University Teaching Trust

Fibromyalgia/ Chronic widespread pain service

Walkden Gateway Rheumatology



0161 206 4264 © G15121006W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2016. Document for issue as handout. Unique Identifier: CS 82 (15). Review date: January 2018.

What is fibromyalgia?

What is it due to?

Fibromyalgia is an often disabling condition that includes widespread muscle and joint pain that is commonly accompanied by tenderness. It is often associated with poor sleep, anxiety, depression, fatigue and in women, irregular periods. It may also be preceded by various types of localised pain such as ill-defined facial pain, back pain and bowel discomfort (irritable bowel syndrome). It is considered as one end of a spectrum of chronic pain conditions.

We don’t completely understand what fibromyalgia is due to but it is often associated with very disturbing events in childhood and adolescence which may result in lasting psychological distress. From research performed in Manchester and other international research groups, we think the pain of fibromyalgia is caused by the brain being under a lot of stress. This activates a group of structures in the brain responsible for feeling pain called the ‘pain matrix’. In patients with fibromyalgia we have discovered that the brain automatically expects bad things to happen. Areas in the front of the brain that would normally control this do not do this so well. We have also shown that there is a problem with how the brain attends to pain. We think that these things together cause the pain experienced in fibromyalgia

What isn’t it? It is not you falling apart although it may feel like that. As far as we know it is not due to damage to the body although it can occur in patients with arthritis and damage to some of the small nerves in the periphery (arms and legs).

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for more details and the latest findings in research visit:

They are also unlikely to do you harm. We see drugs as a shorter-term way to help you exercise and manage your symptoms but the ideal results is managing without tablets in the long-term-although this is not always possible.

http://www.hopeacademic.org.uk/ painresearch/Index.htm and http://www.manchester. ac.uk/research/anthony. jones/publications

Talking therapies:

The good thing is that the problems with fine-tuning the experience of pain are potentially reversible.

Which treatments work? Talking therapies and exercise are the two types of therapy that are most likely to help you in the long-term and enable you to eventually manage your fibromyalgia on your own. For example two months treatment with a meditation-based talking therapy called mindfulnessbased talking therapy can substantially improve the way the brain expects pain. We also know that exercise increases the pain relieving chemicals in the brain called endorphins.

Talking therapies which can range from counselling to a type of therapy called cognitive behavioural therapy have been shown to be effective in Fibromyalgia. These are helpful in changing unhelpful negative thought habits such as “I am falling apart”. It is very important to keep more positive thought habits going after talking therapies. Spending five minutes per day just thinking about what you have learnt from your talking therapy sessions is a good way to do this. Some therapists will also offer ‘top-up’ sessions after a course of treatment.

© G15121006W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2016. Document for issue as handout. Unique Identifier: CS 82 (15). Review date: January 2018.

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Exercise Paced and graded exercise has been shown in the longer term to reduce the symptoms of fibromyalgia. It doesn’t appear to matter which exercise you do to gain these improvements, so try to choose an exercise that you enjoy and that you can do on a regular basis. The research suggests that exercise will not only improve your fitness levels but also will reduce pain and fatigue levels. Exercise can be done in your house, in the local area, at a gym or a local hall or centre that offers an exercise class. The exercise that you do should be sufficient to get you slightly short of breath and sweaty. Whatever exercise you choose to take up you must take it slowly in the initial stages If you have not exercised at that level for more than 6 weeks it will take your body some time to re-gain fitness. Try to build up your exercise at a rate that you are comfortable with, and don’t be disappointed if this feels like too slow progress for you. 3

You may find that the pain and tiredness become worse at first as you start to exercise muscles that haven’t been used for a while. Try and do the same amount of exercise each day so that you build up your muscle strength and stamina. Increasing your exercise little by little will also improve your fitness and flexibility.

Swimming: This form of exercise places the least strain on your joints to allow you to exercise in a way you may not manage on dry land, you can also do some stood exercises at the shallow end of the pool to stretch off any tight muscles and work on focussed muscle strengthening work.

Whilst we cannot recommend specific exercises, there follows a list of suggested activities: Stretches at home: People with fibromyalgia often find that their muscles can be stiff and tense and this can make general exercise more difficult, it is therefore wise to get into a habit of stretches off your muscles, if tight, on a daily basis

Dog walking: This is a good choice as the dog themselves will encourage you to go out daily for a short exercise, you can gradually increase the distance walked, or the time walking.

Cycling: If this is an exercise form that interests you then good fitness improvements can be achieved. This could be with a static exercise bike indoors or with a bike on the open roads. You are taking less weight through your knees, hips and spine then you would do in walking, so cycling can be a good option if you have more specific problems in these areas.

Walking: you of course do not need to have a dog to be able to commit to and enjoy regular walks!

© G15121006W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2016. Document for issue as handout. Unique Identifier: CS 82 (15). Review date: January 2018.

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Yoga: This has been shown to help some people with fibromyalgia. Joining a class that meets weekly will encourage you to commit to regular sessions. Most exercise instructors should be able to adapt their class to suit your physical fitness levels and any joint specific issues you may have Healthy Hips and Hearts (or other chair based exercise classes): If you need to start at a more gentle level to work on your fitness, or if your fitness goals are more limited, there are exercise classes that will be suitable for you.

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It is normal than you will have aches for 1-2 days after commencing a new exercise programme and this is the same for people without fibromyalgia, do not worry that this is a fibromyalgia flare or that you cannot manage to exercise. Once you have found the correct level to start at all people with fibromyalgia will be able to maintain a regular exercise programme and start to reap the benefit. In starting a new exercise programme there is, for anyone, a risk of injury. If you have sustained an injury with your exercise, assess the damage and use your GP, physiotherapist or self-management strategies if you have had an injury If a pre-existing injury, joint or muscle problem if preventing you committing to exercise programme then do consider getting this assessed and treated to allow you to go on to reap the benefits of regular exercise.

Your chosen exercise doesn’t have to cost anything It would be more fun and more sustainable if you could find a friend, family member or colleague to do the exercise with you. If you need to use your painkillers to allow you to keep exercising this is probably a better idea on balance than not exercising without pain relief. Regular exercise should be combined with other good lifestyle habits. If you smoke do try to stop. To get best effects of your exercise try to maintain a healthy diet. The quality of your sleep will affect your mood and your ability to exercise. Whilst sleep problems are a big issue for many with fibromyalgia it has been scientifically proven that regular exercise within your capabilities improves quality and quantity of sleep in the longer run.

Tablets There are a number of types of medication that can help fibromyalgia. These include simple and safe analgesics such as Paracetamol for any aches and pains from arthritis. Tramadol has also been found to be helpful for both fibromyalgia and arthritis pain. However, it can cause side effects such as a sense of distance from your surroundings (dissociation), low blood pressure on standing, excessive sleepiness and confusion, so always start on a small dose and work with your doctor to choose the right dose for you. Different types of antidepressants have been found to be effective and there is evidence that such drugs can act as pain killers in their own right. However, these drugs do have quite a lot of side effects including weight gain and dry mouth. Fibromyalgia is often associated with depression but we would always suggest that for mild to moderate depression that talking therapies are tried in the first instance.

© G15121006W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2016. Document for issue as handout. Unique Identifier: CS 82 (15). Review date: January 2018.

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Opiate drugs such as morphine can be helpful in individuals with fibromyalgia, however only Tramadol which has some opiate and some actions like antidepressants (changing levels of serotonin and other neurochemicals in the brain) have been shown to be effective in clinical trials. It is generally advised not to go onto strong opiates for fibromyalgia unless absolutely necessary and in consultation with an expert pain specialist, as patients can quite easily end up on high doses without much obvious benefit. The use of anti-inflammatory drugs such as ibuprofen and naproxen is not advised in fibromyalgia as there is no evidence for a beneficial effect. These types of drugs are associated with increases vascular problems such as heart attacks, stroke as well as gut and kidney damage. Other things to consider: Patients with fibromyalgia often have other medical 7

problems and it is really important that you have an increased Lifestyle, General health

Information: Services: Salford There are lots of activities and exercise classes all over Salford. Whether its trampolining, swimming, roller discos or Tai Chi, you can find out what’s on at your local leisure centre or FitCity. You can also find out about other community leisure activities going on in your area. Health walks: Health walks are free, sociable, organised walks of under an hour which take place weekly across Salford. They are perfect for those who lack the confidence and knowledge about where to walk. For more information call Kirsty or Jo on

0161 778 0540 or 0161 778 0559.



Gentle exercise: Salford’s Health Improvement Service runs exercise sessions for people of all ages and fitness levels who prefer gentle forms of exercise, including: chair-based sessions, Tai Chi, regular walks, and indoor kurling, which is similar to boules. To find out what may suit you, call

0800 952 1000

benefits you may qualify for concessionary membership rates, giving you discounted use of the gyms, swimming pools and exercise classes run by Salford Community Leisure. And if you are aged over 70, Aspire membership costs just £15 a year.

Support groups

or just turn up to one of their sessions. Free outdoor gyms: Salford has 16 outdoor gyms in parks across the city. Suitable for adults and children over 12, they are a great way to improve your health and fitness for free. Each green gym has a mixture of easy to use fitness equipment including: rowing machines, steppers and cross trainers. What does it cost? Most community leisure activities are free. You have to pay at Fit City leisure centres - there is the option to pay per class or join as a member (called Aspire Unlimited). If you are on certain

These groups are run by people with fibromyalgia for people with fibromyalgia; they offer a forum to share experiences, learn more from guest speakers and each other as well as supporting each other. Salford Fibromyalgia Support Group (Eccles Gateway) 3rd Thurs 1-3pm Call:



0844 887 2603

10am - 4pm weekdays Energise Centre Fibromyalgia Support group 1st Thurs 1-3pm Call:



0161 212 5700

© G15121006W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2016. Document for issue as handout. Unique Identifier: CS 82 (15). Review date: January 2018.

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Services outside of Salford We know a lot about services in Salford, but are less aware of other areas services. A good place to start looking is your local “Health Trainers” service; they have a central phone number of

Greater Manchester: Ashton, Leigh and Wigan Bolton Bury Heywood, Middleton and Rochdale Manchester Oldham Stockport Tameside and Glossop

0300 300 0103.

There are listed Health Trainer services in:

Cheshire and Merseyside: Halton & St Helens Knowsley Liverpool Sefton Warrington Wirral Cumbria and Lancashire: Blackburn with Darwen Blackpool Central Lancashire Cumbria East Lancashire

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Produced in association with the Salford Fibromyalgia Support group and the Greater Manchester Pain Consortium.

© G15121006W. Design Services, Salford Royal NHS Foundation Trust, All Rights Reserved 2016. Document for issue as handout. Unique Identifier: CS 82 (15). Review date: January 2018.

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© G15121006W. Design Services Salford Royal NHS Foundation Trust All Rights Reserved 2015 This document MUST NOT be photocopied

University Teaching Trust

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