Young woman is having a pain in her back

Fibromyalgia

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FIBROMYALGIA

I have a particular interest in Fibromyalgia. This interest has arisen over time and is driven by the presentation of the individuals I see in clinic, the various lenses that my colleagues bring to their care and the “system” response to the health care needs of individuals with Fibromyalgia.

I am in the last third of my career as a Doctor, (where did all the time go?) qualifying in 1990 and I have decided to commit this part of my career to develop a better pathway for individuals diagnosed with Fibromyalgia, who I meet in my clinics or who may be struggling with their fibro elsewhere.

The first steps towards this goal are being developed on fibroforward.com a platform that has been several years in gestation and will hopefully go live in the November 2018. If you want to be in the first group to come on board then sign up at the bottom of the page.

African-american woman having back pain after sleep

A couple of thoughts on fibromyalgia and things that I always tell my patients.

1. It’s a proper pathological process, you’re not going mad, it’s not in your head and you are not malingering.

2. Fibromyalgia is a term that probably covers multiple pathological pathways, which then converge in more generic process of central sensitisation.

3. Fibromyalgia is still considered a primarily psychosocial condition by many of my fellow clinicians and will continue to be so, in my opinion, until the underlying pathological drivers are better understood.

4. Medicine in the broader sense and clinicians, in particular, are poor at accepting that there may be a (commonly) presenting condition which they have yet to describe the underlying pathology of. In the face of this, there is a tendency to attribute the resultant issues to the patient or more specifically the patients psychologically or psychosocial pressures. That is not to say that psychology is unrelated to pain experience or pain development, however, I do believe that when we eventually elucidate the underlying epigenetic triggers of Fibromyalgia we will appreciate that the underlying vulnerabilities are constitutional but may also require a variety of environmental triggers or biopsychosocial triggers.

So what the way forward…?

Currently, the best assessment of the evidence for treatment of fibromyalgia is described in the EULAR Fibromyalgia guidance. The issue that faces us is how we deliver this current best practice.