Fibromyalgia: Creating a Treatment Plan

Fibromyalgia is a complicated condition. It has no specific causes and no known cure. Yet for those who have it -- as many as one in 50 Americans -- the chronic pain, fatigue, and psychological strain of fibromyalgia are all too clear.

Fibromyalgia symptoms are treatable, however. Many experts believe the best treatment is a multifaceted approach that combines medication with lifestyle changes and alternative treatments.

You may need to work with your doctor, a physical therapist, and possibly others to tailor a treatment plan to your needs. Here’s how to get started.

Fibromyalgia Treatment: Start With a Diagnosis

Fibromyalgia is a syndrome-- a collection of symptoms, rather than a specific disease. Some of the most recognizable fibromyalgia symptoms are:

Doctors often diagnose fibromyalgia by considering criteria such as how long you’ve had pain and how widespread it is, and by ruling out other causes. This can be tricky, however, because symptoms associated with fibromyalgia can be caused by other conditions. So it’s best to see a doctor who is familiar with fibromyalgia.

There is a blood test that can help diagnose fibromyalgia. The test identifies markers produced by immune system blood cells in people with fibromyalgia. 

Learn About Fibromyalgia Medications

Once you’ve been diagnosed with fibromyalgia, your doctor will talk to you about treatment options. Several types of medicines are used to help manage fibromyalgia symptoms such as pain and fatigue.

Three medications are FDA-approved to treat fibromyalgia:

  • Cymbalta (duloxetine): Cymbalta is atype of antidepressant called a serotonin and norepinephrine reuptake inhibitor (SNRI). Researchers aren't sure how Cymbalta works in fibromyalgia, but they think that increasing levels of serotonin and norepinephrine help control and reduce feelings of pain.
  • Lyrica (pregabalin): Lyrica is a nerve pain and epilepsy drug. In people with fibromyalgia, it may help calm down overly sensitive nerve cells that send pain signals throughout the body. It has been effective in treating fibro pain.
  • Savella (milnacipran): Savella is also an SNRI. While researchers aren't exactly sure how it works, studies have shown that it helps relieve pain and reduce fatigue in people with fibromyalgia.

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Antidepressants are also sometimes prescribed to help people manage fibromyalgia symptoms:

  • Tricyclic antidepressants. By helping increase levels of the brain chemicals serotonin and norepinephrine, these medications may help relax painful muscles and enhance the body's natural painkillers.
  • Selective serotonin reuptake inhibitors (SSRIs). Your doctor may prescribe one of these types of antidepressants by itself or in combination with a tricyclic antidepressant. SSRIs prevent serotonin from being reabsorbed in the brain. This may help ease pain and fatigue.

These medications are also sometimes prescribed for fibromyalgia:

  • Local anesthetics that are injected into especially tender areas can provide temporary relief, usually for no longer than three months.
  • Anticonvulsants or seizure medications such as Neurontin are effective for reducing pain and anxiety. It is unclear how these medications work to relieve the symptoms in fibromyalgia.
  • Muscle relaxants are occasionally prescribed to help alleviate pain associated with muscle strain in those with fibromyalgia.

 

Your Fibromyalgia Treatment Plan: Stay Active

Exercise is an important part of managing fibromyalgia symptoms. Staying physically active can relieve pain, stress, and anxiety.

The key is to start slowly. Begin with stretching and low-impact activities, such as walking, swimming or other water exercises, or bicycling. Low-impact aerobic exercises such as yoga, tai chi, or Pilates can also be helpful. If you want to increase the intensity of your exercise, talk with your doctor.

Whatever exercise you choose, focus on three areas: range of motion, aerobic, and strength training.

Physical Therapy for Fibromyalgia

Physical therapy can help you get control of your illness by focusing on what you can do to improve your situation rather than on your chronic symptoms.

A physical therapist can show you how to get temporary relief from fibromyalgia pain and stiffness, get stronger, and improve your range of motion. And she can help you make little changes, such as practicing good posture, that help prevent painful flare-ups.

Alternative Treatments for Fibromyalgia

A number of popular fibromyalgia treatments fall outside the realm of mainstream medicine. In general, there hasn’t been extensive research on complementary and alternative medicine (CAM), but anecdotal evidence suggests that some may work. Always talk with your doctor before starting any alternative treatment.

Popular alternative treatments include:

  • Acupuncture. This ancient healing practice aims to increase blood flow and production of natural painkillers with thin needles inserted into the skin at strategic points on the body. Some studies report that acupuncture may help ease pain, anxiety, and fatigue.
  • Massage therapy. This may help reduce muscle tension, ease pain in both muscles and soft tissue,improve range of motion, and boost production of natural painkillers.
  • Chiropractic treatment. Based on spinal adjustments to reduce pain, this popular therapy may help relieve fibromyalgia symptoms.
  • Supplements. A number of dietary and other supplements are touted as treatments aimed at relieving fibromyalgia symptoms. Some of the most popular for fibromyalgia include magnesium, melatonin, 5-HTP, and SAMe, which may affect serotonin levels. However, results of studies on these supplements are mixed. Be sure to talk with your doctor before taking any supplements. Some may have side effects and could react badly with medication you are taking.
  • Herbs. As with supplements, scientific evidence for the effectiveness of herbs is mixed. A few studies have shown that St. John’s wort can be as effective as certain prescription medication for treating mild depression.
WebMD Medical Reference Reviewed by Carol DerSarkissian on April 02, 2017

Sources

SOURCES:

Mease, P. The Pain Practitioner, Spring 2008; vol 18: pp 26-35.

National Center for Complementary and Alternative Medicine: “Fibromyalgia and CAM: At a Glance.”

National Institute of Arthritis and Musculoskeletal and Skin Diseases: “Questions and Answers about Fibromyalgia.”

WebMD Medical Reference: “What is Fibromyalgia?;” “Fibromyalgia Medications;” “Fibromyalgia and Exercise;" “Fibromyalgia Treatments;” “Fibromyalgia and Alternative Treatments;” and “Herbs and Supplements for Fibromyalgia.”

National Fibromyalgia Association.  

WebMD Health News: "A Blood Test for Fibromyalgia?"

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