Fibromyalgia Treatment in Marylebone, London
Fibromyalgia is widespread pain with fatigue, unrefreshing sleep and difficulty thinking, and it is diagnosed from that pattern rather than from a blood test. Normal results are part of the process, not a verdict on you. We treat the nervous system that is amplifying the signal, and we measure whether it is working.
Overview
Understanding fibromyalgia
Fibromyalgia is pain on both sides of the body, above and below the waist, lasting three months or longer, together with fatigue, sleep that does not refresh you and difficulty with memory and word-finding. Many people also find touch, noise, light and cold register more strongly than they used to. Most diagnoses are made between the ages of 30 and 50, and most are made in women.
It is diagnosed clinically, from that pattern. Blood tests and scans are done to rule out other conditions, not to confirm this one, which is why they come back normal. A normal result tells you where the problem is not. It is not evidence that nothing is wrong, and it is not a comment on you.
What is going wrong sits in how your nervous system processes signals rather than in the muscles that hurt. Pain is amplified instead of filtered. The body stays braced, which shows up as reduced heart rate variability. Sleep stops restoring you, which lowers your pain threshold further, and the two feed each other. That is the loop treatment has to interrupt.
Magnetic stimulation is one way of doing that, and here is the state of the evidence. There is published work on rTMS in fibromyalgia, looking at both motor cortex and prefrontal targets with pain, fatigue and quality of life as outcomes. It is more limited than the depression evidence and the studies are smaller. NICE has not issued interventional procedures guidance for fibromyalgia as it has for depression. Your clinician will say which of those categories your treatment sits in before you agree to a course.
Alongside stimulation, the things that hold fibromyalgia in place are worth treating in their own right. Sleep, pacing, mood and gradual conditioning all change what a course can achieve, and none of them is a suggestion that your pain is imagined.
Why it happens
What causes fibromyalgia?
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Central sensitisation: pain signals are amplified by the nervous system rather than filtered
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Reduced descending inhibition, so the pain-damping system works less effectively
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Non-restorative sleep, which lowers pain threshold and deepens the fatigue
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Autonomic imbalance, visible as reduced heart rate variability
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A triggering illness, injury or period of sustained stress, though many people never identify one
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A genetic contribution, which is why fibromyalgia often runs in families
Treatment approach
How do we treat fibromyalgia?
NayaScore assessment
On enquiryFibromyalgia is the condition most often assessed by asking how you feel today, which is the least reliable moment to ask. Grip strength, continuous heart rate variability from a wearable ring and cognitive testing across twelve domains give you a baseline for the pain, the fatigue and the fog separately. It informs clinical judgement rather than replacing it.
See treatment detail →Precision rTMS
From £350 a sessionBoth motor cortex and prefrontal targets have been studied in fibromyalgia, and which one suits you is decided at assessment rather than by protocol. The dose is a percentage of your own motor threshold, which matters when your nervous system is already sensitised. Sessions are quiet, seated and drug-free.
See treatment detail →Restore programme
From £350 a sessionDesigned for sensitive nervous systems, which is the point here. The pathway builds in a slower start, a mid-course reassessment and a plain decision about whether to continue, rather than asking you to commit to a long course on the strength of a first appointment.
See treatment detail →Progress tracking
On enquiryWith fibromyalgia the day-to-day variation is large enough to hide a real trend. Tracking the same measures across the course separates a bad week from a course that is not working, which is exactly the distinction you need in order to decide whether to keep going.
See treatment detail →Integrated therapy
On enquirySleep, mood and pacing hold fibromyalgia in place, and stimulation on its own leaves them untouched. Working on them alongside a course is not a suggestion that your pain is psychological. It is how you keep any gain the course produces.
See treatment detail →FAQ
Common
questions
How is fibromyalgia diagnosed?
Clinically, from the pattern: widespread pain for three months or more, unrefreshing sleep, fatigue and difficulty thinking. Blood tests and scans are used to rule other conditions out, not to confirm it. That is why they come back normal, and why a normal result is not a verdict on you.
Is there evidence for rTMS in fibromyalgia?
There is published work, and it is more limited than the depression evidence. Studies have looked at both motor cortex and prefrontal targets, with pain, fatigue and quality of life as outcomes. Your clinician will tell you what a realistic course looks like and what it may not change.
Will it help the fibro fog as well as the pain?
It may, and we measure it rather than guess. Cognitive testing across twelve domains is part of your baseline and is repeated during the course, so the memory and word-finding side is tracked separately from pain. Some people improve on one and not the other.
I have been dismissed by three doctors. Why would this be different?
Because the appointment starts from the assumption that your symptoms are real and asks what is driving them. You get measurement instead of reassurance, a named mechanism, and a clinician who will say plainly if stimulation is not the right answer for you. Scepticism is reasonable here.
How long is a course for fibromyalgia?
Your clinician gives you a number after the assessment, not before it. Courses at this clinic have ranged from five sessions for cognitive work to thirty for complex chronic fatigue, so the spread is wide. The reassessment partway through the course is what decides whether to continue.
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Naya • 1 Orchard Street, London W1H 6HJ
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