Fibromyalgia is a chronic pain disorder that consists of chronic widespread pain and is frequently accompanied by severe fatigue, insomnia, depression, not being able to think clearly or being forgetful, headaches and abdominal pains. These symptoms make it really difficult to get through the day and can affect both your ability to work and to do the things you love, like spending time with your friends and family.
We now know that fibromyalgia is not caused by any type of tissue damage.
What causes it then?
Fibromyalgia is caused as a result of your body’s internal threat system being set on hyperalert. This hyperalert state is caused by a dysfunction in your hypothalamic-adrenal-pituitary axis. This causes your sympathetic system to be constantly ‘switched on’. The sympathetic system is where your flight-fight-or freeze response comes from.
Pain is a way of your body telling you that you need to get help. It is a highly effective way of protecting you and getting you out of danger. With fibromyalgia, your brain experiences many things as a potential threat and in order to defend you, warns you by telling you that things hurt.
Why does this happen?
There are many reasons why this can happen: early childhood trauma; traumatic events whether acute or chronic such as intimate partner violence, divorce, assault, living through a pandemic such as COVID, the sudden death of a loved one. These events alter that axis I mentioned earlier, the hypothalamic-pituitary-adrenal axis which sets things in motion that keep the volume turned up in your fight-flight-freeze response. It takes the smallest thing to set off a stress response… and as a result things hurt.
Genetics plays a role too. We know that the effects of trauma can be intergenerational. Some research links our gut microbiota to the development of fibromyalgia (and other chronic pain conditions).
What can you do about it?
The first step is to confirm your diagnosis.
The fibromyalgia self-report questionnaire:
Depression frequently occurs with fibromyalgia and as a result, it is important that you are screened for this.
Because trauma plays such a big role in the development of fibromyalgia, it is important that you are screened for Post-traumatic stress disorder
You can bring these with to your first consultation or email them to email@example.com
What to expect regarding your treatment?
You will be referred to either one of our physiotherapists as a starting to point if your main symptoms are chronic widespread pain and the screening tools did not show that you might be suffering from depression and/or PTSD. If the screening tools show that you might have depression or PTSD you will see Dr King first.
The cornerstone of treating fibromyalgia is understanding why you experience chronic pain. There is level 1A evidence that Pain neuroscience education helps to treat chronic pain. Your sessions will focus on this as a result.
Please watch these two Youtube videos before your first session:
Why things hurt: Why things Hurt
Tame the beast: Tame the Beast
There is still a lot of misinformation out there regarding treatment of fibromyalgia so it is important that you are partnered with therapists who speak the right ‘chronic pain language’
At your first session, you will be asked to complete two assessment questionnaires (these can be completed before hand and emailed ahead of time or brought with to the consultation).
Central sensitisation inventory: Central sensitisation inventory
Brief pain inventory: Brief pain inventory
The central sensitisation inventory (csi) gives a good idea of what other things you might be experiencing are due to changes that occur with chronic pain.
The brief pain inventory (BPI) gives us a good idea of how your pain is currently impacting your life. We will repeat it at the end of the workshop.
At your first session your therapist will speak with you about how your fibromyalgia is impacting your life and a full assessment will be completed. She will speak to you more about why things hurt. Treatment might be initiated eg stretching program or medication.
From here your therapist meets with the interdisciplinary team and an individualised program is developed based on your profile. Other team members that might meet with you include psychologist, occupational therapist, mindfulness practitioner.
Topics that will be covered with you include Exercise, Medication, Learning to pace yourself, Identifying what makes your pain worse and what makes it better, Nutrition and the role of gut bacteria, Stress reduction and self-care (including managing insomnia), Managing flare-ups. Unresolved trauma will be addressed in sessions with our psychologist.