Fibromyalgia and Neuropathic Pain Clinic

The Guttmann Barcelona Fibromyalgia and Neuropathic Pain Clinic deals with patients in a way that addresses all aspects of fibromyalgia and neuropathic pain. Pain causes suffering, and prolonging this for any reason leads to a lower quality of life and alterations in the patient’s usual activities and relationships with other people.

Pain is an unpleasant sensation that is usually located in one or many areas, and is common to most living things. Acute pain plays a vital role in our survival: it tells us which actions we should prevent, warns us which contacts we should avoid and informs us about any alterations that arise in the functioning of our organs and systems. The mechanisms by which pain is transmitted, regulated and perceived are not fully known, but nowdays we know that they are much more complex than those of a simple sensor system that informs the brain that something is wrong. Multiple pathways that “ascend” to our brain from the pain receptors and that “descend” and try to balance the two are involved in our perception of pain.

All of these elements can be used as targets to help mitigate or eradicate pain, and the main priority for medical science is undoubtedly to try and find out more about these mechanisms and develop treatments to treat pain at all levels.

Chronic pain is associated with emotional changes that can eventually cause diseases like depression and functional alterations, with cognitive (mainly in memory, attention and planning skills) and motor consequences (fatigue and loss of strength). In turn, all of these collateral effects of pain make it last longer and increase its intensity, so breaking this vicious circle is essential in order to improve the patient’s perception of their pain and their quality of life. In this sense, the consensus of specialists and guides on how to treat chronic pain recommends a generalised and multidisciplinary approach that covers all the factors mentioned.

Bearing in mind this complexity, at Guttmann Barcelona we aim to address all aspects of fibromyalgia in our patients:

PHARMACOLOGICAL TREATMENT

Drugs, mainly antiepileptics and antidepressants, are usually used to treat neuropathic pain. Logically, painkillers are often used to relieve pain.

PSYCHOLOGICAL ADVICE

Many patients present emotional alterations and anxiety that affect their state of health and functional performance. Proper assessment and treatment of these aspects has positive repercussions on people affected by fibromyalgia.

There is a clear consensus on the efficacy of cognitive-behavioural therapies, and cognitive-behavioural therapies based on mindfulness that can be used in this context. In some cases it can be associated with depression, requiring psychiatric assessment. If memory and attention problems are detected, cognitive training helps us develop strategies to cope with these symptoms.

The cognitive therapy and mindfulness approach can be used to work on the following:

• Recognising negative thoughts and difficult emotions in order to help increase tolerance to pain and reduce aversion-avoidance responses.
• Starting or restarting a particular physical activity, adapted to the needs of each individual.
• Encouraging the skill of observing through personal experience the relationship between pain, fear, behaviour and the influence of thoughts and emotions on the behavioural response.
• Learning to separate the experience of the painful sensation, the need to respond by running away or trying to escape the pain using all means necessary.
• Stopping running away from the pain can be very liberating as the person no longer wishes to run away to tolerate it better and can be aware of a wide range of activities with their accompanying sensation of relaxation, thereby breaking up the vicious cycle of pain/running away.

PHYSIOTHERAPY

Physiotherapy in patients with fibromyalgia and/or neuropathic pain can improve strength, elasticity and resistance, both helping to improve tolerance to the symptoms of fibromyalgia and modifying the way they are represented in the body’s central nervous system. In turn, it positively influences physical mechanisms that act on our perception of pain and on tolerance and fatigue. In many cases, hydrotherapy is the ideal way to perform the different exercises in a way that is well tolerated.

OCCUPATIONAL THERAPY

It is very important to be taught how to perform different daily activities to improve efficiency, reduce pain and, in many cases, get back into the labour market and improve social participation.

NON-INVASIVE STIMULATION TECHNIQUES

In particular, when associated with the different therapies described, transcranial direct current stimulation (tDCS) can be of use to accelerate and adapt the plastic changes in areas related to the processing of pain and increase the effects of the other therapies.

RECOMMENDATIONS

In turn, good personal care and a lifestyle that helps us cope with the symptoms of the disease is recommended.

• Correct sleep hygiene (it is essential that patients have enough regular sleep to improve symptoms like fatigue)
• Do gradual and regular exercise
• Follow healthy eating habits
• Avoid situations that increase emotional stress or maintain strategies when carrying out activities that do not increase pain, but that are compatible with a correct rhythm.

Although each of these therapies separately can have positive effects on the symptoms of fibromyalgia, this is a multidisciplinary approach that includes different complementary therapies that offer the best way of handling this pain.