Fibromyalgia (FMS)
Treatment options
Because the central cause of fibromyalgia is unknown, there is no one treatment that will make your symptoms go away. Therefore it is important to work closely with your doctor and other health professionals to develop a complete body and mind treatment plan that will help you feel better.
Recently the first medication was approved by the Food and Drug Administration (FDA) specifically for treating the symptoms of fibromyalgia. Pregabalin (Lyrica) has been shown to reduce pain and improve sleep. Learn more about pregabalin.
Other options for your treatment plan include:
- Education: Understanding the nature of the condition and learning ways to manage your symptoms are the basis of any treatment program.
- Medications: Some can diminish pain and others can improve sleep.
- Analgesics: Different types of painkillers are available for people with fibromyalgia. Acetaminophen (Tylenol) is available over the counter and is quite safe; tramadol (Ultram) is a stronger analgesic than acetaminophen rarely as addictive as narcotics. Narcotic analgesics rarely would be prescribed for fibromyalgia pain.
- NSAIDs: Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen (Advil, Motrin) and naproxen sodium (Aleve), often are used for their pain-relieving effects rather than their anti-inflammatory effects. They may help ease the muscle aches, menstrual cramps and headaches often associated with fibromyalgia.
- Tricyclic antidepressants: This class of antidepressants, including amitriptyline (Elavil), nortriptyline (Pamelor) and the newly approved duloxetine (Cymbalta), work by raising the levels of norepinephrine (formerly called adrenaline) in the brain. Given in doses lower than what is required for antidepressant effects, these drugs can improve the quality of your sleep. They also can relax painful muscles and heighten the effects of endorphin – the body’s natural painkiller.
- SSRIs: The selective serotonin reuptake inhibitors are antidepressants, such as fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), that increase the amount of serotonin in your brain, reducing fatigue and possibly pain in people with fibromyalgia. SSRIs will often be prescribed in combination with a tricyclic antidepressant because SSRIs alone may interfere with sleep.
- Mixed reuptake inhibitors: Some newer antidepressants raise levels of both serotonin and norepinephrine and are being studied for their use in treating fibromyalgia. These drugs include venlafaxine (Effexor) and nefazadone (Serzone).
- Muscle relaxants: The muscle relaxant cyclobenzaprine (Cycloflex, Flexeril) has proved useful for the treatment of fibromyalgia and is often prescribed to help ease muscle tension and improve sleep.
- Other medications: Benzodiazepines (clonazepam [Klonopin] and diazepam [Valium]) may help relax painful muscles, improve sleep and relieve symptoms of restless legs syndrome (unpleasant sensations in the legs that force you to move them constantly), but they are addictive. Tegaserod (Zelnorm) and alosetron (Lotronex) are now available for the treatment of irritable bowel syndrome (alternating constipation and diarrhea with bloating). Gabapentin (Neurontin) is an anticonvulsant medication that is being studied for use in people with fibromyalgia.
- Exercise: Studies have shown that exercising is essential for easing the symptoms of fibromyalgia. Because of the pain, fatigue and weakness felt by people with fibromyalgia, most have become physically unfit. Aerobic exercise, however, has analgesic and antidepressant effects, and it enhances your sense of well-being and control. If you start in an exercise program slowly and build gradually, you will reap the benefits of exercise without becoming more fatigued and having more pain.
- Stretching: Giving your tight painful muscles a good stretch once a day or in short bouts several times a day will provide pain relief. Warming the muscles with gentle movements or with warm water before stretching will make the stretch more comfortable.
- Coping skills: There are many techniques you can learn to help ease tension, anxiety and pain, including relaxation, visualization, meditation and biofeedback, as well as minimizing negative self talk, hopelessness and victimization.
- Complementary therapies: Some people with fibromyalgia have gotten relief from such therapies as massage, movement therapies (such as Pilates), chiropractic manipulations and acupuncture, among others.
Your doctor can tailor your treatment plan to meet your individual needs. Some people with fibromyalgia have mild symptoms and need very little treatment once they understand what fibromyalgia is and how to avoid what worsens their condition. Other people, however, require a comprehensive care program, involving medication, exercise and training to help them cope with pain.
