Young woman is having a pain in her back


Lorem ipsum dolor sit amet, consectetur adipiscing elit. Donec imperdiet aliquam dictum. Morbi nisi leo, bibendum eu nisi at, volutpat molestie ipsum. Sed porttitor viverra egestas. Suspendisse lorem ex, tempor non pulvinar sit amet, tincidunt at ante. Etiam fringilla, ipsum non luctus tempor, ipsum mauris laoreet mauris, vitae placerat ipsum leo vitae ligula. Vestibulum ut consequat dolor. In at cursus turpis, quis fermentum nisi. Maecenas sit amet mattis justo. Integer fermentum, sem sed semper posuere, nisi metus luctus leo, quis pellentesque ante ipsum quis leo.

Vivamus condimentum nibh urna, in sollicitudin purus auctor eu. Curabitur pulvinar augue eros, bibendum sodales lacus euismod vel. In eget neque a mi auctor interdum. Donec viverra faucibus urna eget eleifend. Donec iaculis facilisis nibh in lobortis. Fusce volutpat facilisis ipsum et finibus. Vestibulum lacus sem, mattis quis enim at, commodo consequat eros. In convallis odio nunc, a sodales justo blandit eu. Morbi sit amet rutrum arcu, vitae placerat nibh. Ut tellus urna, interdum et pulvinar gravida, pharetra id dolor. Donec non lacus et mi tempus rhoncus quis sed eros. Suspendisse vel tellus odio. Phasellus tincidunt nulla est, sed elementum purus ultricies ut.

Nunc tellus est, blandit a pellentesque vitae, pellentesque sed mauris. Nullam rutrum rutrum libero, sit amet tempor metus pulvinar quis. Sed rutrum, nunc ac tristique feugiat, nulla ipsum laoreet diam, non auctor nulla ipsum in odio. Curabitur dignissim purus vel metus vulputate, at ultricies eros porta. Sed auctor semper arcu, vel facilisis elit commodo sit amet. Ut feugiat arcu quis ante cursus, nec fermentum justo laoreet. Suspendisse dictum turpis libero, ut condimentum odio facilisis in.

Praesent ut efficitur lorem, eu mattis risus. Nunc in elit magna. Nam maximus sem auctor nulla rutrum, fringilla vulputate nisl maximus. Mauris vel euismod lacus. Fusce at convallis ligula, ut rhoncus tortor. Suspendisse sed velit quam. Mauris eu ligula nec diam suscipit ullamcorper ut vitae tellus. Quisque ut turpis ut velit vestibulum convallis nec sit amet eros. Praesent sit amet quam neque. Proin dignissim nisi in consequat faucibus. Cras eget ullamcorper enim, non maximus sapien. Sed venenatis urna risus, non laoreet nisl molestie at.


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 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.