Private fibromyalgia clinic in London, same-day physiotherapy.

What it involves

• Widespread pain for more than three months, in multiple body regions
• Fatigue, often profound and not relieved by sleep
• Unrefreshing sleep, and difficulty getting to or staying asleep
• Cognitive difficulty — often called fibro fog
• Frequently alongside: headaches, IBS, bladder urgency, restless legs, temperature sensitivity, anxiety and low mood
• Symptoms fluctuate, often with weather, stress, activity and sleep

What helps most

• Graded exercise, started very gently. This has the strongest evidence of anything. Begin below what you think you can manage — five minutes of walking or water-based exercise — and increase by a small amount every week or two. It will hurt initially and that settles. Doing too much too soon is the commonest reason people stop.
• Sleep — a consistent schedule, and treating any sleep apnoea or restless legs.
• Pacing rather than pushing hard on good days and collapsing afterwards.
• Psychological approaches — CBT, acceptance and commitment therapy, mindfulness. These target the pain system, not your credibility.
• Heat, warm water exercise, and gentle massage for symptom relief.
• Education about the mechanism, which measurably reduces pain and disability in trials.

Medication

• Amitriptyline at low dose is the usual first choice, taken at night, helping pain and sleep together.
• Duloxetine has good evidence, and is particularly useful where low mood coexists.
• Pregabalin helps some people, with sedation and weight gain as common drawbacks.
• Anti-inflammatories and paracetamol have little effect in fibromyalgia, because there is no inflammation to treat.
• Opioids should be avoided. They do not work well for this type of pain, and long-term use worsens pain sensitivity, causes dependence and adds side effects. This is now a firm recommendation.
• Expect trial and error, several weeks per trial, and modest rather than dramatic benefit from any one drug.

Work and daily life

Fibromyalgia may meet the definition of a disability under the Equality Act 2010, allowing reasonable adjustments — flexible hours, seating, reduced physical demands, working from home. Many people remain in work with the right adjustments, and staying in work where possible is associated with better outcomes.