Fibromyalgia Treatmentby Karen Lee Richards Patient Advocate
Since there is no known cure for fibromyalgia (FM), treatment efforts are directed at relieving symptoms and improving quality of life. A multi-disciplined approach using prescription medications, alternative therapies, gentle exercise and lifestyle adaptations seems to work best for most patients.
Unfortunately, what works well for one individual may not work at all for another. Finding an effective fibromyalgia treatment program is usually a matter of trial and error. It requires the doctor, patient, and perhaps other health care professionals working together as a team to develop an individualized plan.
Thus far three drugs, Lyrica, Cymbalta and Savella have received FDA approval for the treatment of fibromyalgia. A number of other medications are also used to treat fibromyalgia symptoms but must be prescribed off-label. Because people with FM are sometimes highly sensitive to many drugs, medications should be prescribed with great care.
Over-the-counter pain relievers such as ibuprofen and acetaminophen can be used to relieve mild pain, however, in many cases stronger medications are needed. Some of the prescription medications used to treat fibromyalgia symptoms include:
Antidepressants - Although sometimes used to treat an overlapping diagnosis of depression, low-dose antidepressants are also prescribed for FM to improve sleep and reduce pain. Types of antidepressants used include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and tricyclics. The FDA approved drugs Cymbalta and Savella are SNRIs. (Since the development of SSRIs and SNRIs, the use of tricyclic antidepressants to treat fibromyalgia has decreased significantly.)
COX-2 inhibitors (like Celebrex)
Anti-convulsants /drugs used to treat nerve pain. (The FDA-approved drug Lyrica--generic name pregabalin--is in this category.)
Non-narcotic pain relievers
Narcotic pain relievers - (Generally, narcotic pain relievers are only prescribed in severe cases, when patients do not respond to other treatments. Although many FM patients report that they've had success using opiate treatments, a Danish survey study indicated that the use of opiods by chronic pain patients may not result in a significantly improved quality of life in the long term.)
Injections of a local anesthetic or corticosteroid are sometimes used for severe tender point pain.
A number of different therapies, both traditional and alternative, have been effective in helping some fibromyalgia patients manage their symptoms. Some of these therapies include:
Cognitive behaviorial therapy
Hot/cold pack application
Relaxation and breathing exercises
Although many fibromyalgia patients feel like they are in too much pain to exercise, it's an essential component of any fibromyalgia treatment plan. The fact is that without exercise, muscles become deconditioned, causing the pain and stiffness to get worse. On the other hand, exercise that is too strenuous can also increase pain. The best answer to this problem seems to be a very gentle, slowly graded exercise program. (See Fibromyalgia and Exercise.)
One of the best forms of exercise for fibromyalgia patients is warm water aquatic therapy. There are a variety of different water exercise programs available, ranging from water aerobics to watsu. It takes less effort to move in water yet water provides resistance, so individuals get more benefit with less exertion. Being immersed in warm water also reduces the perception of pain and aids in relaxation.
Lifestyle changes are key to the effective management of fibromyalgia symptoms. Making positive lifestyle changes lays a good foundation upon which other treatment plans can be built. Recommended lifestyle adaptations include:
Getting more rest. (Avoid complete bed rest if at all possible as it will lead to deconditioned muscles and increased pain and stiffness.)
Pacing activities and following a manageable daily routine.
Reducing physical and emotional stress.
Improving nutrition. (Avoid alcohol, caffeine, sugar and food additives. Many fibromyalgia patients find a high protein, low carbohydrate diet to be most effective.)
Remembering to breathe deeply and practice relaxation techniques.
In addition, try to notice which things you do that cause you to have a flare. Consider keeping a log or journal noting what you do and your pain and fatigue levels each day so you can look for patterns. Take household chores for example. I've found that I can dust and do dishes without too much problem, but if I vacuum, mop or scrub the bathtub, my pain level goes up for several days.
Think about how you can get help with those things that cause you more pain. Get someone else in the household to do those chores or pay for someone to come in and help. If you can't afford to pay for help, perhaps you can swap services with a friend, doing something you're able to do for her and vice versa. For more tips on lifestyle adaptations, read Little Things Can Make a Big Difference.
Fibromyalgia. National Fibromyalgia Association, 2004.
Eriksen, J., P. Sjogre, E. Bruera, O. Ekholm, N.K. Rasmussen. "Critical issues on opioids in chronic non-cancer pain: an epidemiological study." Pain, 2006. 125(1-2):172-9.
© Karen Lee Richards, 2010
Last Updated: 1/14/10