Fibromyalgia is a mysterious condition. Its causes are still largely unknown, as is how it causes damage. No strong evidence indicates that any single treatment (or combination of treatments) has any significant effect for most patients.
In 2007 pregabalin (Lyrica) became the first drug FDA-approved for the treatment of fibromyalgia, after a study showed the medicine reduced fibromyalgia pain in 63% of patients. A year later, the FDA approved the drug duloxetine (Cymbalta) for fibromyalgia. Cymbalta has been shown to reduce fibromyalgia pain by more than 30%. The serotonin-norepinephrine reuptake inhibitor (SNRI) milnacipran (Savella) is also approved for this condition.
Many patients with fibromyalgia are treated first with medication; however, the American Pain Society Fibromyalgia Panel recommends a combined approach using cognitive-behavioral therapy, education, medication, and exercise. Treatment usually involves not only relieving symptoms but also changing a patient's attitude about the disease. Treatment should also teach patients behaviors that help them cope.
Treatments usually involve trial and error:
- Patients may start with physical therapy, exercise, stress reduction techniques, and cognitive-behavioral therapy.
- If these methods fail to improve symptoms, an antidepressant or muscle relaxant may be added to the treatment. Doctors usually prescribe these drugs because they may improve pain tolerance.
- Patient education and programs that encourage coping skills are an important part of any treatment plan.
A combination of non-drug therapies appears to work just as well as drug therapy in improving pain, depression, and disability. This combination includes exercise, stress management, massage, and diet.
Preparation for Treatment
Patients must have realistic expectations about the long-term outlook of their condition, and their own individual abilities. It is important to understand that fibromyalgia can be managed, and patients can live a full life. The following tips may be helpful when starting a treatment program for fibromyalgia:
- The goal of therapy is to relieve symptoms, not cure them.
- Treatment must be tailored to each patient, and a combination approach is often needed.
- Patients must begin all treatments with the attitude that these treatments are trial-and-error. There is no clear treatment solution. Patients and doctors need to work together to make the best choices for individual symptoms and concerns.
- Treatments are long-lasting, in some cases lifelong, and patients should not be discouraged by the return of symptoms (relapses).
- Enlisting family members, partners, and close friends, particularly to help with exercise and stretching programs, can be helpful.
- Joining a fibromyalgia support group also helps many patients. Support groups may also help family members, particularly the parents of children with fibromyalgia.
The definition of improvement is personal. For example, some patients are pleased with only a 10% reduction in pain and other symptoms.
Review Date: 12/27/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.