While there is no cure for fibromyalgia, the key to finding relief from the pain, fatigue and other symptoms is usually a combination of medications and natural therapies. The best doctor to treat fibromyalgia is a rheumatologist, a physician who specializes in the treatment of arthritis and related conditions. It may take some trial and error to find an effective combination of treatments. Here are some options worth trying:
Currently, there are three FDA-approved drugs for use as fibromyalgia treatments – pregabalin, duloxetine and milnacipran.
Pregabalin was originally developed as an anti-seizure medication, but has since shown benefits in relieving anxiety, some sleep problems and pain in people with fibromyalgia. Another anti-seizure medication, gabapentin is sometimes used off-label as a fibromyalgia treatment. Off-label means it is used by doctors because of demonstrated benefits is but not FDA-approved for a condition).
Duloxetine and milnacipran are anti-depressants, which raise concentrations of neurotransmitters known to inhibit feelings of pain.
Other anti-depressants found to be useful in the treatment for fibromyalgia and are used off-label include:
- Tricyclics, such as amitriptyline that relieves pain and improves sleep
- Cyclobenzaprine, which works similarly to amitriptyline
- Selective serotonin reuptake inhibitors, or SSRIs, such as fluoxetine, paroxetine and sertraline, that relieve pain and improve mood
These drugs work to treat fibromyalgia in patients with and without depression, so don’t think your doctor feels that you’re depressed just because they prescribe one of these drugs.
Other drugs that have been shown to be effective in fibromyalgia include venlafaxine, tizanidine and tramadol, cannabinoids (medications derived from the components of marijuana), gamma-hydroxybutyrate (GHB) and low-dose naltrexone.
Modest doses of nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen or ibuprofen, may provide some pain relief. Most doctors don’t prescribe opioid pain relievers or tranquilizers except for the most severe cases of fibromyalgia, because these drugs aren’t as effective for fibromyalgia pain as other types of pain. Also, taking them long term can affect the organs.
Physical activity has been shown to be a valuable fibromyalgia treatment, but activities must be chosen carefully and started at a low level. In some cases people with fibromyalgia are given the drug pyridostigmine prior to exercise to help reduce pain.
Biofeedback teaches people how to change physiological functions, such as slowing a racing heartbeat or relax clenched or tight muscles. People who clench their jaw muscles may have temporomandibular joint (TMJ) pain, which is common in those with fibromyalgia.
A few studies have shown statistically significant improvement of pain with acupuncture, but others have not. If you are curious about acupuncture, try three treatments. If you think you have benefited from the sessions, continue up to six or eight treatments. By then, you can decide whether acupuncture is cost-effective helpful enough for you to continue further.