Fibromyalgia and Functional Disorders
- Fibromyalgia is one of the very challenging presentations for our patients. Patients present with generalised pain, tiredness and easy fatigability that’s affecting their daily functioning and quality of living.
- What our patients find very frustrating, and challenging is the fact that they don’t have an obvious biomedical disorder to justify the magnitude of pain and the drained energy state they are experiencing which makes it difficult for their surrounding circles such as families and employers to understand the problem and makes patients feel embarrassed of being labelled as malingerers or frauds when their pain is 100% genuine and real.
- Our patients usually go in circles visiting different doctors and doing large battery of investigations and receiving different classes of medications and treatments without improvement and more importantly without an answer until they come and visit us.
- Fibromyalgia is largely a clinical diagnosis based on symptoms with many theories to try to justify the reason underlying the problem but what’s most important and reassuring and we always educate our patient around is the fact that fibromyalgia doesn’t hide any sinister pathology in their system and it’s largely secondary to sensitivity of their nervous system that’s firing pain signals without a need or reason, none of which is their fault and the fact that their pain is very real.
- Fibromyalgia is one of the pain disorders where the concept of the 3 -dimensional nature of chronic pain disorders is obvious; biomedical and here this might be minimal if any , psychological, and social.
- While Fibromylagia patients are not immune against having wear and tear changes in their system that could cause pain, it’s not uncommon to find elements of psychologic distress such as psychologic trauma or social turbulences that contribute to amplification of pain and compromise of quality of life and daily functioning.
- While no pharmacologic management has proven effective for Fibromyalgia yet a trial of certain medication classes is not uncommon but evidence supports the use of a holistic approach that minds the 3-dimensional nature of chronic pain, educating patients around their problem and helping to steer their mind set to coping and acceptance that there will always be an element of pain in the back ground and the fact that it’s safe and important to keep functioning to avoid deconditioning while adopting pacing and moving away from expecting radical cure for their pain.
- This is successfully achieved as part of a self-management approach supported by their pain consultant along with input from Pain psychology and Pain physiotherapy to address any stressors or abnormal thinking and behaviour that could have developed around this pain either as one to one or as part of a wider pain management programme joined by other patients struggling with similar condition with focus on regaining function and quality of life.