How Fibromyalgia Is Treated

Traditional and Complementary Approaches to Treatment

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There is no cure for fibromyalgia. And because no two cases of the disorder are alike, there is also no single treatment able to ease the symptoms of the disorder. Instead, treatment must be multi-faceted and tailored to the types and severity of symptoms you are experiencing. This may involve over-the-counter (OTC) and prescriptions drugs, physical and supportive therapies, stress reduction, lifestyle changes, and complementary treatments aimed at reducing your pain and restoring your quality of life.

Medications

As the defining feature of fibromyalgia, pain is the primary focus of treatment. To this end, doctors turn to variety of OTC and prescription drugs, some of which are approved for the treatment of fibromyalgia and others which are used off-label.

The aim of therapy is to treat the often diverse range of symptoms with as a few drugs as possible to achieve the greatest clinical effect. These may include analgesics, antidepressants, anticonvulsants, muscle relaxants, and other types of oral medication.

Analgesics

For the treatment of mild fibromyalgia pain, Tylenol (acetaminophen) may provide ample relief of acute symptoms with few, if any, side effects. While nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) and Aleve (naproxen) also offer analgesic (pain-relieving) effects, it is important to remember that fibromyalgia is not an inflammatory disease and that regular use of most NSAIDs may increase your risk of gastric bleeding, stomach ulcers, liver impairment, and cardiovascular disease.

Prescription NSAIDs like Celebrex (celecoxib) or Voltaren (diclofenac) also carry the same risks as their OTC counterparts but may be appropriate for short-term relief if kept at the lowest possible effective dose.

Antidepressants

Antidepressants are often used in therapy as they are able to treat multiple symptoms, alleviating pain, fatigue, and depression, while aiding sleep and elevating mood.

There are two antidepressants approved by the U.S. Food and Drug Administration (FDA), both of which are serotonin and norepinephrine reuptake inhibitors (SNRIs). They work by preventing serotonin and norepinephrine from being reabsorbed by cells and, by doing so, ensure greater concentration of these "feel-good" hormones in the body.

  • Cymbalta (duloxetine): Initial dose of 30 mg per day, increasing to a target dose of 60 milligrams per day
  • Savella (milnacipran): Initial dose of 12.5 milligrams taken once daily, increasing to 50 milligrams taken twice daily (A total maximum daily dose of 200 milligrams may be used in severe cases.)

Side effects may include nausea, dry mouth, constipation, decreased appetite, drowsiness, increased sweating, and agitation.

Other antidepressants are commonly prescribed off-label to treat fibromyalgia, including SNRIs like Celexa (citalopram), Lexapro (escitalopram), Paxil (paroxetine), and Zoloft (sertraline).

While older-generation tricyclic antidepressants are less commonly used, lower-dose Elavil (amitriptyline) has proven effective as a sleep aid while helping to ease chronic pain and depression. (Sleeping pills are generally avoided for anything but short-term relief as prolonged use can lead to dependence.)

Anticonvulsants

While scientists are not quite sure how they work, anticonvulsant drugs commonly used to treat seizures and epilepsy have proven effective in treating fibromyalgia. It is believed that they help reduce the number of nerve signals and, by doing so, calm overly sensitive nerve cells.

Lyrica (pregabalin) is the first anticonvulsant approved by the FDA for the treatment of fibromyalgia. If prescribed, treatment begins with smaller doses before reaching a maximum daily dose of 300 milligrams for the regular capsule (taken three times daily in 100-milligram doses) or 330 milligrams for the extended-release tablet (taken once daily). Common side effects include dizziness, drowsiness, and weight gain.

Other anticonvulsants, such as Neurontin (gabapentin), offer a similar mechanism of action and may work just as effectively. Vimpat (lacosamide) and Keppra (levetiracetam) have also been used.

Muscle Relaxants

Muscle relaxants also seem to help in certain cases, and scientists are not exactly sure why. Because the drugs can cause drowsiness, they are typically taken at night just before bedtime.

As unrefreshing sleep is a common symptom of fibromyalgia, it has been suggested that the restoration of normal sleep patterns may reduce a person's sensitivity to pain. (By contrast, sleep deprivation is known to trigger often profound pain symptoms.)

The two muscle relaxants commonly used to treat fibromyalgia are Flexeril (cyclobenzaprine) and Zanaflex (tizanidine). Side effects may include dry mouth, dizziness, nausea, and blurred vision.

Other Medications

Opioid drugs like Vicodin (hydrocodone) and OxyContin (oxycodone) have long been used to treat fibromyalgia, although this is no longer recommended due to lack of data supporting efficacy, the high risk of addiction, and the availability of newer generation fibromyalgia drugs. The only exception may be the use of low-dose Ultram (tramadol) for the short-term use of acute fibromyalgia flares. Even then, the drug is reserved for severe cases only when other painkillers have failed to provide relief.

Irritable bowel syndrome (IBS) is common in people with fibromyalgia and is believed to share similar disease pathways. Depending on your symptoms, you may be prescribed laxative, antidiarrheals such as Imodium (loperamide) or Lomotil (diphenoxylate), or antispasmodics like Norpramin (desipramine).

Drugs in the Pipeline

A number of pharmaceutical companies are seeking FDA approval of new fibromyalgia drugs, some of which are showing more promise than others.

Among them is an investigational drug known as IMC-1, which combines the antiviral drug famciclovir with the anti-inflammatory drug Celebrex (celecoxib). A phase 2 placebo-controlled trial revealed that IMC-1 cut pain levels by half in just over a third of the 149 participants (a result slightly better than Cymbalta).

Effirma (flupirtine) is a non-opioid long used in Europe to treat fibromyalgia but one that was downgraded in 2013 due to the high risk of liver toxicity. As such, it can no longer be used for more than two weeks. While submitted for approval to the FDA in 2008, the drug has yet to receive approval in the United States.

Xyrem (sodium oxybate), long used off-label to treat fibromyalgia, was rejected by the FDA in 2010 due to concerns about misuse. Also known as JZP-6, the narcolepsy medication contains a form of gamma-hydroxybutyrate (GHB), a chemical commonly referred to as the "date-rape drug."

Therapies

In addition to medications, your doctor may refer you to specialists to help overcome any physical or emotional challenges you may be facing. While we tend to think of fibromyalgia as a disease of the nerves, it is actually a multi-dimensional disorder in which depression, anxiety, and ill health all play a part.

To this end, you may benefit from seeing the following specialists:

  • Psychologists can provide counseling and employ cognitive behavioral therapy (CBT) to boost happiness by modifying dysfunctional emotions, behaviors, or thoughts.
  • Psychiatrists can help if you are suffering from depression, panic attacks, and anxiety disorders like post-traumatic stress disorder (PSTD) commonly seen in people with fibromyalgia. Close coordination with your treating doctor is needed to ensure there is no overlap or contradiction of pharmaceutical treatments.
  • Physical therapists can improve your strength and physical well-being by teaching you ways to stretch and exercise in a way that doesn't exacerbate your symptoms. They can also offer therapeutic treatments to ease pain and improve posture for more effective muscle function.
  • Occupational therapists can provide you the tools and strategies to adapt to the challenges of living with fibromyalgia. They may include energy conservation, pain management, relaxation techniques, problem solving, sleep hygiene, and goal setting.

Lifestyle

As much as we rely on medications to treat fibromyalgia, they can never be the sole facet of treatment. In addition to taking prescribed medications, you need to make healthy lifestyle choices to ensure the sustained relief of your symptoms.

Exercise is central to this. While your instinct may tell you not to move for fear to triggering pain, it will only make things worse when you have to move (which, of course, is inevitable). By working within your limits and gradually building your strength and flexibility, you will progressively decrease your sensitivity to pain. Working on an exercise plan with your physical therapist is a great way to get started.

As an added bonus, exercise stimulates the production of endorphins, hormones that not only have an analgesic effect but can elevate your mood.

Diet and weight loss are equally important. Carrying excess weight not only adds to the structural burden on your muscles and joints, it reduces the efficiency of your cardiovascular system and leaves you all the more tired and fatigued.

While there is no specific fibromyalgia "diet," most doctors will endorse a well-balanced diet plan comprised of:

  • Fruits, vegetables, and whole grains
  • Low-fat dairy and lean protein
  • Healthy fats, such as olive oil
  • Avoidance of caffeine, a central nervous system stimulant
  • Avoidance of processed foods, fried foods, and refined sugar

Alcohol, a depressant, should also be pared back and may even need to be avoided when taking Cymbalta, Savella, and Tylenol due to the increased risk of liver damage.

You should also consider quitting cigarettes as numerous studies have linked smoking to increased pain intensity and poorer sleep in people with fibromyalgia.

Complementary Medicine (CAM)

People faced with chronic diseases will often turn to complementary and alternative medicine (CAM) as a means to take charge of their physical, psychological, and spiritual health. This is especially true for a condition like fibromyalgia in which the cause is not fully understood.

If pursuing an alternative means of treatment, be sure to tell your doctor about it to ensure that it neither interferes with your treatment (as herbal remedies like St. John's Wort can sometimes do) nor causes you any harm. The fact that something is "natural" doesn't mean that is inherently safe.

Mind-Body Therapies

Mind-body therapies are a group of practices often used by people with chronic illness to reduce the physiological effects of stress while enhancing physical and emotional well-being. With a disorder like fibromyalgia, any practice that can tamp down the body's hardwired response to stress without drugs should be considered beneficial.

Among some of the more helpful mind-body practices:

  • Mindfulness meditation is a form of meditation in which you learn not to react negatively to thoughts that might otherwise cause stress.
  • Guided imagery is a technique in which you create mental images to induce calm.
  • Deep breathing exercises (pranayama) employ rhythmic breathing techniques to induce a state of meditation.
  • Yoga and Tai Chi incorporate mindfulness with movement to gain greater acuity over the control your body.
  • Massage therapies, such as myofascial release, aim to gently release muscle tension and stress without pain.
  • Progressive muscle relaxation (PMR) is a technique in which you systematically tense and relax muscles throughout your body to induce calm.
  • Biofeedback employs an electronic monitor to help you observe and control the stress response.

Complementary Medications

Natural medicines, including herbs, extracts, vitamins, and traditional Chinese medicine (TCM) options, are embraced by some as complementary forms of therapy. Among those that may offer benefits to people with fibromyalgia:

  • Capcaisin, the active component in chili peppers, is available in creams, sprays, and patches. Used to treat different forms of neuralgia (nerve pain), it is considered safe but may cause localized redness, itching, or burning. A 2013 study from Italy reported that the use of a 0.075 percent topical capsaicin cream applied three times daily for six weeks reduced pain scores by 30 percent.
  • 5-HTP (5-hydroxytryptophan), a refined amino acid derived from the African Griffonia simplicifolia plant, may help raise serotonin levels. While the supplement is also considered safe, there is little data available as to its effectiveness in treating fibromyalgia.
  • Medical marijuana is well known for its ability to reduce pain, elevate mood, and improve sleep. A small study from Israel conducted in 2018 reported that use of medical cannabis in 60 adults with severe fibromyalgia resulted in the improvement of pain scores in all participants. After one year, 13 were able to stop their fibromyalgia drugs, while eight reported only mild side effects.
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