Fibromyalgia - Treatment

Highlights	Conditions with Similar Symptoms	Medications
Introduction	Prognosis	Resources
Causes	Treatment	References
Risk Factors	Lifestyle Changes
Diagnosis	Behavioral Therapy

Treatment

Fibromyalgia is a mysterious condition whose causes and basic disease mechanisms are still largely unknown. There is no strong evidence that any single treatment or combination has any significant effect for most patients. Treatment must involve not only relieving symptoms but also changing the patients' perceptions of their disease and helping them to develop behaviors that enable them to cope.

text continues below

Therapies generally employ a trial and error, multi-faceted approach:

Patients may start initially with physical therapy, exercise, stress reduction techniques, and cognitive-behavioral therapy.
If non-pharmacologic methods fail to improve symptoms, then an antidepressant or muscle relaxant may be added to the treatment regimen. These drugs are typically prescribed for their effects on the central nervous system that help to improve pain tolerance. Because many fibromyalgia patients have difficulty sleeping, the drowsiness that these drugs produce can be beneficial.
Patient education and programs that bolster coping skills are an important part of any treatment plan.

According to a 2005 study published in theClinical Journal of Pain, a combination of non-drug therapies (exercise, stress management, massage, and dietary therapy) work just as well as drug therapy in improving pain, depression, and disability. In 2004, the Journal of the American Medical Association published an evaluation of various fibromyalgia treatments. Based on clinical trial data reported in medical journals, the researchers assessed and ranked the evidence supporting the efficacy of these treatments.

Non-Drug Treatments:

Strongest evidence: Cardiovascular exercise; cognitive-behavioral therapy; patient education groups; combinations of these treatments.
Moderate evidence: Strength training; acupuncture, hypnotherapy; biofeedback; balneotherapy.
Weak evidence: Chiropractic; massage therapy; electrotherapy; ultrasound.
No evidence: Trigger point injections; flexibility exercise.

Drug Treatments:

Strongest evidence: Amitriptyline; cyclobenzaprine.
Moderate evidence: Tramadol; fluoxetine; venlafaxine; milnacipran; duloxetine; pregabalin.
Weak evidence: Growth hormone; 5-HT; tropisetron; SAMe.
No evidence: Opioids; corticosteroids; NSAIDs; benzodiazepine and non-benzodiazepine hypnotics; melatonin; calcitonin; thyroid hormone; guaifenesin; DHEA; magnesium.