Fibromyalgia

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Treatment

The goal of treatment is to reduce pain, improve sleep, and relieve associated symptoms. Treatment is tailored to the individual. Some patients experience significant relief of symptoms, some find moderate improvement, and others report little or no relief. Only about 5% of fibromyalgia patients become symptom free. Most treatment regimens include medication, lifestyle changes, exercise, physical therapy, and behavior modification.

Medication

Antidepressant agents known as tricyclics relieve sleep disorders, reduce muscle pain, and treat depression. The tricyclic drug most commonly prescribed for fibromyalgia is amitriptyline (Elavil®).

Another class of antidepressants used in fibromyalgia is selective serotonin-reuptake inhibitors (SSRIs). They boost the level of the neurotransmitter serotonin in the brain, which modulates mood, but do not improve physical symptoms. Fluoxetine (Prozac®) is a commonly prescribed SSRI.

Taking two types of antidepressant may be more effective. A low dose of Prozac combined with Elavil is more effective than either medication used alone.

Antidepressants are first taken at the lowest possible dosage and then gradually increased, if necessary. Their overall benefit appears to be limited, as far as relieving pain, fatigue, and sleeplessness. Many patients are unable to tolerate the side effects of these drugs, even at low doses, and stop taking them. Side effects include nausea, loss of appetite, and insomnia.

Small doses of aspirin or acetaminophen may provide some pain relief and relieve muscle stiffness. Nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen), narcotics, and corticosteroids (e.g., prednisone) have not proven to be effective. Due to potenially severe gastrointestinal and cardiovascular side effects, NSAIDs should only be used as instructed.

In June 2007, the FDA approved pregabalin (Lyrica®) to treat fibromyalgia. This drug reduces pain and improves function in some patients. Side effects include dizziness, excessive sleepiness (somnolence), blurred vision, and weight gain.

Trigger point injections involve injecting a local anesthetic, such as lidocaine, and/or a corticosteroid into a tender point and then stretching the involved muscle. Local anesthetic increases blood flow to the muscle and corticosteroids reduce inflammation. The injections can be painful, and it may take 2 to 4 days for improvement.

Lifestyle Changes

Lifestyle changes that can help alleviate symptoms include avoiding caffeine (it can aggravate sleep disorders), sticking to an exercise program, avoiding nonessential activities, performing tasks more efficiently, establishing regular sleep routines, and eating a healthy diet. Learning relaxation techniques (e.g., meditation, biofeedback) may help control symptoms.

Exercise

Routine low-impact aerobics and strength may help reduce pain, tender-point counts, depression, and sleep disturbance. During aerobic exercise, endorphins, hormone-like substances, are released. Endorphins help relieve pain and produce a feeling of well-being. Walking, swimming, and riding a stationary bicycle provide excellent low-impact aerobic exercise.

The patient should choose an exercise program they enjoy and stick with it because exercise must be routine to be beneficial.

Physical Therapy

Depending on symptoms, heat, ice, massage, whirlpool, ultrasound, and electrical stimulation may be used to reduce pain. Physical therapists can also design an exercise program to improve flexibility, fitness, and posture.

Behavior Modification

Behavior modification involves learning coping skills, relaxation exercises, and self-hypnosis. Pain perception involves both physical and psychological components. Counseling or another type of therapy may help patients learn better methods of coping with their illness, enhance self-esteem, and reduce stress.

Behavioral cognitive therapy effectively strengthens a person's belief in their own abilities and enables them to develop tools for dealing with stress. A specific goal of cognitive therapy is to change the idea that patients are helpless against their pain.

Emotional Support and Education

Patients who take an active role in their care can often improve their quality of life. Emotional support is very important when dealing with a chronic condition such as fibromyalgia. Some patients find support among family and friends, and others find support groups or group therapy to be helpful.

Fibromyalgia, Treatment reprinted with permission from neurologychannel.com
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