Fibromyalgia involves central sensitization — the nervous system amplifies pain signals, making normal sensations feel painful. This means the pain isn't imaginary but the processing is abnormal: the volume knob in the spinal cord and brain is turned up too high. Breathing exercises address central sensitization by reducing sympathetic activation, which directly modulates spinal cord pain-gating mechanisms and reduces the gain on pain processing.
The gentle protocol (intensity matters — aggressive breathing can flare fibromyalgia symptoms): coherence breathing (inhale 5, exhale 5) for 5-10 minutes, twice daily, in a comfortable supported position. Start with 5 minutes and increase only if tolerated. The emphasis is on gentleness — the breath should feel effortless, not forced. If any breathing practice increases pain or fatigue, reduce duration or switch to simple diaphragmatic awareness (observing the breath without controlling it).
Over 4-8 weeks of consistent practice, fibromyalgia patients typically report: reduced pain intensity (the central gain decreases), improved sleep quality (parasympathetic tone supports sleep architecture), reduced fatigue (autonomic regulation improves energy distribution), and better mood (vagal activation reduces depressive symptoms). These improvements are modest but meaningful, and they compound with other treatments (exercise, cognitive therapy, medication). Breathing exercises are particularly valuable because they're accessible on high-pain days when other activities aren't possible.