Fibromyalgia

Treatment

Despite the lack of a definitive cause, fibromyalgia symptoms can be significantly improved with a multifaceted approach. The goals are to lessen pain and improve sleep. Much of the success of treatment lies with the patient, and many people report improvement simply because a diagnosis has been made. It is reassuring for people to know that the disorder is not deforming or life threatening and that they are able to take control of their situation.

This section has more on:

• Exercise and physical therapy
• Improving sleep patterns
• Improving body mechanics
• Psychological counseling and medication

Exercise and physical therapy

Exercise. Getting up and moving are key to improving fibromyalgia. A lack of activity worsens symptoms because unconditioned muscles are more sensitive to pain. Although exercising may be the last thing people with fibromyalgia want to do when they feel achy and tired, studies have shown that symptoms improve after six to eight weeks of moderate aerobic exercise.

It is important not to overdo it, however. Start slowly, with perhaps five to 10 minutes of brisk walking a day. Gradually increase the exercise time to 30 to 40 minutes of aerobic activity at least three times a week. People whose pain is exacerbated by the jarring movements of weight-bearing exercise (such as walking or jogging) may try swimming or riding a stationary bicycle instead.

Physical therapy. In some cases, doctors may refer people with fibromyalgia to a physical therapist, either to design an exercise program or to treat particularly painful flares. Physical therapists employ several techniques. For example, in "spray and stretch," a physical therapist sprays the sore region with ethyl chloride to anesthetize it before stretching the patient's muscles.

Improving sleep patterns

Many doctors recommend that people with fibromyalgia try to establish a regular sleep schedule that involves the following measures: going to bed and getting up at the same time every day; getting at least eight hours of sleep; avoiding alcohol, caffeine, and smoking in the evening; and eliminating daytime naps. This approach may not work for everyone, however, and some people may require medication. Some people have had success with low doses of tricyclic antidepressants at bedtime; these drugs enhance the action of neurotransmitters involved in the regulation of deep sleep.

Improving body mechanics

Many day-to-day activities and hobbies (such as needlepoint, golf, and tennis) require repetitive movements. If they are not performed correctly, they can cause fatigue and increase pain. Several sessions with a physical therapist or professional sports instructor can make sure that these activities are being done properly.

Changes to improve symptoms also can be made at the workplace. When people with fibromyalgia were surveyed to determine which job-related activities aggravated their symptoms, prolonged tasks or repetitive ones that required working under adverse conditions--such as at night or in the cold--were the most troublesome. Working on an assembly line and typing are two common causes of problems.

To help prevent a symptom flare, people with fibromyalgia should not overdo any activity. Frequently changing the types of tasks performed is a good way to keep occupational activities from aggravating symptoms.

Psychological counseling and medication

Psychological counseling. Talking to a psychologist or a therapist may help to manage the emotional stress that can exacerbate symptoms and may even help reduce the severity of symptoms. The need for psychological counseling is not a sign of weakness or mental instability, and it does not mean that a patient's symptoms are all "in their head." Rather, counseling can be valuable in helping to manage a chronic illness.

Medication. Drug therapy for fibromyalgia can relieve pain and improve sleep. Since inflammation is not a part of this syndrome, corticosteroids or high doses of NSAIDs are not prescribed. However, judicious use of NSAIDs or acetaminophen may provide pain relief during flares.

Abnormal sleep patterns typically are treated with low doses of tricyclic antidepressants, such as amitriptyline (Elavil and Endep), or nortriptyline (Aventyl and Pamelor). Antidepressant drugs called selective serotonin reuptake inhibitors, such as fluoxetine (Prozac) and sertraline (Zoloft), are another option.

If people have severe pain in a specific area, injection of an anesthetic (usually procaine) can provide relief. Benefits are felt within two to five days and can last two to four months. However, injections can be given only every three months.

This section has more on the various medications used to treat fibromyalgia (PDF).