Rheumatology and chronic pain · London
A private fibromyalgia clinic, run as a real MDT.
A structured ACR 2016 diagnosis, the full mimic workup, and a 12-week programme that puts rheumatology, pain medicine, clinical psychology, physiotherapy and a specialist nurse in the same plan, not the same waiting list.
Why patients choose us
- 01
A true MDT, not a single clinic room
Rheumatology, pain medicine, clinical psychology, physiotherapy and a specialist nurse in one coordinated programme, not a series of solo appointments.
- 02
ACR 2016 diagnosis, mimics ruled out
A structured assessment against the ACR 2016 criteria, with the full blood-panel workup to exclude hypothyroidism, PMR, inflammatory arthritis, myopathy and sleep-disordered breathing.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing. If you do not need private care, we say so.
Indicative pricing
What a private fibromyalgia clinic costs in London.
Indicative ranges across our partner centres. Send a short summary and we quote firm figures across two or three options.
In short
A single MDT assessment: £350–£550. A 12-week programme: £3,500–£8,500.
| Service | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Initial rheumatology consultation (60 min) | £350–£550 | 60 min | Same visit |
| Pain medicine consultation | £300–£500 | 45–60 min | Same visit |
| Clinical psychology (CBT for chronic pain, per session) | £120–£180 | 50 min | 12–16 sessions |
| Physiotherapy session (graded exercise, hydrotherapy) | £90–£150 | 45 min | Ongoing |
| 12-week MDT fibromyalgia programme | £3,500–£8,500 | 12 weeks | Programme |
| Low-dose naltrexone (LDN 4.5 mg, compounded, monthly) | £30–£60/month | — | Ongoing |
| Second-opinion review of prior records | £250–£450 | 30 min | 48 hours |
Prices vary by centre, by consultant, by whether psychology and physiotherapy are bundled, and by how long the programme runs. We come back with a firm quote within one working day.
The journey
From first message to a 12-week plan, in order.
One coordinator from first message to review at week 12 — with your GP in the loop from day one.
- 01
Before
You send a short summary
A confidential form: your symptom pattern, sleep, mood, pain map, previous investigations and any medications you have tried.
- 02
Before
We come back within a working day
A recommendation: which rheumatologist or pain specialist fits, whether an MDT programme is worth the money, indicative prices across two or three centres.
- 03
Before
We book the assessment and bloods
Usually within one to two weeks. Baseline bloods (TSH, ESR, CRP, anti-CCP, RF, ANA, CK, vitamin D, ferritin, B12) ordered before you arrive so the consultant has results in hand.
- 04
On the day
The 60-minute rheumatology consultation
A full history, tender-point and control-point examination, WPI and SS scoring, review of bloods and any imaging, and a written formulation of what is (and is not) driving the pain.
- 05
On the day
The MDT plan is drafted
A written 12-week plan: education, graded aerobic exercise, sleep work, pharmacotherapy, CBT or ACT if indicated, and a review date. Shared with your GP.
- 06
After
The programme runs
Weekly or fortnightly sessions with physiotherapy, psychology and the specialist nurse. Medication titrated with the pain physician. Sleep and OSA addressed if flagged.
- 07
After
Review and step down
A review at week 12 to measure change (FIQR, PHQ-9, GAD-7, sleep), taper the programme and hand back to your GP with a written maintenance plan.
When a clinic like this helps
The patterns we see, and the red flags that need a different door.
Most people arrive after years of appointments. A structured MDT visit is often the first time everything is looked at together.
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Widespread pain over months, no clear cause
Pain in multiple body regions for three months or more, with normal inflammatory markers and no structural explanation on imaging.
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Fatigue, unrefreshing sleep, cognitive fog
The classic non-pain triad: exhaustion out of proportion to activity, waking unrested, and difficulty with word-finding and concentration ("fibro fog").
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Failed trials of simple analgesia
Paracetamol, NSAIDs and codeine have not helped, or you have been left on opioids you would rather not be taking.
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Comorbid IBS, migraine, endometriosis
Overlapping conditions from the central-sensitisation family — bowel symptoms, headache, pelvic pain, TMJ pain — all in one person.
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Anxiety, depression or PTSD alongside
Mood and trauma symptoms that interact with pain and need treating in parallel, not sequentially.
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Autonomic symptoms and possible POTS
Postural dizziness, palpitations, heat and cold intolerance, brain fog on standing — worth an active look, not a shrug.
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Diagnostic uncertainty from your GP
You have been told "it might be fibromyalgia" without a structured assessment or a plan. A single MDT visit can settle the question.
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Red flag: new inflammatory features
Joint swelling, morning stiffness over an hour, weight loss, rash, or a raised CRP is not fibromyalgia. That needs a rheumatology referral on its own terms.
What the programme contains
Diagnosis, education, exercise, therapy, medication.
Every part is optional in principle and disciplined in practice — the evidence base guides what goes in.
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ACR 2016 diagnostic assessment
A structured 60-minute consultation. Widespread Pain Index (WPI) and Symptom Severity (SS) scored: WPI ≥7 + SS ≥5, or WPI 4–6 + SS ≥9, with symptoms for at least three months and no other explanation.
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The mimic panel
Bloods to exclude the impostors: TSH (hypothyroidism), ESR and CRP (PMR, inflammatory arthritis), anti-CCP and RF (RA), ANA and ENA (connective tissue disease), CK (myopathy), vitamin D, ferritin, B12, HIV and hepatitis screens. Sleep study if OSA is suspected.
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Patient education first
The single most powerful intervention. A clear explanation of central sensitisation — that the pain is real, generated by an amplified nervous system, and modifiable — reframes the illness and unlocks the rest of the plan.
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Graded aerobic exercise
The intervention with the strongest evidence. Pool-based Ai Chi, walking or cycling, started low and built slowly. Physiotherapy-led to avoid boom-and-bust flares.
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CBT for chronic pain, ACT and MBSR
Cognitive behavioural therapy for chronic pain, acceptance and commitment therapy, and mindfulness-based stress reduction. Not "it is in your head" — they change how the nervous system processes pain.
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Pharmacotherapy, in a stepped way
Amitriptyline 10–50 mg nocte first-line in the UK; duloxetine 30–60 mg or venlafaxine 75–150 mg for pain and mood; pregabalin 150–450 mg (Cochrane: modest benefit, real side effects); gabapentin off-label. Tramadol only short-term. Chronic opioids avoided. NSAIDs have a limited role.
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Low-dose naltrexone (LDN)
LDN 4.5 mg nightly is an emerging option with a growing evidence base for fibromyalgia. Compounded in the UK, £30–£60 per month, discussed as an off-label choice with proper consent.
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Sleep, autonomic and comorbidity work
CBT-I for insomnia, treat obstructive sleep apnoea and restless legs, screen for POTS with a lying-standing BP. Actively manage IBS, migraine, mood and anxiety — the pain rarely improves in isolation.
Our vetted London network
The centres and clinicians we introduce you to.
We work with King's Private Rheumatology, HCA Wellington, Chelsea and Westminster Private, Imperial Private at Charing Cross Pain, the Nightingale Hospital MDT, London Pain Clinic at Guy's, and the Royal National Hospital for Rheumatic Diseases in Bath.
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Consultant rheumatologists with a declared fibromyalgia and chronic-pain interest
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Pain medicine specialists comfortable with rational polypharmacy and de-prescribing opioids
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Clinical psychologists trained in CBT for chronic pain, ACT and MBSR
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Physiotherapists running graded aerobic and hydrotherapy programmes, not passive treatments
Safety and medication
The honest bits about drugs, flares and comorbidity.
Fibromyalgia care goes wrong more often than it needs to — usually because opioids are started, exercise is stopped at the first flare, or the mood side is ignored.
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Amitriptyline: start low, go slow
Begin at 10 mg two hours before bed, titrating by 10 mg every one to two weeks. Dry mouth, morning grogginess and constipation are common. Avoid in significant heart block.
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Duloxetine and venlafaxine cautions
Check blood pressure at baseline and on dose changes. Do not stop abruptly (discontinuation syndrome). Watch for serotonin syndrome if combined with tramadol.
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Pregabalin: modest benefit, real burden
Cochrane shows modest analgesic benefit at 300–450 mg with a high side-effect rate — dizziness, weight gain, oedema, cognitive slowing. Controlled drug (Schedule 3). Not first-line.
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Chronic opioids: avoid
Opioids do not work for fibromyalgia and worsen central sensitisation, sleep and cognition. Tramadol short-term only. If you are already on opioids we will taper safely, not stop overnight.
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Cannabis-based products: not licensed
Sativex is not licensed for fibromyalgia in the UK. Private prescribing exists but the evidence is weak and the cost is high — discussed honestly rather than sold.
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Exercise flares are normal
Expect a temporary flare in the first few weeks of graded exercise. That is the nervous system recalibrating, not damage. Pacing prevents boom-and-bust; do not stop.
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Sleep hygiene and OSA screening
Fibromyalgia is worsened by untreated OSA and restless legs. A screening STOP-BANG and a low threshold for a sleep study are part of good care.
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Mood and suicide safety
Depression, anxiety and suicidal thoughts are common. We screen with PHQ-9 and GAD-7 at intake and review, with a written safety plan if scores are high.
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Red flags after the programme
New joint swelling, morning stiffness over an hour, weight loss, rash, unexplained fever, or a new neurological deficit — call the clinic or your GP; that is not a flare.
Reading your MDT letter
Your MDT letter in four parts. Read the last one first.
Whichever centre runs your programme, the letter that goes to you and your GP keeps to the same shape.
- 01 Header
ACR 2016 scores and mimic panel
Your WPI, SS score, symptom duration and the results of the blood panel used to exclude other causes. The line that says "criteria met" or "not met".
- 02 Formulation
What is driving the pain, and why
The rheumatologist's written explanation of central sensitisation in your case: sleep, mood, autonomic and comorbid contributors, and what is amplifying what.
- 03 Plan
The 12-week MDT programme
The week-by-week schedule: education, exercise, psychology, medication titration, sleep work and specialist nurse contact points.
- 04 Impression
Outcome measures and maintenance
Read this first: which measures (FIQR, PHQ-9, GAD-7, sleep, work capacity) will be tracked, the review date, and how you step down from the programme.
Recognised by major UK insurers
Cover for MDT fibromyalgia programmes varies by insurer. Consultations and medication are typically funded; psychology and physiotherapy vary. We confirm cover before booking.
Frequently asked
Everything we get asked about fibromyalgia care.
Quick answers on diagnosis, medications, exercise, psychology and where to be seen.
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How is fibromyalgia diagnosed in 2026?
Against the ACR 2016 criteria. You need widespread pain for at least three months, a Widespread Pain Index (WPI) of 7 or more plus a Symptom Severity (SS) score of 5 or more, or a WPI of 4–6 with an SS score of 9 or more, and no other condition that better explains the symptoms. It is a clinical diagnosis, but blood tests are essential to rule out mimics like hypothyroidism, PMR, rheumatoid arthritis and connective tissue disease.
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What does a private fibromyalgia clinic cost in the UK?
An initial rheumatology consultation is £350–£550 for 60 minutes. A full 12-week MDT programme (rheumatology, pain medicine, psychology, physiotherapy and specialist nurse) is £3,500–£8,500. CBT for chronic pain sessions are £120–£180 each, typically 12–16 sessions. Low-dose naltrexone is £30–£60 a month if it forms part of your plan.
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Which medications actually work for fibromyalgia?
First-line in the UK is amitriptyline 10–50 mg at night for pain and sleep. Duloxetine 30–60 mg or venlafaxine 75–150 mg help pain and mood. Pregabalin 150–450 mg has modest Cochrane-graded benefit but real side effects. Gabapentin is used off-label. Tramadol is short-term only. Chronic opioids should be avoided — they worsen fibromyalgia. NSAIDs have a limited role. Low-dose naltrexone 4.5 mg is an emerging option.
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Is exercise really the strongest treatment?
Yes. Graded aerobic exercise has the strongest evidence base of any single treatment for fibromyalgia. Pool-based Ai Chi, walking and cycling all work when they are started low, built slowly and paced to avoid boom-and-bust flares. Physiotherapy-led programmes give the best results because they manage the initial flare and stop patients quitting.
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Do I need psychology, or does that mean it is all in my head?
Fibromyalgia pain is real, and generated by a nervous system that has become sensitised. Psychology (CBT for chronic pain, ACT, mindfulness) does not treat imaginary pain — it retrains how the nervous system processes signals, reduces the amplification, and gives you tools for the flares. Skipping it usually means the medication and exercise underperform.
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Which London centres run private fibromyalgia MDT programmes?
The centres we work with include King's Private Rheumatology, HCA Wellington Rheumatology, Chelsea and Westminster Private, Imperial Private at Charing Cross Pain Service, the Nightingale Hospital MDT, London Pain Clinic at Guy's, and the Royal National Hospital for Rheumatic Diseases in Bath for out-of-London referrals. We match the centre to your case, not the other way round.
Ready to be seen properly
One MDT visit is often worth five separate ones.
Send a short summary. We come back within one working day with a matched consultant, a firm price across two or three centres, and an honest read on whether an MDT programme is right for you.
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