Fibromyalgia

You may look well enough for people to forget. Then you are left explaining pain that moves, tiredness that sleep does not touch, and a body that can punish you for something ordinary you did yesterday.

Fibromyalgia is a long-term condition involving widespread pain, disturbed and unrefreshing sleep, fatigue, and problems with memory and concentration that many people call fog. The current understanding is that the nervous system amplifies pain signals, so ordinary sensation is registered as pain and pain is registered as more severe. It means the pain is real and generated by a real mechanism, and it is not a sign of ongoing damage in the place that hurts. Hurting is not evidence of ongoing tissue damage. Those two facts are both true at once, and holding them together is one of the hardest parts of living with this.

By the time many people look for therapy, they have spent years being tested, referred, dismissed, believed for a while, then doubted again. That history matters. It can leave you braced with doctors, with employers, with family, and sometimes with yourself.

When a better day has a cost

A good day can bring relief and also calculation. If you use it, tomorrow may be worse. If you do not use it, life gets smaller. Many people are caught in a cycle of doing far too much on a better day and then paying for it with a flare that can cost several days, so activity swings between overdoing and collapse and never settles into anything steady. Pain, poor sleep, low mood and fear of the next flare feed one another, and the more the body is braced against pain the more pain it tends to produce.

There is often grief in this. Grief for the reliable body you used to have, for work you could do without planning your recovery around it, for being able to say yes without checking the likely cost.

Fibromyalgia also gets into the private corners of life. Sleep breaks up and does not restore you. Words go missing mid-sentence. Noise, light and ordinary demands feel like too much. It can be hard to describe any of this without sounding as if you are making excuses, so you may stop describing it at all.

How I work with it

I use cognitive behavioural therapy adapted for long-term physical health conditions and chronic pain, with acceptance and commitment therapy where it helps. NICE guidelines treat fibromyalgia as a form of chronic primary pain. It says people should be offered a supervised group exercise programme, and that cognitive behavioural therapy for pain or acceptance and commitment therapy should be considered. It also tells doctors not to start opioids, paracetamol, anti-inflammatories or gabapentinoids for this kind of pain, although certain antidepressants may be considered with your GP. The aim is not to talk you out of pain. It is to loosen the grip of the cycle around it, so that sleep, activity, mood and the fear of flares are not all pulling in the same direction, and so that your life is shaped by more than the next crash.

Much of my experience, drawn from my work as a Consultant Cognitive Behavioural Psychotherapist, comes from an NHS specialist unit working with fibromyalgia, chronic fatigue and complex pain, which is where I learned that pacing is not the same as giving in, and that steadying activity to a sustainable level usually achieves more over time than either pushing through on a good day or shutting down after a bad one.

Therapy is not a substitute for medical assessment or treatment. I do not diagnose and I do not prescribe, and I will work alongside the medical care you already have. Sessions are fifty minutes, online, and usually weekly to begin with.

I am known for a thoughtful, client-centred approach, combining clinical expertise with practical strategies, in a space where you feel able to open up. Together we can look at the pressure to push through, the resentment of needing rest, and the strain of being disbelieved. We can work with the anxiety and low mood that so often grow around fibromyalgia, without treating them as the cause of your pain. If part of you is reading this and already rehearsing how you would prove to me that it is real, you do not need to. That part can rest here.