Unraveling the Mystery: Treating Fibromyalgia
Every year, Americans make 1.8 million doctor visits because of fibromyalgia, a chronic pain syndrome involving the brain's inability to accurately process pain signals from various body sites. There is no cure for this condition, and pain relief can be elusive. Because doctors are still trying to understand what causes fibromyalgia, relieving the symptoms is often difficult.
For most people, a combination of therapies and a team approach to treatment works best. You might start by visiting a clinic dedicated to treating pain or rheumatic diseases. Or, seek out a doctor who has experience treating fibromyalgia. He or she could be a family doctor, internist, or rheumatologist. Rheumatologists are specially trained to treat arthritis and other disorders affecting your joints and soft tissues.
Other members of your care team might include physical therapists, occupational therapists, and complementary or alternative medicine practitioners. Medications, cognitive behavioral therapy, and lifestyle changes are typically used together. The goal of treatment is to relieve your pain and help you resume your daily activities.
There are currently three approved for this purpose in the U.S. Two are antidepressants, duloxetine (Cymbalta®) and milnacipran (Savella™). The third is the anti-seizure drug pregabalin (Lyrica®). However, many other medications are regularly used to treat fibromyalgia, because clinical experience shows they may help in individual cases. These include other antidepressants, muscle relaxers, pain relievers, and anti-inflammatory medications.
Chronic pain and depression often go hand in hand. The brain chemicals serotonin and norepinephrine underlie both conditions. However, that doesn’t mean your pain is all in your head. The active ingredient in antidepressants help relieve pain even in people without depression.
Antidepressants may stop pain signals from traveling between your brain and nerves, relieve anxiety, and improve sleep. These medications may work faster, and at lower doses, for pain than they do for depression. However, they may have some side effects, including nausea and vomiting, sleep problems, sweating, headaches, and sexual dysfunction. Side effects are minimized by starting with low doses and gradually increasing until an effective dose is found.
The other medication approved to treat fibromyalgia, pregabalin, was originally developed to treat seizures in people with epilepsy. It works by blocking overactive nerve cells that may transmit too many pain signals. Side effects include dizziness, sleepiness, dry mouth, and swelling in your arms and lower legs.
Your doctor may also recommend over-the-counter or prescription pain medications, muscle relaxants, or other drugs that treat symptoms of fibromyalgia.
Cognitive Behavioral Therapy (CBT)
With this type of counseling, you learn strategies to manage your pain. These include tracking your symptoms, controlling negative thoughts, and setting limits for yourself. Your doctor will usually recommend CBT alongside medications and other treatments.
You are a critical member of your own treatment team. Steps you can take every day to reduce your symptoms include:
Moving with exercise. Physical activity may be difficult at first. But over time, it’s one of the most effective treatments for fibromyalgia. Start by becoming more active in your daily life, then progress to regular walking, swimming, or other gentle workouts. Gradually increase how long and how hard you exercise. Physical activity also helps control your weight. This may relieve some of your symptoms. Studies show that pain and disability related to fibromyalgia are more severe in people who are obese.
Getting enough sleep. Seven to eight hours of restorative slumber may ease pain and reduce fatigue. However, fibromyalgia symptoms can interfere with your rest. Try to stick to the same sleep schedule, even on weekends and vacations. Don’t drink caffeine or alcohol in the late afternoon or evening, and avoid exercise within three hours of bedtime. Talk with your doctor if sleep problems persist.
Making changes at work. Some people with fibromyalgia stop working altogether. Others find they can keep their job with some modifications. Options to explore might include cutting back on your hours, switching to a less physical role, or asking an occupational therapist to help adapt your work environment for comfort and efficiency.
Eating a healthy diet. Some people report fewer symptoms when eating or avoiding certain foods. No specific diet has been proven best for people with fibromyalgia. However, eating nutritious food—including fruits, vegetables, and whole grains—is always a good idea. A healthy diet can boost your energy, protect against nutritional deficiencies that may worsen symptoms, and help you control your weight.
Complementary and Alternative Therapies
An estimated 90 percent of people with fibromyalgia try therapies that are outside mainstream medicine. Most of these treatments aren’t supported by scientific research. However, some people have found pain relief by using:
Acupuncture, an ancient treatment in which thin metal needles are inserted in the body at special pressure points
Magnesium supplements, as some scientists believe low levels of this mineral contribute to fibromyalgia
Massage therapy; some studies suggest it helps, although others are inconclusive
SAMe, an amino acid derivative taken as a supplement
Tai chi and yoga, which combine slow movements, meditation, and deep breathing
It’s important to check with your doctor before trying a complementary or alternative therapy. These treatments can have side effects or interact with other medications you’re taking.