Recognising symptoms of fibromyalgia and how to intervene

Written by: Dr Shankar Ramaswamy
Edited by: Laura Burgess

Fibromyalgia is a condition that is characterised by chronic, widespread/ diffuse musculoskeletal pain and tenderness. This is associated with a wide variety of symptoms including sleep disturbance, fatigue, mental and physical symptoms. It occurs in 2-5% of the population.

Dr Shankar Ramaswamy is an expert pain management specialist in London and here he explains everything that you need to know about fibromyalgia, from the first signs to the possible ways of managing the pain condition.

Is fibromyalgia considered to be a chronic pain condition?

In the recent release of International Classification of Disease (ICD)-11 by the WHO, fibromyalgia syndrome is included as a form of chronic widespread pain (CWP) as a subcategory under the chronic primary pain.

In ICD-11, fibromyalgia is defined as pain in at least four of five body regions (in at least three or four body quadrants), which is associated with sleep disorders, cognitive dysfunction, and somatic symptoms.

What causes fibromyalgia?

The exact cause of fibromyalgia is unknown but several factors can trigger its appearances, such as physical or emotional trauma, infection or a disease such as rheumatoid arthritis. Also, several theories have been proposed including abnormal hormone function, changes in the chemicals in the nervous system such as serotonin and substance P, genetics and hypersensitivity of the nervous system, otherwise called central sensitisation.

What are the first signs of fibromyalgia?

Patients with fibromyalgia often initially complain of:

  • Fatigue
  • Lack of energy
  • Sleeping problems
  • Anxiety or depression
  • Concentration and memory problems (often called fibro fog)
  • Headache
  • Muscle cramps and twitches
  • Whole-body pain involving muscles and ligaments.

Often patients have other associated conditions such as painful jaw (due to temporomandibular joint problems), abdominal pain due to digestive problems often linked to irritable bowel syndrome and painful bladder symptoms.

Presence of such multiple painful conditions points toward a more central pain problem involving the nervous system (central sensitisation) as opposed to isolated peripheral pain problem.

Who is at risk of fibromyalgia?

The exact cause of fibromyalgia is still unclear. Fibromyalgia is more common in women than men although it can occur in both genders. It usually starts in the middle age group although it can start in childhood. Often there is a significant delay of over five years in diagnosing fibromyalgia.

Recent history of stressful or traumatic events such as a car accident, stressful relationship/ divorce or post-traumatic stress disorder, viral illness, repetitive joint injuries, can precipitate fibromyalgia symptoms.

There is some genetic link as a family history of fibromyalgia is a known risk factor.

Certain inflammatory conditions such as rheumatoid arthritis and lupus increase the risk of developing fibromyalgia.

Fibromyalgia also has a weak association with obesity.

What are the best ways to treat fibromyalgia?

The treatment for fibromyalgia mainly revolves around patient education, devising an effective self-management strategy, medications to help with pain, sleep and mental health, psychological and relaxation techniques, exercise and some targeted interventions.

The treatment strategy should be individualised and aimed at managing the multitude of symptoms that the patient is presenting with.

A variety of medications have been used to relieve pain, improve sleep as well as mood, which includes some antidepressants such as Amitriptyline and anti-seizure medication such as Gabapentin.

Targeted interventions include identifying specific trigger points in muscles and injecting with a variety of medications such as local anaesthetics, steroids or Botox, or performing radiofrequency treatment at the trigger points. 

Some patients may also need a series of interventions involving a drip with an infusion of a local anaesthetic to combat the widespread pain. These treatment strategies are usually offered under the care of a pain consultant.

You can book an appointment with Dr Ramaswamy via his Top Doctor’s profile here and if you’re currently unable to go far because of the coronavirus ‘stay at home’ measures, he is available via video call thanks to our e-Consultation tool.

By Dr Shankar Ramaswamy
Pain medicine

An important note with regard to the COVID-19 pandemic: We are offering video consultations to all patients at flexible times and at short notice. This is authorised by all insurance providers. Our team also offers physiotherapy via video consultation and we are able to offer interventions quickly for 'low risk' patients at safe premises in London. We will risk-assess all patients prior to this.

Dr Shankar Ramaswamy is a leading consultant in anaesthesia, pain management and neuromodulation based in Central London, Southeast London and Kent. Among the wide range of conditions that he manages are neck and back pain, headache and facial pain, cancer pain, neuropathic pain, musculoskeletal pain including fibromyalgia and joint pain, abdominal and pelvic pain, sports injury and trauma and accident-related pain including whiplash injury.

He is the clinical lead for the busy inpatient pain service at the Royal London Hospital and also the lead for pain management for the Newham MSK Collaboration. He is also the lead for education in pain management for Barts Health and QMUL and a course director and honorary senior lecturer for MSc Pain Management, University of Edinburgh.

His first qualifications and training in the field of anaesthesia were earned in India, including at one of the most prestigious medical and research institutions in India, the PGIMER. Once in the UK, he continued his anaesthetic training and then underwent the Advanced Pain Fellowship at the renowned Imperial Healthcare, London.

Over the duration of his career, he has garnered extensive experience that he uses to provide care of the highest quality to his patients. He commits to providing comprehensive pain management plans that are centred on each patient's individual needs. He uses a variety of techniques including self-management advice, pharmacotherapy, and cutting-edge (X-ray-guided and ultrasound-guided) interventions such as epidural, facet joint injections, peripheral joint injections (e.g. hips, knees, shoulder), radiofrequency, laser disc therapy, regenerative medicine (PRP) and neuromodulation. He is part of a large multi-disciplinary team to facilitate and individualise pain management approach.

Dr Ramaswamy has also received training in medico-legal report writing and is familiar with civil procedure protocols including CPR part 35 and PD 35 protocol. He can provide detailed insights into causality, prognosis, assessing capacity to work understanding specific roles, assess the ability to function and also comment on the prospect of achieving pain relief. He also offers medicolegal appointments at short notice and can produce a report with a quick turn around time. He sees patients for personal injury claims and criminal negligence claims.

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