Guest Blog: Fibromyalgia

Our latest guest blog is written by Alexandra Cardoso Pinto, a medical student at Imperial College London. In this blog, Alexandra writes about a patient she met with fibromyalgia, and what she learnt from her time with this patient with chronic pain. She discusses how Leva Clinic's multidisciplinary approach to pain management is vital for patients like the one she met.

On my very first clinical attachment, I spoke with a patient who suffered from widespread, intense pain for two years. She was exhausted because the pain wouldn’t let her sleep, frustrated because no medication seemed to relieve the pain and anxious because the pain had forced her to stop working. She had also been recently diagnosed with depression. Fibromyalgia is an underdiagnosed condition characterised by widespread chronic pain(1). It is more common in women, and is thought to be due to a nervous system abnormality in processing pain(1, 2). Fibromyalgia is also associated with extreme tiredness, poor sleep, depression and compromised cognitive function(1,2). This constellation of symptoms can significantly impair a patient’s overall wellbeing and challenge their lifestyle. After the initial plethora of blood tests and scans in search of a diagnosis, this patient was given long-term pain medications. However, she still found herself calling her GP regularly, because "nothing seemed to help". Watching your patient deteriorate, even after following all of NICE’s recommendations, can make chronic pain management a difficult and a demotivating task for healthcare professionals – and an exasperating experience for patients. Effective management of fibromyalgia must consider all three aspects of the biopsychosocial model; yet this is often an ambitious goal, particularly for an already-overwhelmed primary care setting(3). It demands a multidisciplinary approach: medication, lifestyle changes, physical therapies and psychological therapies(1,2). Even within medication there is a world of options, each with its own limitations and monitoring requirements, suggesting the complexity involved in managing this condition(4). This patient, like many others, could have benefited from a more personalised care plan that followed a multidisciplinary, holistic approach, with regular monitoring and support. Chronic pain in fibromyalgia is often challenging to manage, and can have significant effects on a person’s mental health, physical capabilities, social and work life. Leva Clinic embodies this multidisciplinary approach, with a wide range of healthcare professionals providing patients with personalised care plans, convenient ways of accessing care and even a focus on innovative approaches to chronic pain management, widening options for all of its patients. This approach brings optimism for supporting patients with fibromyalgia, and I look forward to more patients benefiting from Leva Clinic's services.

References: (1) Rahman A, Underwood M, Carnes D. Fibromyalgia. BMJ. 2014;348:g1224. Available from: doi: 10.1136/bmj.g1224 (2) Sumpton J, Moulin D. Fibromyalgia. In: Handbook of Clinical Neurology. 2014;119:513-27. Available from: doi: 10.1016/B978-0-7020-4086-3.00033-3 (3) Darnall B, Carr D, Schatman M. Pain Psychology and the Biopsychosocial Model of Pain Treatment: Ethical Imperatives and Social Responsibility. Pain Medicine. 2017;18(8):1413-1415. Available from: doi: 10.1093/pm/pnw166 (4) Mao J, Kitz R. Challenges of managing chronic pain. BMJ. 207;356. Available from: doi: 10.1136/bmj.j741