You might be trying to manage chronic pain and low mood. Some antidepressants can be useful for pain whether there’s low mood or not.

All medications can have side effects. Sometimes this can cause more problems than the condition itself, including making your pain worse or creating a physical dependency. With chronic pain it’s good to consider whether you think you’re getting more benefit from your medicines than side effects. You can speak to your GP, a Pharmacist or Pain Specialist for a review of your medications.

Pain and work

Being in work is good for your physical and mental health. Living with chronic pain can impact your ability to find work, stay in work, and return to work.

There are different ways you can spend your time. This could include paid employment, self-employment, volunteering and education. You do not have to be 100% healthy to work.

If you’re struggling to remain in work, you could:

• discuss with your employer what you’re finding difficult about work
• think about what reasonable workplace adjustments like variations in job pattern or hours could help keep you in work

If you’re on sick leave and want to work towards going back to work, you can:

• start ‘stay in contact’ conversations with your employer
• start to explore a return-to-work plan with your employer even if the date might some time in the future
• consider ways for going back to work in a gradual way
• explore what current options exist for return to work

Chronic pain and your mental health

Pain doesn’t just affect our bodies. It can also affect your mental health.

The close links between the emotion and pain centers in our brains make it almost impossible to have pain without difficult emotions as well.

Chronic pain can have a huge impact on all aspects of life, which can cause emotional strain on top of the pain.

Talking therapies, like counselling, can also be helpful in managing the impact of pain on your mental health. Speak to your GP to discuss your options.

Coping with a flare up of chronic pain

A flare up of chronic pain is a period of time where the pain increases and can become more difficult to cope with.

Many people feel able to cope with their day-to-day activities if the pain stays the same. During a flare up it might feel like the pain is overwhelming. People often say they feel a sense of helplessness.

Flare ups are a normal part of chronic pain. They’re not necessarily a sign that things are getting worse.

What causes a flare up of chronic pain?

Sometimes a flare up of chronic pain might be caused by:

• overactivity or underactivity
• stress or worry
• low mood and depression

Sometimes there isn’t an obvious cause for a flare up of chronic pain.

How to manage a flare-up of chronic pain

There are some things you can do to help manage a flare up of chronic pain.

You need to be kind to yourself during a flare-up – you didn’t choose this. Caring for yourself and slowing down a little will help you get past the flare-up quicker.

Be prepared for a flare up of chronic pain

By having an action plan for when your chronic pain flares up, you can feel more prepared and ready to cope.

There are some things you can consider as part of your action plan:

• increase relaxation and mindfulness activities
• prioritize your tasks
• cut back on physical activities but do not stop altogether – some activity is better than no activity
• acknowledge that although you may feel bad just now, the pain will pass
• do what you can to soothe the pain like taking a warm bath or using a heat pad

You might be able to adjust your medication during a flare up. Discuss this with your doctor or healthcare professional in advance so you’re prepared.

Keep an activity diary

You can use an activity diary to track what you’re doing for a few weeks. We often do more or less than we think. An activity diary can help to identify possible causes of a flare up of chronic pain. It can also help you to identify when you might be trying to do too much during a flare up.

Pace yourself during a flare up of chronic pain

Pacing encourages you to choose when to take a break from an activity before pain, tiredness or other symptoms become too much. Pacing your activities during a flare up helps prevent overactivity or underactivity.

Continuing to use your pacing strategies can help to prevent future flare ups.

Manage your stress

Stress can make pain worse, so it’s important to learn how to manage it. At the same time, pain itself can make you feel stressed and anxious, creating a vicious cycle.

Learning relaxation skills can help you to break this cycle and manage both stress and pain in a way that works for you.

We have a number of breathing and relaxation exercises on NHS inform that can help with anxiety and stress.

Sleep

Chronic pain can cause a lot of problems with sleep. You might find it hard to get to sleep or wake up during the night because of pain. Unfortunately, the more you try to force yourself to sleep the harder it can become.

Lack of sleep and struggling to sleep can also increase your stress levels, making the pain worse.

Use our self-help guide for sleep problems and insomnia to help you deal with these issues.

 

Communicate

Chronic pain can cause you to lose your confidence and make it hard for you to express your needs. If you can’t say what you need, you may find yourself dealing with more pain and discomfort. This can make you feel more tense, and tension can increase your pain.

Follow these tips to help you become more assertive and confident about communicating:

• say what you mean clearly and don’t be afraid to be firm
• try not to shout or raise your voice
• remember you don’t have to apologize for needing something
• make sure your message is clear – don’t expect people to guess what you mean or know what you’re thinking
• explain to people why you’re asking them to do something
• ask for help when you need it
• remember it’s okay to say no

Fibromyalgia

Fibromyalgia is a long-term condition that causes pain all over the body.

Symptoms of fibromyalgia

The main symptom of fibromyalgia is widespread pain that might feel like:

• an ache
• a burning sensation
• a sharp stabbing pain
• a mixture of these 3 feelings

The pain is likely to be continuous, but it might be better or more severe at different times.

As well as widespread pain, people with fibromyalgia might also have:

• increased sensitivity to sensations like touch, light, temperature, noise
• fatigue (extreme tiredness)
• muscle stiffness
• difficulty sleeping
• problems with mental processes (known as “fibro-fog”) – like problems with memory and concentration
• headaches
• irritable bowel syndrome (IBS) – a digestive condition that causes stomach pain and bloating
• dizziness and clumsiness
• feeling too hot or too cold
• restless legs syndrome
• tingling, numbness, prickling or burning sensations in your hands and feet (pins and needles, also known as paresthesia)
• unusually painful periods (if you get periods)
• anxiety
• depression

Causes of fibromyalgia

It’s not clear why some people develop fibromyalgia. The exact cause is unknown, but it’s likely that many factors are involved.

Altered pain messages

Your brain, nerves and spinal cord make up your central nervous system. Changes in the way your central nervous system sends and receives information to your body might cause fibromyalgia.

Fibromyalgia is a type of chronic pain.

Genetics

Some people are more likely than others to develop fibromyalgia because of the genes inherited (passed on) from their parents.

Triggers

Fibromyalgia is often triggered by a stressful event. This might be a physically stressful event or an emotionally (psychologically) stressful event.

Possible triggers of fibromyalgia might be:

• an injury
• a viral infection
• giving birth
• an operation
• the breakdown of a relationship
• being in an abusive relationship
• the death of a loved one

Sometimes there isn’t an obvious trigger.

Diagnosing fibromyalgia

Diagnosing fibromyalgia can be difficult. There’s no specific test to diagnose the condition.

The symptoms of fibromyalgia can vary. The symptoms can be similar to those of several other conditions. Your GP will have to rule out other conditions with similar symptoms.

You’ll be asked about how your symptoms are affecting your daily life. You’ll be examined to check for signs of other conditions. They’ll check for swollen joints which might suggest arthritis, rather than fibromyalgia.

Tests to check for some of these conditions include urine and blood tests. You may also have X-rays and other scans. If you’re found to have another condition, you could still have fibromyalgia as well.

Criteria for diagnosing fibromyalgia

For fibromyalgia to be diagnosed, certain criteria usually have to be met. The most widely used criteria for diagnosis are:

• you have pain in multiple areas of your body
• your symptoms have stayed at a similar level for at least 3months
• your symptoms can’t be explained by any other reason
• you feel unrefreshed after sleep
• you have problems thinking or remembering (cognitive difficulties)
• you experience fatigue

Diagnosing other conditions

It’s also possible to have other conditions alongside fibromyalgia, like:

• depression
• anxiety
• irritable bowel syndrome (IBS)
• osteoarthritis
• hypermobility spectrum disorder

Identifying all possible conditions will help to guide your treatment.

Treating fibromyalgia

Fibromyalgia is a long term (chronic) condition.

There’s no cure for fibromyalgia. But there are treatments to help relieve some of the symptoms. This can make the condition easier to live with.

Traditional treatments like pain medication aren’t always helpful for people with fibromyalgia. Learning about your condition and finding the best self-management approaches for you is the best way to manage it.

A healthcare professional can help you explore your options.

Exercise, movement and activity

Exercise, movement and activity can be helpful way to manage pain.

A physiotherapist can help you to develop self-management skills to reduce the impact of pain on your life. They might help you create a tailored exercise program suited to your needs, abilities and goals.

Physiotherapy can also help prevent further loss of strength and increase your fitness.

Occupational therapy can help you manage your everyday activities around fibromyalgia. The aim is to do this without increasing your pain or overwhelming yourself.

Your occupational therapist may suggest new ways to do things. They may be able to support you to continue to work, if you want to.

Group support

Some pain clinics offer pain management programs run by a team of specialists. These specialists can include physiotherapists and psychologists. They can provide support to develop coping skills and manage your activity levels.

Speak to your GP if you think you’d benefit from a pain management program.

Talking therapies

Talking therapies can help you manage the stress of living with fibromyalgia.

Examples of talking therapies are:

• cognitive behavioral therapy (CBT) – a treatment approach to help you understand the link between how we think and what we do
• acceptance and commitment therapy (ACT) – often used for pain management

Medication

Medication can’t treat fibromyalgia but it can help reduce some symptoms. Speak to your GP or pain specialist to find out the potential benefits and risks.

Your GP will likely suggest you try exercise, CBT and physiotherapy first. This is because these treatments are more likely to help.

Antidepressants can help some people with fibromyalgia. They help:

• relieve pain
• treat sleep problems

This can be useful even if you haven’t been diagnosed with depression.

Other medications can be used for the treatment of fibromyalgia symptoms, but they’re likely to be less effective.

Speak to your GP, pharmacist or healthcare professional if you’re taking medication and you don’t feel it's helping.

Alternative therapies

Some people with fibromyalgia try complementary or alternative treatments, like acupuncture or massage.

There’s little scientific evidence that these treatments help in the long term. Some people find that certain treatments help them to relax and feel less stressed. This allows them to cope with their condition better.

If you decide to use complementary or herbal remedies, check with your GP or healthcare professional first. Some remedies can react unpredictably with other medication or make it less effective.