Let's Talk About Fibromyalgia Treatment
It can take some trial and error to find relief from this chronic pain condition, but there are multiple strategies that can help you take control of your life again.by Erin L. Boyle Health Writer
Fibromyalgia can be daunting—it’s a complicated condition that’s still not entirely understood. The primary symptom is pain, but it comes with a lot of other symptoms, too, along with a wide range of treatment possibilities—some more conventional than others. It’s important to know that these treatments are effective in managing this chronic pain disorder, even if it may take a while to find the right approach. From medicines to massages, there are ways to fight fibro, even if you might have heard differently. Let’s dive in.
Our Pro Panel
We went to some of the nation’s top experts in fibromyalgia to bring you the most up-to-date information possible.
Anca Askanase, M.D.
Rheumatologist, Director of Rheumatology Clinical Trials
Columbia University Medical Center
New York City
Andrea L. Nicol, M.D.
Comprehensive pain management physician, Assistant Professor
University of Kansas Medical Center
Kansas City, KS
Manisha Mittal, M.D.
Rheumatologist, rheumatology director, Graduate Medical Education
St. Agnes Medical Center
There are currently three drugs that are FDA-approved to treat fibromyalgia. Two are a type of antidepressant known as serotonin-noradrenaline re-uptake inhibitors (SNRIs). These meds increase serotonin and norepinephrine activity in the brain, which helps halt pain signals. The third is an antiseizure drug which reduces sensory sensitivity in the brain. Other drugs may be used off-label to treat fibro.
In CBT (cognitive behavioral therapy), you learn to challenge thoughts that are counterproductive to your situation and replace them with ones that will help you achieve your goal. That might not seem related to a condition like fibromyalgia, but pain is both an emotional and physical experience, and while you cannot control the physical aspect, you may be able to retrain your brain for how it handles pain on a psychological level.
Yes, several studies suggest regular massage therapy may ease some of the painful symptoms of this condition. What’s more, research shows that massage can reduce feeling of depression—a major symptoms of fibromyalgia.
People with fibro often experience periods of time when symptoms worsen for days or weeks. This is known as a flare. It may be brought on by stress, anxiety, lack or sleep or another illness. Meds can help control the symptoms.
What Is Fibromyalgia, Again?
Fibromyalgia—sometimes called fibro for short—is a chronic neurologic pain disorder that isn’t curable but is treatable. Here’s what it isn’t: It’s not an autoimmune disease, and it’s not an inflammatory-related condition, either.
It’s likely a brain pain disorder, where your central nervous system can’t control its pain response, causing people to feel extraordinary pain from things that others might not even notice.
Experts are not sure, exactly, what causes it, but it could be genetic (with a first-degree relative who has fibro, you’re about eight times more likely to have it) or related to environmental factors (stress, viral infections, obesity, and injuries could all play a role).
It’s estimated that about 10 million Americans, or 2% to 4% of the population, have fibromyalgia. It appears to strike more women than men, and can happen at any age, but is mostly seen in middle age.
Common symptoms are widespread pain that can be severe, fatigue, waking unrefreshed, and cognitive issues (like thought or memory problems, known informally as fibro fog). People with fibromyalgia are also three times more likely to have depression than those without this condition.
What Causes a Fibro Flare?
During a fibro flare, fibromyalgia symptoms worsen and you feel as though your body is under siege. Flares may seem to appear out of nowhere, but they generally have triggers that set them off. In the case of fibromyalgia, these triggers may include:
Lack of sleep
Understanding that fibro flares can be triggered by your emotional state is key, as this opens another avenue of treatment possibilities. So what are the treatments for fibro?
Pharmacological Pain-Relief Treatments for Fibromyalgia
Research into drug intervention for fibromyalgia is still young, and there are not many fibro-specific medications approved by the U.S. Food and Drug Administration. The goal of these (and any) medications for fibromyalgia is to lower feelings of pain, either by reducing inflammation, relaxing muscles, or crating chemical changes in the brain. These are some of the meds your doctor will most likely prescribe to you:
OTC Pain Relievers
Advil and Motrin (ibuprofen), Aleve (naproxen sodium), and Tylenol (acetaminophen) are all first line of defense options for easing fibro pain. Doctors do not recommend prescription painkillers like opioids because they have not been found to be particularly effective with this disorder and are highly addictive.
This antidepressant is in a class of drugs called serotonin-noradrenaline re-uptake inhibitors (SNRIs). It works by increasing the activity of serotonin and norepinephrine in the brain, which helps halt pain signals. This med is primarily used for treating depression, generalized anxiety disorder, and sometimes stress urinary incontinence, as well as nerve pain from diabetes, osteoarthritis, chronic back pain, and fibromyalgia.
Of note: Just because your doctor prescribes you an antidepressant for this disorder doesn’t mean you’re depressed (though having fibro can make you three times more likely to have major depression than someone without it). Possible side effects include nausea, vomiting, and constipation.
This anti-epileptic drug is often used off-label to aid with fibro flares. It affects chemicals and nerves in the body that are associated with seizures as well as certain types of pain.
An anti-seizure medicine, this drug helps reduce sensory hypersensitivity by regulating calcium channels. It’s used to treat seizures, nerve pain in diabetes, postherpetic neuralgia (persistent pain from shingles), and neuropathic pain after a spinal cord injury and for fibromyalgia. Possible side effects include tiredness, dizziness, and headaches.
This antidepressant is also in the SNRIs class, but in contrast to duloxetine, this drug is not used to treat depression (just fibro). It also works to increase the amount of serotonin and norepinephrine in the brain. Possible side effects include nausea, vomiting, and constipation.
Other medications may be prescribed by your doctor to lessen symptoms. These are considered off-label, meaning they weren’t approved specifically for fibro treatment but have been found effective, including:
Alpha 2 agonist
Tricyclic antidepressants (amitriptyline, nortriptyline, and imipramine)
Lifestyle Pain-Relief Treatments for Fibromyalgia
The thing is, medication doesn’t work all the time for all people with fibro. In studies looking at the effectiveness of pain meds in fibromyalgia treatment, drugs reduced pain symptoms in about one in 10 people—meaning 90% did not get relief from medication alone. Side effects can be an issue with fibro meds, including sleep problems and nausea. Five to 12 out of 100 people stop taking their fibro meds due to side effects.
Fortunately, multiple non-drug forms of treatment have been shown to help improve symptoms in fibromyalgia, including traditional Eastern practices like yoga and meditation. They can often be combined with each other as part of complementary and alternative medicine therapy (known as CAM) or coupled with medication. These CAM options include:
Daily mild to moderate exercise is recommended for easing fibromyalgia stiffness and joint pain. This might include swimming, tai chi, aquatic aerobics, and yoga. A regular low impact aerobic exercise program for 30 minutes, five days a week, can be beneficial if you have fibro—just don’t go hard because research has shown that intense exercise can worsen symptoms. Try and pick an activity that’s fun for you, so you don’t dread it and skip it on those days you’re feeling super-stiff and sore.
Cognitive Behavioral Therapy (CBT)
This form of psychological treatment is helpful in treating a wide range of issues, including depression and anxiety. According to the American Psychological Association, CBT teaches you to reconsider your thought patterns, examining why you’re having problems, then use problem-solving to address difficult situations. It can be useful with conditions like fibro, where the uncertainty of what is causing your pain can lead to counterproductive thoughts about treating it. In fact, when 56 fibro patients were randomly assigned to either a six-week CBT program or a standard care program, patients in the CBT program had less pain and quality of life issues after six weeks than those in the control group.
In a randomized prospective trial of 91 women with fibromyalgia, clinicians found that using aspects of mindfulness-based stress reduction, including a body scan, seated meditation, and yoga for 45 minutes a day significantly reduced perceived stress, sleep disturbance, and symptom severity.
Getting adequate, good-quality sleep is important for everyone, but especially key if you have fibro. Aim for seven to nine hours of sleep every night, giving your body time to heal and restore your energy for the next day ahead. Try to keep a consistent sleep schedule as well, going to bed and waking up at roughly the same time, to avoid major swings in energy and fatigue.
You know the drill on this one—leafy green vegetables, fresh fruit, healthy fats like olive oil and avocado, lean protein, and all foods in moderation are the secret to healthy diet success.
Breathing exercises, guided imagery, and listening to your favorite music are all ways to help turn your brain off from the stresses of life and chronic illness, and turn it on to feelings of calm and relaxation. Make sure to schedule time—even just 10 minutes each day—so you can effectively reduce your stress.
In athletes with tight or injured muscles, heat is applied to help relax the affected area. Heat therapy, in the form of hot showers or soaking baths, may be beneficial to people with fibromyalgia as well and is currently being researched in clinical studies.
A review of studies looking at massage therapy as a treatment for fibromyalgia found that there is little downside to getting a massage: Five weeks of regular massage therapy improved pain, anxiety, and depression levels in this patient population.
Research is ongoing for acupuncture’s use for fibro, but a review of nine clinical trials indicates that electro-acupuncture may be more effective than manual acupuncture without electrical stimulation for pain, stiffness reduction, sleep, and fatigue. However, the benefits appear to last only one month, meaning fibro patients pursuing this method of treatment need regular acupuncture sessions.
Who Treats Fibromyalgia?
Knowing who to turn to for fibromyalgia treatment is not exactly straightforward. First, it can take a lot of trial and error before you find the right healthcare professional who gives you the correct diagnosis. The condition has only been considered an official disorder by the American Medical Association since 1987, and not all physicians are aware of the ins and outs of fibro.
In fact, a survey of 800 patients with fibromyalgia and 1,622 physicians found that from the first time a patient went to a doctor with fibro symptoms to when they finally received a diagnosis, 2.3 years had passed. And little wonder: 11% of the doctors surveyed reported that diagnosing fibro was “very difficult.” You might need to see more than one doctor to get the proper diagnosis: The survey found that fibro patients saw an average of 3.7 physicians before receiving a diagnosis.
Here are the doctors you might encounter along the way to receiving an accurate fibro diagnosis:
Primary care physician: Your family doctor is usually the first stop on any diagnosis and treatment journey, and with fibro, it’s no different. Your doc can continue on the road with you as you explore treatment options and, as long as you both are comfortable with it, your doc can treat your fibro over the long-term.
Rheumatologists: Even though fibromyalgia is not a form or arthritis or autoimmune disease, which these specialists predominately treat, people with fibro experience chronic pain and fatigue similar to arthritis, so these doctors have traditionally included fibro patients in their practice as well, according to the American College of Rheumatology. But keep in mind that not all rheumatologists specialize in fibro.
Pain management specialists: These doctors are trained in diagnosing and treating pain disorders. They can often be great in helping treat fibromyalgia long-term because understand the intricacies of managing chronic pain. Make sure to ask if they treat fibro, though.
Neurologists: With a neurological component to fibro that we’re just beginning to understand, neurologists can be helpful in the treatment side. Before boking an appointment, ask if the doctor has experience with treating fibromyalgia patients, and if not, keep looking.
Physiatrists/phycologists: These doctors on the mental health side can help with medications and therapies like CBT that can help lessen the mental load from the disorder.
Physical therapists: These “doctors of movement” can assist you in doing the right exercises to build strengthen and boost energy without worsening pain or other symptoms. Your PT will likely give you exercises you can do at home to keep you healthy.
Living With Fibromyalgia
Having a disease that you can’t see and can’t “prove,” is frustrating. There is no single test you can take to show you have fibromyalgia, and there is no cure, either. But while the elusiveness of this condition can make you feel like no one is taking you seriously, the science behind fibromyalgia is growing daily. In the near future, treatments may be able to target much more specifically the sources of your pain.
Meanwhile, in addition to specific classes of antidepressants and antiseizure meds, there are numerous lifestyle changes you can make that will have a real, positive impact on your illness. Consistent, quality sleep is crucial for fibro, as is a healthy diet low in inflammation-causing foods like sugar and saturated fat. If you can, treat yourself to a spa day, where you can explore massage therapy and sit in a steam room, to test whether either treatment can help with your pain.
And give mental techniques, like CBT and meditation, a try for a week or two. It might take a few sessions to get in a rhythm with it, but as with many things in life, good results come to those who persist.
- Number of Americans With Fibromyalgia: National Fibromyalgia & Chronic Pain Association. (2020). “What is Fibromyalgia?” fibroandpain.org/fibromyalgia/what-is-fibromyalgia
- Medications Overview: Arthritis Foundation. (n.d.). “Medications for Treating Fibromyalgia Symptoms.” arthritis.org/diseases/more-about/medications-for-treating-fibromyalgia-symptoms
- Duloxetine: MedlinePlus. (2020). “Duloxetine.” medlineplus.gov/druginfo/meds/a604030.html
- Milnacipran: MedlinePlus. (2018). “Milnacipran.” medlineplus.gov/druginfo/meds/a609016.html
- Pregabalin: MedlinePlus. (2020). “Pregabalin.” medlineplus.gov/druginfo/meds/a605045.html
- Medication Effectiveness: InformedHealth.org. (2018). “Medication for the Treatment of Fibromyalgia.” ncbi.nlm.nih.gov/books/NBK492992/
- Time to Diagnosis/Treatment, Number of Doctors to Diagnosis/Treatment: BMC Health Services Research. (2010). “A Patient Survey of the Impact of Fibromyalgia and the Journey to Diagnosis.” ncbi.nlm.nih.gov/pmc/articles/PMC2874550/
- CAM Overview for Fibro: InformedHealth.org. (2018). “Fibromyalgia: Complementary and Alternative Treatments.” ncbi.nlm.nih.gov/books/NBK492996/
- What Is CBT?: American Psychological Association. (2017). “What Is Cognitive Behavioral Therapy?” apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral#
- CBT and Fibro: The Ochsner Journal. (2014). “Fibromyalgia: Can Online Cognitive Behavioral Therapy Help?” ncbi.nlm.nih.gov/pmc/articles/PMC4171792/
- Meditation, Yoga: Annals of Behavioral Medicine. (2015). “Mindfulness Meditation Alleviates Fibromyalgia Symptoms in Women: Results of a Randomized Clinical Trial.” ncbi.nlm.nih.gov/pmc/articles/PMC4802162/
- Massage Therapy: PLoS One. (2014). “Massage Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.” ncbi.nlm.nih.gov/pmc/articles/PMC3930706/
- Acupuncture: Cochrane Database of Systematic Reviews. (2013). “Acupuncture for Treating Fibromyalgia.” pubmed.ncbi.nlm.nih.gov/23728665/
- Rheumatologists: American College of Rheumatology. (2019). “Fibromyalgia.” rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Fibromyalgia
- Pain Management Specialists: American Society of Regional Anesthesia and Pain Medicine. (2020). “The Specialty of Chronic Pain Management.” asra.com/page/44/the-specialty-of-chronic-pain-management