Fibromyalgia is a chronic pain syndrome characterised by widespread musculoskeletal pain, fatigue, sleep disturbance, cognitive symptoms, and heightened pain sensitivity.
It is considered a disorder of central pain processing rather than a primary inflammatory or structural disease. However, it may also represent an underlying subclinical inflammatory or autoimmune process that is not detectable through routine blood markers.
Multiple mechanisms have been associated with the pain presentation, including central sensitisation (amplified pain processing in the brain and spinal cord), neurochemical imbalance (altered serotonin, norepinephrine, and dopamine pathways), genetic predisposition, and abnormal pain modulation pathways, among others.
Management is multidisciplinary and focuses on symptom control, functional improvement, and improving quality of life. The mainstay of treatment relies on education, lifestyle modifications, medication titration as tolerated, and physical and psychological therapies. This requires a multidisciplinary approach and structured pain management programmes, where all the above treatment domains can be closely monitored in one setting. Pacing of activities with a graded exercise regimen has been shown to be beneficial in most cases for symptom control and improved functionality.
I offer the following pain interventions along with medication titration as deemed appropriate: a. Trigger zone injections
b. Lignocaine / ketamine infusions
You can request your GP to arrange a named consultant referral to the Barts neuromodulation service to access these advanced treatment options if they are not available in your area.