Fibromyalgia

Fibromyalgia is best understood as a problem with how the nervous system processes pain. The nerves and brain become more sensitive to signals, so ordinary sensations can be felt as painful and pain is amplified, a process sometimes called central sensitisation. It is not caused by damage or inflammation in the joints, which is why the joints themselves remain structurally sound.

There is no single cause. It often emerges after a period of physical or emotional stress, an infection, an injury or an operation, though sometimes it begins for no obvious reason. It is more common in women and frequently appears alongside poor sleep, low mood or anxiety, and conditions such as irritable bowel syndrome or hypermobility syndromes. A family tendency is recognised.

Fibromyalgia can affect people in several ways. Common features include:

• Widespread pain affecting many areas of the body
• Persistent fatigue, often not relieved by rest
• Disturbed or unrefreshing sleep
• Difficulty with memory or concentration, sometimes described as brain fog
• Sensitivity to touch, and sometimes headaches or digestive symptoms

There is no single test for fibromyalgia. The diagnosis is made from the characteristic pattern of symptoms, a careful history and examination, and tests to exclude other conditions that can cause similar pain and fatigue, such as inflammatory arthritis or thyroid problems. An important part of the assessment is taking the symptoms seriously and ruling out other causes, so the diagnosis is reached with confidence.

Where there is any question of joint inflammation, ultrasound can help clarify whether inflammation is present. Dr Borukhson uses point-of-care ultrasound during the consultation. You can read more on the ultrasound clinic page.

Fibromyalgia is usually best managed with a combination of approaches tailored to the individual, which may include graded exercise and activity, attention to sleep, strategies for managing pain, and sometimes medication aimed at the way the nervous system processes pain. The medicines with the most consistent support in current UK guidance are certain antidepressant-type tablets, such as low-dose amitriptyline or duloxetine, used here for their effect on pain processing rather than for mood. They can cause drowsiness and do not suit everyone, and any plan is discussed fully with you. Current UK guidance advises against opioids and against medicines such as pregabalin and gabapentin for fibromyalgia. The aim is to improve daily function and quality of life, and the plan is developed together with you.

Self-management is central to living well with fibromyalgia, and small, consistent steps tend to help more than occasional large efforts.

• Keep moving within your limits. Gentle, gradually increasing activity such as walking, swimming or stretching helps over time, even when it feels counterintuitive.
• Pace yourself. Spread tasks across the day and rest before you are exhausted, rather than overdoing things on good days.
• Protect your sleep. A regular routine and wind-down period can ease both fatigue and pain.
• Address stress. Relaxation, breathing techniques and talking therapies are genuinely useful, not a suggestion that the pain is imagined.

Symptoms typically fluctuate, with better and worse spells. Many people find that, with a steady plan and time, daily function and confidence improve and flares become easier to manage.

Because fibromyalgia does not damage the joints or organs, genuinely new or different symptoms should never simply be attributed to it, and deserve assessment in their own right.

Arrange a prompt medical review if you develop:

• A joint that becomes visibly swollen, hot or red
• New weakness, numbness, or problems with bladder or bowel control
• Fever, unexplained weight loss, or night sweats
• New severe headache, or pain and stiffness around the shoulders or hips with difficulty rising in someone over 50

Seek urgent, same-day care for sudden severe chest pain, breathlessness or signs of a stroke.

For low mood, anxiety or thoughts of self-harm, speak to your GP without delay; emotional health is an important part of this condition and support is available. Stable, long-standing symptoms can be reviewed routinely.

Fibromyalgia is often poorly understood, and people sometimes struggle to have it recognised. A careful specialist assessment confirms the diagnosis, excludes other conditions, and sets out a clear, practical plan. If you have widespread pain and fatigue, a considered review can help you move forward.

How can fibromyalgia be diagnosed if my test results are normal?

No single blood test or scan can confirm fibromyalgia, so normal results do not rule it out. The diagnosis rests on the characteristic combination of widespread pain, fatigue and unrefreshing sleep, together with a careful history, an examination and tests to exclude other causes. Because the pain arises from the way the nervous system handles pain signals rather than from damage in the joints, test results are often entirely normal.

What happens at the first appointment for fibromyalgia?

Dr Borukhson takes an unhurried history of your pain, sleep, energy and concentration, examines the relevant areas, and reviews or arranges blood tests to exclude conditions such as inflammatory arthritis or thyroid problems. If there is any question of joint inflammation, point-of-care ultrasound can be used during the consultation itself. The aim is for you to leave with a clear explanation and a practical plan.

Will I need to take medication for fibromyalgia?

Not necessarily. Management usually combines paced, gradually increasing activity, good sleep habits and practical pain-management strategies, with tablets considered only where they are likely to add benefit. Where medication is used, certain antidepressant-type medicines, such as amitriptyline or duloxetine, are chosen for their effect on pain processing rather than mood, and UK guidance does not recommend opioids, pregabalin or gabapentin for fibromyalgia.

How long does it take to feel better?

Improvement tends to be gradual rather than immediate, and it usually builds as the different parts of the plan, particularly graded activity and better sleep, take effect. The aim is steady gains in day-to-day function and quality of life, with the plan reviewed and adjusted as you progress.

When should I seek medical advice rather than put new symptoms down to fibromyalgia?

Fibromyalgia does not cause damage or inflammation in the joints, so symptoms that look different deserve attention in their own right. If a joint becomes visibly swollen, hot or red, or you feel markedly unwell in a new way, arrange a prompt medical review rather than assuming it is part of the fibromyalgia.