Patient information · Rheumatology and pain
Fibromyalgia
real pain, from a real mechanism
Fibromyalgia causes widespread pain, profound fatigue and cognitive difficulty. Blood tests and scans are normal, which has led generations of patients to be told there is nothing wrong. In fact the mechanism is now reasonably well understood: the nervous system amplifies pain signals. The pain is not imagined; the volume control is set too high.
Seek assessment before assuming fibromyalgia if you have
- joint swelling, redness or heat, or morning stiffness lasting over an hour
- fever, night sweats or unexplained weight loss
- muscle weakness rather than pain — difficulty climbing stairs or lifting arms
- a new rash, mouth ulcers, or dry eyes and mouth
- numbness, tingling or bladder and bowel changes
- new widespread pain over the age of 50
Inflammatory arthritis, polymyalgia rheumatica, lupus, thyroid disease, vitamin D deficiency and some statin side effects all cause widespread pain and are treated entirely differently. A proper assessment excludes these before settling on fibromyalgia.
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
Why the tests are normal
Fibromyalgia is a disorder of pain processing rather than of tissue damage. Nerves carrying pain signals become sensitised and the brain's own pain-dampening systems work less effectively, so ordinary signals are experienced as painful. There is nothing to see on an X-ray or in a blood test because there is no inflammation or destruction — which is precisely why a normal scan should not be taken as evidence that nothing is wrong. Understanding this mechanism genuinely helps: it explains why treatments aimed at the nervous system work and anti-inflammatories largely do not.
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.
Why come to us. Fibromyalgia is diagnosed by exclusion and then usually abandoned. We offer unhurried appointments, the full exclusion panel in-house — inflammatory markers, thyroid, vitamin D, ferritin, autoimmune screening — with results explained face to face, and rheumatology and physiotherapy input under one roof. We prescribe and review medication properly rather than leaving you on something that is not working, and provide detailed letters for employers and benefit applications. Seven days a week.
Properly assessed, and taken seriously
Exclusion bloods in-house, rheumatology and physiotherapy on site.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.