Nick Critchley, owner of The Good Physio, has a specialist interest in chronic pain management and recently completed a Master’s degree in The Management of Pain and Headache Conditions at the University of Edinburgh.

“We are seeing increasing numbers of patients at The Good Physio who are being successfully treated for chronic pain conditions such as fibromyalgia (FM), chronic fatigue syndrome (CFS) and more recently, ‘long covid’. When we see these patients they invariably have the same general presentations although, as with any condition, each person’s story is unique to them.”

FM is characterised by widespread pain and stiffness, fatigue and poor quality sleep, problems with general mental wellbeing including low mood and or anxiety as well as other mental health issues such as decline in cognitive function, memory and concentration. Other symptoms can include irritable bowel syndrome (IBS), pelvic pain and headaches and this all leads to a really profound loss in overall function and quality of life.

FM affects between 2-4% of the population with women being more likely to experience the condition than men but we still do not really know what FM actually is or what the underlying causes of it are. Some research groups are still focused on identifying a biological cause or disease process that explains FM but despite considerable efforts this has remained largely elusive; there are currently no reliable or valid bio-markers of FM and so there is no obvious disease process that appears to drive the condition. Clinicians working in the field of pain management often prefer to look at this not as a disease with a specific cause, but viewed from a broader perspective and within a ‘biopsychosocial’ framework rather than just a medical one. This is complex and understandably makes people involved in the science of understanding diseases, as well as many patients, feel uneasy – we like to be able to explain illness or suffering as a result of something being medically wrong. This validates it, makes patients feel understood or believed and also provides hope that it might then be possible to find a cure for it.

However, most clinicians working in pain management have understood for a long time that there is a big difference between disease and illness. Patients with FM certainly suffer with illness – these are the outward symptoms that patients tell us about, i.e. their pain, their stiffness as well as fatigue and low mood. We 100% believe their story and understand how this has a devastating effect on their quality of life. But we also know that in a great many people it is possible to have symptoms of suffering without having an underlying disease process. Conversely, we see some people with an active ‘disease’ or underlying pathology who do not display any signs of that disease at all. This is true in all types of pain but even in neurological conditions such as Parkinson’s, where autopsy can reveal the typical signs of brain damage seen in this disease and yet that individual died of natural causes without any outward signs of illness at all.

What modern neuroscience is pretty clear about is that in these widespread pain conditions, as well as in IBS and many other ‘medically unexplained’, chronic illnesses, there are changes in the way the central nervous system functions so that normal levels of electrical ‘noise’ from what are essentially quite healthy tissues becomes distorted and amplified – this is called ‘central sensitisation’. We also know that the brain becomes increasingly unable to dampen this sensory input from our body tissues – something that in most of us happens quite effectively all of the time – and so what should be filtered as unimportant sensory activity gets increasing bandwidth. The brain opens up neural pathways and circuits and listens more intently to what it should really be ignoring as ‘not newsworthy’. We are beginning to understand now how the brain is constantly sampling all sensory inputs and matching them against its own predictions of how the world should be (and importantly in terms of our health, how we feel in ourselves). Essentially our perception of how we feel as well as how we perceive the world around us is our brain’s best guess of reality and heavily influenced by our prior experiences, our beliefs and expectations as well as fears and anxieties, our emotions and certain contextual cues. Sometimes we get this pretty much right and sometimes we do not.

The good news is that people who specialise in pain management are becoming increasingly effective in understanding these groups of patients. We are able to provide long-term fibromyalgia ‘management’ for some but also quite effective treatment for a great many. Importantly, we work using a joined up team approach providing medical help where needed as well as tackling the underlying lifestyle problems to do with sleep quality, physical and mental wellbeing as well as the social and psychological stressors that drive hypersensitivity in these patients’ central nervous systems. Best practice suggests that patients who suffer with FM should be viewed from this biopsychosocial perspective and those individuals treated as whole people with tailored individual programmes of rehabilitation rather than a one size fits all approach.