A few years ago, before my final GP exam, I was stressed. It didn’t help that it had cost me £1,600 to take.
In the weeks running up to the exam, I was staying up late reading textbooks and going through practice questions, as you would expect any dedicated future-GP to do.
When I did get to bed I was exhausted but I found it hard to switch off my brain: it was full of thoughts of failing. It didn’t help that my son was about four months old at the time and was still waking up two or three times in the night for milk (he was what’s known as a “hungry baby”).
As a result there was a period of about two weeks in which I got very little sleep – not much more than four hours a night – and even then it was broken by a baby crying at least once.
I was exhausted.
I soon started to notice a dull ache in my forehead, which I put down to spending too much time reading. A few days after that, I developed pain in my neck and upper back, which seemed to spread down my spine after another day or two.
The sensation was not pain exactly, more a very intense achy-tingling. Whenever I tried to pick my son up onto the sofa the pain increased and my lower back would to seize up completely.
I also seemed to become more sensitive to pain in general. I remember knocking my elbow on the arm of a chair – the kind of knock that I wouldn’t normally think twice about – and almost jumping into air in agony.
My capacity for exercise went right down too; five minutes at the gym seemed like an hour, and afterwards I felt terrible.
The worst symptom by far was that my brain felt woolly: I had the strangest feeling of detachment from my body. Focusing on the textbooks became difficult: the words seemed somehow blurry, even though my vision was normal, and I needed to re-read whole paragraphs over and over again.
Don’t worry – I cured myself.
Unlike many of my patients, I knew after only a few days that I was developing fibromyalgia.
If you don’t know what fibromyalgia is, you’re not alone – medical science has yet to come up with a convincing answer. It is a medical condition characterised by multiple symptoms including fatigue and chronic pain.
It has no known cause.
That is not to say that there is no cause or, by implication, that the symptoms are imagined, just that whatever does cause it is not something we can see with current medical tests. Bloods are normal and scans do not reveal any underling cause that we can appreciate.
There are multiple other symptoms, each of which could have a hundred other causes:
What causes it?
It’s probably best not to ask.
Current theories about the cause of fibromyalgia are focused on possible abnormalities in the way in which the neurons of our central nervous system transmit pain signals.
According to Wikipedia (the General Practitioner’s Friend), the condition is thought to be caused by:
“impairments in monoaminergic, glutamatergic, neurotrophic, opioid and proinflammatory cytokine signaling”.
Or to put it another way: it’s complicated.
We do know that it often occurs with other chronic pain conditions and that it is strongly linked to anxiety, depression and insomnia, but it is not known if these are a cause or a symptom.
For a long time fibromyalgia was a seen as a ”diagnosis of exclusion” – a diagnosis which is only made once every other possible cause has been tested for.
The key to treating fibromyalgia is to stay positive
In recent years there has been a shift in attitudes amongst doctors as we have been encouraged by national guidance and clinical research to make the diagnosis at a much earlier stage in a patient’s illness.
This is what’s known as a “positive diagnosis” or as it would sound to a patient:
“your symptoms sound a lot like fibromyalgia, and some basic blood tests are normal, shall we just say you have fibromyalgia rather than putting you through lots more unpleasant tests?”
There are many advantages to making an early positive diagnosis:
- It avoids unnecessary investigations, reducing the risk to the patient and saving money for the health service;
- It allows for earlier treatment – the longer a patient suffers with fibromyalgia, the harder it is to treat, and;
- It gives both doctor and patient a positive outlook and motivates both to take an active role in managing the condition, rather than both getting frustrated that no cause can be found.
How I cured myself
When I developed my symptoms I started to pray again (I had been neglecting my prayers because of revision). Not only did this help me to relax and ease my physical pain, but it helped me to put my worries into perspective. It also helped me to sleep. I met up with friends, I read a book, and I went for a mindfulness walk in the park.
After a couple of days looking after myself – and not doing any revision – my symptoms started to get better. My concentration improved and the fogginess in my brain lifted. The aches and pains took a bit longer to improve but at least I could pick my son up and go to the gym without wincing.
I was one of the lucky ones
I was lucky because as part of my revision I had looked at the recent guidelines on fibromyalgia and recognised the symptoms very early, so I was able to do something about them before they had a chance to become persistent. Unfortunately, most patients do not get a diagnosis for month, or even years.
Early diagnosis is key
Doctors should be thinking of the diagnosis as soon they see the patient and certainly if the initial blood tests are all normal, so long as the history and examination findings fit. We also need to explain clearly what we think is happening and make sure patients understand.
We should discourage our patients from seeking further tests, as well. Of course this means that we need to see our patients regularly in the months following diagnosis, in order to monitor the condition and be certain that we are not missing something more serious.
If you have fibromyalgia the most important thing I can tell you is that it is curable with relatively simple treatments.
If you want to know more I would recommend the following resources: