Fibromyalgia (cont.)
What is the treatment for fibromyalgia?
Since the symptoms of fibromyalgia are diverse and vary among
patients,
treatment programs must be individualized for each patient. Treatment
programs are most
effective when they combine patient education, stress
reduction, regular
exercise, and medications. Recent studies have verified that
the best outcome for each patient results from a combination of
approaches that involves the patient in customization of the
treatment plan.
Patient education
Patient education is an important
first step in helping patients understand and cope with the diverse symptoms.
Unfortunately, not all physicians are intimately acquainted with the vagaries of
this illness. Therefore, community hospital support groups and the local
chapters of the Arthritis Foundation have become important educational
resources for patients and their doctors. Arthritis Foundation is a national
voluntary health organization that provides community education through
their many local chapters. Community hospital support groups also provide
an arena for patients to share their experiences and treatment successes
and failures.
Stress reduction
It is extremely difficult to measure stress levels in different
patients. For some people, spilling milk on the table can
represent a significant tragedy. For others, a tank rolling into the living
room might represent "just another day!" Therefore, stress
reduction in the treatment of fibromyalgia must be individualized. Stress
reduction might include simple stress modification at home or work, biofeedback,
relaxation tapes, psychological counseling, and/or support
among family members, friends, and doctors. Sometimes, changes in
environmental factors (such as noise, temperature, and weather exposure) can
exacerbate the symptoms of fibromyalgia, and these factors need to be modified. Optimal sleep is encouraged.
Exercise
Low-impact aerobic exercises, such
as swimming, cycling, walking and stationary cross-country ski machines can be
effective treatments for fibromyalgia. Exercise regimens are most beneficial when
performed on an every-other-day basis, in the morning. How exercise benefits
fibromyalgia is unknown. Exercise may exert its beneficial effect by
promoting a deep level of sleep (non-REM sleep). Similarly, avoiding alcohol and
caffeine before bedtime can also help promote a more restful sleep. While these diet changes may not apply to everyone, they can be very helpful for some. There is no specific fibromyalgia diet or food supplements that are recommended for all patients.
Medications
Traditionally, the most effective medications in the treatment of
fibromyalgia have been the tricyclic antidepressants, medications traditionally used in
treating depression. In treating fibromyalgia, tricyclic antidepressants
are taken at bedtime in doses that are a fraction of those used for
treating depression. Tricyclic antidepressants appear to reduce fatigue,
relieve muscle pain and spasm, and promote deep, restorative sleep in
patients with fibromyalgia. Scientists believe that tricyclics work by
interfering with a nerve transmitter chemical in the brain called
serotonin. Examples of tricyclic antidepressants commonly used in treating
fibromyalgia include amitriptyline (Elavil)
and doxepin (Sinequan).
Studies have shown that adding fluoxetine (Prozac), or
related medications, to low-dose amitriptyline further reduces muscle
pain, anxiety, and depression in patients with fibromyalgia. The combination is
also more effective in promoting restful sleep and improving an overall sense
of well-being. These two medications also tend to cancel out certain side
effects each can have. Tricyclic medications can cause tiredness and fatigue,
while Prozac can make patients more cheerful and awake. Even more recently,
study of patients with resistant fibromyalgia found that lorazepam
(Ativan) was helpful in relieving symptoms. Prozac has also been shown to be effective when used alone for some patients with fibromyalgia.
In 2007, pregabalin (Lyrica) became the first medication approved specifically for treating fibromyalgia. Lyrica may be work by blocking nerve pain in patients with fibromyalgia. Lyrica has advantages of flexible dosing that can be adjusted according to persisting symptoms.
More recently, drugs that simultaneously increase the amount of two brain nerve transmitters, serotonin and norepinephrine, have been approved to treat fibromyalgia in adults. These drugs include duloxetine (Cymbalta) and milnacipran (Savella). Research studies have shown significant effectiveness in decreasing pain and improving function in patients with fibromyalgia with these drugs. Cymbalta has been effective in treating depression and relieving pain in people with depression and is also used to treat anxiety.
Other treatments
Local injections of analgesics and/or cortisone medication
into the trigger-point areas can also be helpful in relieving painful
soft tissues, while breaking cycles of pain and muscle spasm. Some studies indicate that the pain reliever tramadol (Ultram) and tramadol/acetaminophen (Ultracet) may be helpful for the treatment of fibromyalgia pains. The muscle relaxant cyclobenzaprine
(Flexeril) has been helpful for reducing pain symptoms and improving sleep.
The nonsteroidal antiinflammatory
drugs (NSAIDs), while very
helpful in treating other rheumatic conditions, have only a limited value in
treating fibromyalgia pain. Narcotic pain relievers and cortisone medications
have not been shown to be beneficial in this condition. Narcotics
and cortisone medications are avoided because they have not been shown
to be beneficial and they have potential adverse side effects,
including dependency, when used long term.
Both biofeedback and electroacupuncture have been used for
relief of symptoms with some success. Standard acupuncture has also been reported to be effective in treating some patients with fibromyalgia.
Next: What is in the future for fibromyalgia therapy? »
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