Once awake, the client encounters anxious thinking, the brain interprets the thoughts as threat and activates further sympathetic arousal, and return to sleep becomes difficult. The pattern is recognizable across both conditions because the underlying physiology overlaps. The dedicated sleep architecture disruption layer page covers the sleep work in depth.

Autonomic dysfunction is often present. Heart rate variability is typically reduced in fibromyalgia, signalling a shift toward sympathetic dominance. Postural changes can produce dizziness or tachycardia in some clients. GI dysmotility is common, as is sensitivity to temperature and noise. These are not separate conditions piling onto the index diagnosis. They are predictable consequences of the same central and autonomic dysregulation that produces the pain and the anxiety. Naming the pattern rather than treating each piece as an isolated mystery is one of the things rheumatology consultations and good multidisciplinary plans do well.

The closed-loop description: central sensitization amplifies pain, amplified pain drives hypervigilance and anxiety, hypervigilance and anxiety further amplify central sensitization. Sleep disruption sits in the middle, both consequence and amplifier. Autonomic dysregulation runs in parallel. Treating any single piece in isolation often fails to break the loop. Treating multiple pieces in coordination is what produces durable change.

Why rheumatology and multidisciplinary care lead

Fibromyalgia diagnosis and management is a rheumatology and internal medicine specialty. That matters for two reasons. First, the diagnosis itself is a clinical one without a single confirmatory blood test or imaging finding, which means the clinician needs to actively rule out look-alike conditions that have very different treatment paths. Hypothyroidism, polymyalgia rheumatica, autoimmune diseases like lupus and rheumatoid arthritis, ME/CFS, and undiagnosed sleep apnea can all produce overlapping pictures. Treating any of those as fibromyalgia (or as anxiety-amplified fibromyalgia) means missing the actual condition for months or years.

Second, evidence-based first-line care for confirmed fibromyalgia involves modalities that sit firmly inside medical and physiotherapy scope. Pharmacological options with evidence in fibromyalgia include duloxetine, pregabalin, and milnacipran, used singly or in combination under prescriber oversight. Graded exercise therapy has substantial evidence and is typically delivered by a physiotherapist or kinesiologist with experience in central sensitization conditions. Sleep optimization is often pursued with a combination of behavioural sleep work and, where appropriate, prescriber-managed medication. None of these belong with a hypnotherapist as primary intervention.

Cognitive Behavioural Therapy adapted for fibromyalgia (sometimes described as pain-CBT or fibromyalgia-CBT) has substantial evidence and is typically delivered by a registered psychologist with pain experience. The protocol differs from general anxiety CBT. It addresses pain catastrophizing specifically, paces activity to avoid boom-bust cycles, works on the cognitive content around the chronic illness identity, and often incorporates acceptance-based components. Many clients with fibromyalgia and anxiety do best with pain-CBT as the primary psychological treatment, with anxiety-specific work woven in. Some benefit from a separate anxiety-CBT track if the anxiety presentation is severe and partially independent of the pain. The treating team can advise on sequencing.

Per the scope of practice that defines my work as a Registered Clinical Hypnotherapist, I do not diagnose fibromyalgia, prescribe or recommend changes to medication, deliver primary psychological treatment for severe presentations, or replace the rheumatology and physiotherapy work that anchors a fibromyalgia plan. A hypnotherapist treating the anxiety layer of fibromyalgia without coordinated rheumatology care is operating outside scope. The honest framing is that hypnotherapy is on the periphery of fibromyalgia care, not at the centre, and the centre belongs with the medical team.

The coordinated picture I aim to fit into looks like this. Rheumatology or internal medicine leads the diagnosis and primary management. Pharmacological care runs through the prescriber, often with rheumatology or family medicine carrying that. Graded exercise sits with physiotherapy. Pain-CBT or anxiety-CBT sits with a registered psychologist. Sleep work may involve sleep medicine if there are comorbid sleep-disordered breathing concerns. Hypnotherapy enters as adjunct on the central sensitization arousal layer, the sleep architecture layer, and the catastrophizing layer, with written-consent communication across the team so the pieces actually fit together.

Where hypnotherapy fits across the fibromyalgia and anxiety stack

The honest map of where hypnotherapy realistically helps in this picture is narrower than what some practitioners will sell you. It is also real, and worth knowing. Below is how I think about which presentations are a reasonable fit for adjunct work and which are not.

Mild to moderate fibromyalgia with anxiety overlay, in active rheumatology care

This is the cleanest fit. The diagnosis is confirmed. Primary care with rheumatology or family medicine is in place. Pharmacological and graded exercise pieces are running. The anxiety layer is significant but not severe enough to require psychiatric primary care. In this picture, hypnotherapy is a reasonable adjunct on the anxiety, somatic arousal, and central sensitization layers. Realistic expectation is meaningful reduction in anxiety arousal, modest reduction in pain catastrophizing, better sleep quality, and improved capacity to follow the rheumatology plan. Not pain elimination. Not a replacement for the medical work.

Sleep architecture disruption inside fibromyalgia

Sleep is one of the layers where hypnotherapy has the cleanest mechanism alignment with what fibromyalgia clients need. Slow-wave sleep is particularly disrupted in fibromyalgia, and slow-wave sleep is the restorative stage associated with memory consolidation, immune function, and physical recovery. Cordi 2014 (PMID 24882902) directly addresses this mechanism in healthy young women, with caveats about generalizability. For fibromyalgia clients, the application is mechanism-aligned adjunct work alongside rheumatology-led sleep optimization, not a standalone treatment for fibromyalgia-related sleep disruption.

Pain catastrophizing patterns

Pain catastrophizing (the catastrophic interpretation of pain signals, the rumination on pain experience, the helplessness response to flares) is one of the well-documented amplifiers of central sensitization. It is also one of the things hypnotic suggestion can address particularly well, through attentional reframing, suggestion-based interpretive shifts, and somatic anchoring. Pain-CBT with a psychologist is often the primary tool for this layer. Hypnotherapy can serve as either an alternative primary tool for this specific piece (for clients where suggestion-based work lands more easily than cognitive restructuring) or as a complement to ongoing pain-CBT.

Severe fibromyalgia with active suicidality

Fibromyalgia carries elevated suicide risk, particularly when chronic pain combines with depression and the loss of function and identity that accompany severe presentations. If suicidality is active, psychiatric emergency assessment is the first call, not hypnotherapy. That means urgent contact with your family physician, local crisis line, or emergency department, psychiatric assessment, and stabilization of the acute risk before any adjunct work. As a Registered Clinical Hypnotherapist, I do not provide primary mental health crisis care. The appropriate response to active suicidality is referral and care escalation, immediately. Hypnotherapy can enter as adjunct downstream once the acute picture is stable.

Untreated severe pain or undiagnosed condition

Severe pain that has not been worked up by a physician belongs in workup first. Persistent widespread pain that has not been evaluated by rheumatology, where look-alike conditions have not been excluded, is not ready for adjunct hypnotherapy work. The few months it takes to run a proper rheumatology workup is time well spent. The years lost to treating an undiagnosed inflammatory or autoimmune condition as anxiety-amplified central sensitization is the alternative cost.

Honest framing on the periphery

Across all of these scenarios, the honest framing is the same. Hypnotherapy is on the periphery of fibromyalgia care, not the centre. Mechanism alignment with central sensitization, sleep recovery, and pain catastrophizing is good. Condition-specific randomized trial data for hypnotherapy in fibromyalgia is sparser than for IBS or procedural pain. The case for adjunct use rests on the mechanism alignment and on the broader hypnosis literature for anxiety and pain components, more than on fibromyalgia-specific RCT evidence. Anyone marketing hypnotherapy as a primary fibromyalgia treatment is overselling. Adjunct work inside a rheumatology-led plan is the appropriate framing.

What the research supports (and the honest limits)

The relevant research base for this page sits across two threads: the anxiety hypnosis literature and the sleep hypnosis literature. Fibromyalgia-specific hypnotherapy trials exist but are modest in number and methodologically variable, so the honest case for adjunct use rests primarily on mechanism alignment with broader anxiety and sleep evidence, not on a deep fibromyalgia-specific RCT base.

On the anxiety side, Hammond 2010 (PMID 20183733) reviewed the evidence for hypnosis in the treatment of anxiety and stress-related disorders and concluded that hypnosis is an effective adjunctive intervention for generalized anxiety, situational anxiety, pre-procedural anxiety, and stress-related symptoms, with effect sizes comparable to other psychotherapeutic interventions. The review noted heterogeneity across studies and limitations in the evidence base for specific subtypes, so the honest framing is that hypnotherapy is supported as adjunctive intervention for the anxiety component in a fibromyalgia and anxiety stack, not that it is a stand-alone fibromyalgia anxiety cure.

On the sleep side, Cordi 2014 (PMID 24882902) demonstrated that listening to a hypnotic suggestion audio before sleep increased slow-wave sleep by approximately 81% compared to control in healthy young women who were highly suggestible to hypnosis. Slow-wave sleep is the restorative deep sleep stage associated with memory consolidation, immune function, and physical recovery, and it is one of the sleep stages most disrupted in fibromyalgia. The caveats on this study are important. The participants were healthy young women, not fibromyalgia patients. The effect was specific to highly suggestible participants. The 81% figure is the comparison to control, not an absolute baseline change. The relevance to fibromyalgia is the mechanism rather than direct generalization. For fibromyalgia clients with significant sleep architecture disruption, the Cordi mechanism is one of the cleaner reasons to consider adjunct hypnotic work on sleep, alongside rheumatology-led sleep optimization.

The pain-specific hypnotherapy literature is broader than this page covers. Pain hypnosis has substantial RCT evidence for cancer pain, procedural pain, IBS-related pain, and tension-type headache, and a growing body of work on chronic pain conditions with central sensitization features. Fibromyalgia sits inside that broader picture as a central sensitization condition where mechanism alignment is good and condition-specific RCT data is more modest. The dedicated dedicated chronic pain spoke for the pain-layer evidence base covers the pain hypnosis literature in depth and is the right reference for the broader pain side.

The most reliable application in fibromyalgia and anxiety, then, is adjunct work on the anxiety, sleep, and central sensitization arousal layers, alongside rheumatology-led primary care. The honest claim is not that hypnotherapy resolves fibromyalgia. The honest claim is that hypnotherapy can take meaningful pressure off the anxiety and arousal layers that amplify central sensitization, with mechanism support from the broader anxiety and sleep hypnosis literature.

Treatment sequencing across the stack

Sequencing matters in this picture more than in single-condition work, because the layers feed each other and getting the order wrong wastes time. Here is the sequence I work with, and the points at which hypnotherapy actually enters the picture.

Step 1: Rheumatology workup for fibromyalgia diagnosis

Before any of the rest, the diagnosis needs to be confirmed and the look-alikes ruled out. That means rheumatology referral if a specialist is accessible, family medicine workup with appropriate bloodwork otherwise. Hypothyroidism, polymyalgia rheumatica, autoimmune diseases, and undiagnosed sleep apnea are the common look-alikes that need to be excluded. Without this step, every layer downstream is at risk of treating the wrong condition.

Step 2: Psychiatric assessment if anxiety is severe or suicidality is present

Severe anxiety with suicidality is a psychiatric emergency, not an indication for adjunct work. If the anxiety presentation is severe or if suicidal ideation is part of the picture, psychiatric assessment runs ahead of everything else, with stabilization of the acute risk before any other treatment layer is built.

Step 3: Evidence-based primary treatment for fibromyalgia

With the diagnosis confirmed, the rheumatology-led plan is built. Pharmacological options where indicated, often duloxetine, pregabalin, or milnacipran, run through the prescriber. Graded exercise therapy with a physiotherapist or kinesiologist experienced in central sensitization conditions starts where the client can tolerate it. Sleep optimization is addressed, possibly with sleep medicine involvement if sleep-disordered breathing is suspected. This is the foundation. Adjunct work without it is building on sand.

Step 4: Evidence-based primary treatment for the anxiety layer

CBT remains first-line for most anxiety presentations, ideally pain-CBT or fibromyalgia-CBT delivered by a psychologist with experience in central sensitization conditions. Where anxiety severity warrants it, medication may be part of the picture, run by the prescriber. The anxiety layer needs its own primary treatment, not just adjunct work.

Step 5: Hypnotherapy as adjunct on anxiety, sleep, and central sensitization layers

Once the primary treatments are in place, hypnotherapy can enter as adjunct on the layers where mechanism alignment supports it. Anxiety arousal, sleep architecture, pain catastrophizing, central sensitization arousal. The work runs alongside the rheumatology and psychology plans, not instead of them.

Step 6: Coordinated communication across the team

The piece that often distinguishes coherent care from parallel monologues. With your written consent, my standard practice is a summary note to your rheumatologist, family physician, and treating psychologist or therapist at the start of the work, a check-in note around session four, and ongoing willingness to communicate when the picture changes. This is the difference between adjunct work that fits into your overall plan and adjunct work that runs in a vacuum.

The unifying principle: hypnotherapy alone for fibromyalgia and anxiety is not appropriate, and any practitioner who suggests otherwise is operating outside scope. Adjunct work inside a rheumatology-led plan, with anxiety treatment running in parallel and coordination across the team, is what the evidence supports and what the scope of practice allows.

When the fibromyalgia and anxiety stack is masking something else

The differential diagnosis matters because several conditions look like fibromyalgia plus anxiety, need different primary treatment, and can be missed for years if the picture is assumed to be psychophysiological. These are the masks I see most often and the workup that addresses each.

Hypothyroidism

Underactive thyroid produces fatigue, widespread aches, sleep disruption, cold sensitivity, and cognitive slowing, with anxiety often layered on top. Bloodwork (TSH, free T4) is the workup, and it is fast and cheap. Untreated hypothyroidism worsens with time and responds to thyroid replacement, not to anxiety treatment. Any new fibromyalgia-pattern presentation should have thyroid bloodwork done.

Polymyalgia rheumatica or other inflammatory rheumatologic disease

Polymyalgia rheumatica produces widespread morning stiffness and pain in older adults, with elevated inflammatory markers and a dramatic response to corticosteroids. Lupus, rheumatoid arthritis, and other autoimmune diseases can produce overlapping pictures. The rheumatology workup includes inflammatory markers (ESR, CRP), autoimmune panels where indicated, and clinical examination. Missing inflammatory disease because the picture was attributed to fibromyalgia plus anxiety is one of the more costly errors in this differential.

ME/CFS overlap with fibromyalgia

Myalgic encephalomyelitis and chronic fatigue syndrome (ME/CFS) overlaps with fibromyalgia in the autonomic, cognitive, and fatigue features, but the defining feature of ME/CFS is post-exertional malaise (a disproportionate worsening of symptoms after physical or cognitive exertion). This matters clinically because graded exercise therapy, which is helpful in fibromyalgia, can be harmful in ME/CFS. Getting the distinction right requires clinician familiarity with both conditions and is one of the reasons specialty consultation matters.

Undiagnosed sleep apnea

Sleep apnea worsens fibromyalgia symptoms substantially and can produce a picture that mimics fibromyalgia plus anxiety on its own (fatigue, cognitive slowing, mood changes, pain amplification through sleep deprivation). Sleep study is the workup. Treating sleep apnea appropriately often improves the broader picture meaningfully, and sleep apnea coexisting with fibromyalgia means both need treatment, not one or the other.

Major depression with chronic illness features

Depression with chronic illness can produce somatic pain, fatigue, cognitive symptoms, and anxiety in a pattern that overlaps with fibromyalgia. The two often coexist, and they need their own treatment paths. Psychiatric workup matters when the depressive features are prominent or when the picture has not responded to fibromyalgia-targeted care.

Active untreated trauma compounding the picture

Trauma history, particularly chronic developmental trauma or untreated PTSD, can amplify central sensitization conditions and complicate the anxiety layer in ways that need trauma-trained care. Hypnotherapy without trauma awareness is contraindicated for clients with significant untreated trauma, and the appropriate path involves a trauma-trained primary therapist before adjunct work.

The unifying principle

Always: rheumatology and medical specialty workup before assuming the picture is purely psychophysiological. The cost of running the workup is a few months. The cost of treating undiagnosed disease as anxiety-amplified fibromyalgia is years. As a Registered Clinical Hypnotherapist, my role is to recognize when adjunct work is appropriate and to refer when it is not. Booking adjunct hypnotherapy before the medical workup is in place is putting the adjunct piece ahead of the primary care it is supposed to support.

What CHC’s adjunct approach looks like

Calgary Hypnosis Center delivers adjunct hypnotherapy for confirmed fibromyalgia with anxiety overlay, alongside rheumatology-led primary care. Here is the actual structure of the work.

Intake (60 to 90 minutes)

Longer than a single-condition anxiety intake because there is more to map. Fibromyalgia diagnosis confirmation including who diagnosed and when. Anxiety pattern history and current presentation. Sleep timeline, including any sleep study results or suspected sleep-disordered breathing. Current rheumatology and family medicine team and care plan. Medication review (current and recent, with attention to any agents that may affect responsiveness to hypnotic suggestion). Trauma history screening. Hypnotizability check, which gives a rough read on whether suggestion-based work is likely to land easily or require more groundwork. We agree on what success would look like by session four and again by session eight, so the work has explicit checkpoints.

Sessions 1 to 2: foundational induction and somatic anchoring

Foundational induction work to establish the hypnotic state and build client confidence with it. Somatic anchoring techniques for sympathetic down-regulation, the core skill that supports every other piece of the work. The first self-hypnosis recording is usually introduced at session two for daily between-session use.

Sessions 3 to 5: targeted suggestion and central work

Targeted suggestion work for catastrophic interpretation patterns, attentional training away from constant pain monitoring, and sleep recovery work using the Cordi-aligned approach with appropriate caveats. Self-hypnosis recordings are updated to match the work being done in session.

Sessions 6 to 8: integration with paced activity expansion

Integration with the paced activity work being guided by your rheumatology and physiotherapy team. Self-hypnosis use becomes the dominant between-session tool, with sessions tapering toward a maintenance cadence. Honest review at session eight on what has changed and what has not, with an explicit decision point about continuing, tapering, or referring back to the primary care team for a different angle.

Self-hypnosis recordings as core tool

Self-hypnosis recordings are not optional homework. They are the daily practice that does most of the between-session work. Anxiety regulation recordings, sleep recordings, pain flare recordings. Daily use during the active course, tapering to as-needed use during maintenance.

Realistic course length

Eight to twelve sessions for adjunct work alongside multidisciplinary care, sometimes more if the central sensitization and sleep layers need deeper work. Longer than single-condition anxiety courses because there are more layers to address. Shorter than a primary fibromyalgia plan because we are doing adjunct work, not primary care.

What we do not do

We do not replace rheumatology, prescribe or recommend medication changes, promise pain elimination, or treat fibromyalgia as if it were primary anxiety. The boundaries here are not bureaucratic. They are what protects the integrity of the adjunct work and keeps it inside the scope of what hypnotherapy can honestly deliver.

Practical detail

Per-session fee is $220 CAD. Sessions are delivered virtually across Canada and in-person in Calgary. There are no admin fees. Payment at time of service. Receipts include the practitioner ARCH registration number. Hypnotherapy is generally not directly covered under Canadian extended health benefit plans. Some clients can claim related programs (stress management, behavioural change) under a Wellness Spending Account (WSA) if their plan offers one. Coverage rules depend entirely on plan design, so check with your insurance provider before booking.

Frequently asked questions

If you are reading this and considering whether hypnotherapy belongs in your fibromyalgia and anxiety plan, the honest framing is this. With rheumatology and multidisciplinary care running, hypnotherapy can take meaningful pressure off the anxiety arousal, the sleep architecture disruption, and the catastrophizing that drive central sensitization beyond what the underlying condition would predict. It will not eliminate fibromyalgia. It will not replace your rheumatology or psychology team. Inside a coordinated plan, with realistic expectations on effect size, it is a reasonable adjunct for many fibromyalgia and anxiety presentations. You can start a fibromyalgia-aware intake when the rheumatology piece is in place and you are ready.