Fibromyalgia

Fibromyalgia is a long-term debilitating condition that can affect the whole body. Patients experience widespread pain in various areas of the body and this can move from day to day and week to week. The main symptoms Fibromyalgia Patients experience are as follows:

Symptoms

• Widespread pain
• Fatigue
• Difficulty in concentration and memory – known as ‘Fibro Fog’
• Headaches
• Muscle stiffness
• Increased sensitivity to pain
• Poor sleep quality

At the London Pain Clinic, during the initial consultation, a full history, assessment and examination are completed. If Fibromyalgia Syndrome is a considered condition, the Consultant will assess you using the American College of Rheumatology Guidelines 2010. This helps provide guidance regarding a diagnosis of Fibromyalgia.

Further investigations are often required to rule out other rheumatological causes. We can arrange for these to be done at the London Pain Clinic or request these through your GP.

Fibromyalgia can affect anyone, but typically affects middle-aged women. It normally develops around the ages of 30-50.

Patients fine there are often other family members with the condition, hence research shows there is a genetic predisposition. In the UK, it is reported to affect 7% of the population, however, this may be inaccurate. The reason for this is that Fibromyalgia is difficult to diagnose given that the symptoms match so many other conditions.

There are many associated risk factors for developing the condition and possible triggers can include:

• Stress – at work or in one’s personal life
• Traumatic event – physical or emotional
• Viral infection – be it a simple cold or something more serious
• An operation or a small procedure
• The failure of a relationship – a marriage, a partnership or even a death in the family

These triggers need to be assessed and if possible, discussed and treated. At the London Pain Clinic, we provide the necessary tools and therapy sessions to enable the patient to understand their issues and triggering factors.

Treatment options

Given the extensive nature of the problem, The London Pain Clinic will provide the necessary treatment modalities to help the symptoms of Fibromyalgia and improve your quality of life.

In several cases, a number of healthcare professionals need to be involved in your treatment/recovery. These may include:

• Rheumatologist
• Specialist Pain Physiotherapist
• Specialist Pain Psychologist
• Specialist Dietician
• Neurologist

These individuals will be able to help with the various aspects related to the condition. A combined treatment plan and commitment to the regime can significantly help improve quality of life and reduce symptoms.

Medication

It is very common for Fibromyalgic patients to be taking a multitude of medications. At the London Pain Clinic, we will identify the right medications for you to ensure the best outcomes. There are many different types of medications that can be effective for Fibromyalgia including:

• Simple painkillers

These can vary from Paracetamol to non-steroidal anti-inflammatory to more potent analgesics such as Tapentadol or even opiates such as Morphine. Each one has its benefits and side effects and will be weighed against your symptoms and condition. We will endeavour to make sure that each medication is suited to your needs.

• Anti-depressants and anti-convulsants

Anti-depressants can also be used to help the pain of Fibromyalgia. They can help to change the way the body’s chemicals are made and help to reduce the pain. The medication will be carefully chosen, depending on your symptoms, and initially will be prescribed at a low dose. Once this has been trialled, the dosage may be increased to improve symptom control. This will depend on individual cases and may need to be replaced with a different drug if not found to be suitable. Your Consultant will discuss this with you individually.

• Muscle relaxants

Some patients may suffer from stiffness or spasms that can affect their mobility. A course of a muscle relaxants may help to reduce the effect of the spasms and reduce the associated pain. This can be discussed further at your consultation.

Other treatments

• Specialist Pain Physical Therapy Rehabilitation

A suitably specific gentle graded exercise programme created for you is essential to the improvement of your condition. This might include swimming, exercising or even light weight training. A specialist pain physiotherapist will be able to guide you and ensure the appropriate programme is instigated.

• Specialist Pain Psychology

This is a therapy that helps you understand and deal with your thoughts, change the way you think about things and possibly help you tackle the problems associated with Fibromyalgia. At the London Pain clinic, we have specialists that we can refer you to.

• Other therapies

Acupuncture, yoga, massage and aromatherapy all can help patients deal with their problem. Individually, these treatments have been shown to be effective, however, this may not be the case with everyone.

• Minimally Invasive Pain Management Procedure

Lidocaine/Ketamine infusions – This is a treatment that has been shown to help patients control the pain and possibly improve one’s sleep problems. It involves the administration of Lidocaine, Ketamine or both over a period of a couple of hours whilst you rest and are monitored. There is no requirement for an anaesthetic and there are minimal side effects.

It is a possible treatment option for resistant Fibromyalgic patients who have had minimal benefit from other treatment options.

Botulinum Toxin A injections – This treatment can reduce the scope of pain experienced by the patient. Botulinum Toxin A (Botox) is administered under image guidance to areas of the body which feel the pain most. This treatment can help to ease the tension, reduce the tenderness felt in the muscles and improve your mobility.

The treatment does not require an anaesthetic and has minimal side effects. This can be discussed further at your consultation.