A multidisciplinary approach is needed to treat Fibromyalgia Effectively

I am entirely convinced through my own experience and through the experience of others that the best outcomes come from a multidisciplinary approach to treating Fibromyalgia. There are so many aspects to Fibromyalgia that they all contribute to a cycle of illness that can be in the shape of a downward spiral or, more desirably an upward one. The problem lies in the fact that each of the key areas fall into different medical disciplines and specialities.

How a specific medical problem separate from Fibromyalgia gets dragged into its cycle

Also there are people that have a specific medical problem that triggers their fibromyalgia and which Fibromyalgia in turn heightens the symptoms of the specific medical problem in turn. One of my medical problems that would fit into this definition is thankfully not that serious but might serve as a example to demonstrate what I mean. I have a problem in my shoulders where the muscles are not strong enough or not able to keep the joint together in the way they should. This causes pain and the subluxation of my clavicle when I raise my arms above shoulder height and I am susceptible to dislocations of the shoulder joint although thankfully this has never happened to date. Now when my shoulder is bad it causes me pain and causes problems with my sleep, this then activates my Fibromyalgia cycle and tips the balance of my spiral into a downward one. This then amplifies the pain signal coming from my shoulders and my body fatigue makes those muscles tired and makes my shoulders worse, this completes the cycle of Fibromyalgia & other conditions.

How to manage a multidisciplinary approach within the NHS

This is a difficult topic to talk about as the very way the Nhs works and the pathways they follow are not compatible with a multidisciplinary approach. You go to your GP who tests an refers then your consultant tests, diagnoses and treats with medications or treatments available to his department in a specific location with a view to managing your symptoms or curing the problem to a point where you can be discharged back to the care of your GP. If you have another referral about the same thing the departments run separately, have their own resources, may not be in the same geographical location and do not communicate with each other.

Exceptions to the rule

I will say at this point that I am starting to hear about Fibromyalgia clinics being set up to take a multidisciplinary approach to Fibromyalgia and if your lucky enough to be referred to one then the rest of this page may not be relevant to you. Although these may be more common in other countries such as the USA they are fairly new in this country and are based near population centres and may not be open to out of trust referrals. This is a topic I need more information on so those who have been treated by multidisciplinary clinics are requested to contact me about your experiences. I have been sent a copy of the manual for one of these clinics and I will be looking at it more closely soon.

Someone in the Nhs needs to take charge

A multidisciplinary approach is very much a team effort and in any team your going to need a leader and when treating Fibromyalgia this is no exception. But who should this person be? If you have a particularly good GP then it would make sense to ask them to manage your condition and after all your GP is your primary care provider. I do however life in the real word and have had countless appointments with many many GP’s and although there are some great exceptions I’m not sure I would trust the majority to make me a coffee. When I spoke to the department of health I was told that under the muscoskeletal framework Fibromyalgia should be managed by a Rhematologist or Nerologist. You need to ensure that your specialist consultant believes in Fibromyalgia, understands Fibromyalgia and has experience of successfully treating it. If not move on, ask for a second opinion, ask for a referral to another hospital or ask for a private referral.

Who you need in your team

I would recommend a Rheumatologist, Neurologist, Pain management Consultant and a Physiotherapist at the minimum however this list will expand depending on your condition and symptoms. You may need an Orthopaedic Surgeon if you have problems with the working of joints and bones. You may need a Dermatologist if you have skin problems. You may need an Immunologist if you are getting infections more regularly than normal. You may need an Occupational therapist if you have mobility problems or need to alter your environment. I also believe you should have a Sleep Expert involved but I am very weak in this are and desperately need information to assess what benefit it can bring to this fundamental symptoms. But the most vital part of this team is the leader, they need to communicate and co-ordinate testing, medication & treatment and monitor you closely and on a regular basis.