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Background Fibromyalgia (FM) is a common, disabling, and costly nociplastic pain condition. Most frontline treatments show modest effects in reducing pain in FM, which may be due to a mismatch between the mechanisms of existing interventions and mechanisms underlying nociplastic pain. The current study was a single-arm, open-label trial examining the feasibility, acceptability, and preliminary efficacy of a novel, three-session telehealth behavioral intervention (Brief Pain Reprocessing Therapy (BPRT)). BPRT incorporates psychological techniques specifically targeting the putative mechanisms of nociplastic pain in a brief, telehealth format.Methods 35 adults with FM initiated treatment. Participants were asked to complete three one-on-one intervention sessions via telehealth and online questionnaires at four time points (pre-intervention and at 1, 2, and 3 months post-intervention) assessing average pain intensity, pain interference, and pain-related fear.Results 33 participants (94.3%) completed the BPRT protocol. Acceptability ratings for BPRT were high (62.0 out of 70 on the Treatment Acceptability/Adherence Scale). BPRT completers reported significant reductions in average pain intensity (B=−0.645, 95% CI −0.896 to −0.395, p<0.001; 1-month d=0.56, 2-month d=0.80, 3-month d=0.89), pain interference (B=−2.19, 95% CI −3.06 to −1.31, p<0.001; 1-month d=0.76, 2-month d=1.02, 3-month d=1.06), and pain-related fear (B=−2.29, 95% CI −3.07 to −1.51, p<0.001; 1-month d=0.60, 2-month d=0.88, 3-month d=1.04). At the 3-month follow-up, 42.3% of completers reported being ‘much improved’ or ‘very much improved.’Conclusions BPRT is feasible and acceptable, with promising preliminary efficacy for reducing pain, pain interference, and pain-related fear in FM. These findings highlight the possibility of reducing FM pain and interference using a brief telehealth intervention. Larger randomized controlled trials are needed to rigorously evaluate the efficacy and mechanisms of BPRT.