Treatment for Fibromyalgia

Fibromyalgia (FM) is another example of a ‘medically unexplained’ condition and affects up to 5% of people in the UK. It is more common in women than men and some research also suggests that urban populations are more affected that rural ones. Quite why this condition develops is not well understood but clues for the underlying basis for this syndrome are likely to be found in the range of symptoms described by patients.

The condition is characterised by widespread pain but with no pathological basis for this i.e. no injury or observable disease process. As with chronic fatigue syndrome, there are no blood tests, scans or other medical investigations that are reliable markers of the condition. We know that as pain becomes more chronic, for whatever reason, it will effect many parts of the central nervous system as well as the immune and endocrine systems. These systems work together to protect the body against threat if there is injury, or perhaps the ‘perception’ of threat even when there is no actual injury or loss of body integrity. One consequence to this is lower pain thresholds so that relatively innocuous sensations are increasingly likely to be felt as stiff, uncomfortable or painful. Clearly, patients who have a lowered pain threshold due to chronic, long lasting pain will be tender to touch and have increasing feelings of stiffness and pain with normal movement or stretch - situations which, in healthy individuals, are not symptomatic.

Due to ongoing pain, patients report poor sleep quality and resulting chronic fatigue as well as immune system dysfunction. As this progresses over time, patients find that they increasingly withdraw from normal activity including social and work situations. This inevitably leads many patients to complain of mental health issues such as depression. Because the diagnosis of fibromyalgia is ambiguous, research is not clear as to the cause and effect relationships of all of these various symptoms. But what we know about chronic pain in general is that there is a bidirectional relationship between pain and depression. People with chronic pain would be pretty resilient to not end up having altered mood states, but we also know that people with underlying mental health disorders such as depression are more likely than the general population to develop chronic pain.

As such this is another complex condition that is best treated by a team of specialists in pain medicine, physiotherapy and psychology working together with patients.