Michael Harty (Clare, Independent) | Oireachtas source

Fibromyalgia is a very difficult condition to diagnose and treat. I know that from my own profession. The difficulty in diagnosis, as others have said, is there is no clinical or biochemical marker that will give an exact diagnosis. Most commonly, it is a diagnosis of exclusion. Having gone through all the various conditions that could be leading to chronic pain and stiffness in muscles, one comes to a conclusion that it could be fibromyalgia. There is a prolonged process of elimination before one comes to the diagnosis so many of these patients will be referred on to rheumatology clinics and will have extensive blood tests, scans and X-rays. Eventually, when all other conditions have been eliminated, one is left with a diagnosis of fibromyalgia so it is a very unsatisfactory process to have to work through where one eventually comes to a diagnosis when one cannot find any other answer.

It is much more commonly diagnosed in the US than in Ireland, although it has become more frequently diagnosed here as the medical profession becomes aware of the condition. It can be mixed up with other chronic pain syndromes. It can be difficult to separate it from ME. As Deputy MacSharry noted, Lyme disease can masquerade as fibromyalgia. It is a diagnosis that is made over time nevertheless and sooner or later one comes to the conclusion that somebody is suffering from fibromyalgia. The difficulty then is trying to devise what the care pathway will be because, as Deputy Pringle and others said, it is an invisible disability. There is no outward show of it except for the physical manifestations of pain and muscular stiffness. In response to a parliamentary question in 2015, the then Minister for Health, Deputy Varadkar, spoke about fibromyalgia and outlined the variety of treatments that would be made available to people with the condition, including education, exercise, cognitive behavioural therapy and meditation. The Minister of State referred to how Sláintecare might deliver solutions for people with fibromyalgia. In quoting from Sláintecare, she talked about the transfer of many of our services from hospitals to the community but, unfortunately, the care pathways in the community to treat people with fibromyalgia are not available. In that regard, the national clinical programme for rheumatology was to develop a model of care for the treatment of rheumatological and musculoskeletal conditions, including fibromyalgia, but when that body produced its report in 2017 entitled The Model of Care for Rheumatology in Ireland, there was little or no reference to fibromyalgia in it. There was little or no reference to the pathways that should be provided for people who suffer from fibromyalgia.

The treatment for fibromyalgia is multi-faceted. As the Minister of State has outlined, it involves physiotherapy, occupational therapy, cognitive behavioural therapy, counselling, lifestyle changes and supporting people in self care. Unfortunately, we do not have access to physiotherapy in primary care. Physiotherapy is at a premium in primary care and in many areas, physiotherapy is only supplied to people who have been discharged from hospital after a fracture, surgery or major illness. People with fibromyalgia find it very difficult to get access to physiotherapy. Physiotherapy does not exist in many areas because we do not have physiotherapists to fill the posts. In the same way, occupational therapy is at a premium and is not freely available to people with conditions such as fibromyalgia. Cognitive behavioural therapy is extremely important for people with fibromyalgia. Psychologists and psychotherapists are not available to provide cognitive behavioural therapy in many areas. My area in west Clare has not had access to a psychologist for six years. People with fibromyalgia do not need to be treated by a psychiatrist. It is not a psychiatric condition but, unfortunately, many patients who suffer from fibromyalgia end up on sleeping pills, anti-depressants, opioid painkillers and anti-epileptic medications that have as a side effective some analgesic properties. This is most upsetting because quite often, the only avenue of treatment many GPs have is to prescribe these medications because physiotherapy, occupational therapy and cognitive behavioural therapy are just not available.

Unfortunately, many people who suffer from fibromyalgia end up on these medications - inappropriately in many cases. They then have two problems. They suffer from fibromyalgia and they are on medication which has substantial side-effects and may not have substantial benefits for them. Deputies Gino Kenny and Paul Murphy referred to medicinal cannabis products being made available to people who have chronic pain syndrome. Unfortunately, however, there is no class 1 evidence-based recommendation for the provision of cannabis-based products in the treatment of chronic pain syndromes. The scientific evidence to back it up is not there, unfortunately.

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