Treatments to Consider
There are many treatment strategies and techniques that can trialled for fibromyalgia and CFS patients. Broadly however there are some simple principles to be followed before trialing any of these therapies whether they are drug based or non-drug based.
Essentially GPs and any healthcare professionals need to explicitly demonstrate acknowledgement that pain and fatigue is real and not imagined.
It needs to be reinforced that activity will not cause the patient damage and GPs/HCPs should consider providing various information so patients can start to self-manage their pain.
Self-management is a key strategy as patients may often have a good idea on their ttriggers, helpful and not so helpful factors that can trigger an episode of pain/fatigue.
Some good recommended self-management resources are listed below. These are by no means the only choices and if patients or carers know of any more, please email us and we can update the list.
The pain toolkit: 12 key tools on how to live with the pain. This is a website started by a patient in persistent pain who has published a book of the same name. It offers patients various sources of self-help and advice and also offers workshops to other GPs in order to educate them in dealing with FM patients.
Arthritis care information leaflets such as coping with pain/emotions
Arthritis care Challenging pain: a self management workshop
Books to purchase and read which have been suggested by previous patients as being helpful, such as:
Local referral pathway for fibromyalgia/cfs care on the NHS
When to refer to a complex secondary care RBH pain clinic:
If pain is uncontrolled despite medication.
If opioid therapy is being considered.
If a discreet diagnosis is suspected which may be amenable to interventions/injections.
When psychological distress is high and the patient may need complex pain management programmes.
What is offered to patients with FMS at the pain clinic :
Information, explanation and the provision of resources.
Injections therapy if appropriate.
Advice on strong opioid therapy – screening, prescription advice and follow up.
Lidocaine infusions/Oral ketamine and other medications
Acceptance and commitment therapy and mindfulness based approaches by psychology and physiotherapy. All of the above are at present only offered in Reading.
Once the GP has made the diagnosis using the outlined diagnostic criteria and blood tests have been done to rule out any local inflammation, then they would often be able to refer for physiotherapy and provide them with self-management resources.
If that hasn’t been helpful, they can choose to refer to the Local Integrated Pain and Spinal Service (IPASS) whose staff work at the West Berkshire Community Hospital (WBCH). If patients meet their eligibility criteria then they can often be seen quickly and various programs can be offered locally in and around the hospital.
If the case is sufficiently complex right from the outset then referral is often triaged directly to the complex pain clinic at Royal Berkshire Hospital. Only one clinic is right now offered monthly at WBCH which can then be increased if the demand is higher. All treatments are often performed or offered at Reading thus making commuting harder for the patient.
At present CFS care is only provided by a clinic that is run by the specialist CFS service based in Reading near the Royal Berkshire Hospital.