Treatment and Prevention of Fibromyalgia
Thursday, November 13th, 2008There is no known cure or preventive method for fibromyalgia, but symptoms can be treated. Treatment usually concentrates on reducing symptoms and improving function. No one treatment method can control all symptoms. In fact, most options control only one or two. This makes finding the right combination important.
Other conditions, including many that are symptoms of or occur simultaneously with fibromyalgia (e.g., migraines, depression, anxiety, irritable bowel syndrome) should be treated, as they may aggravate fibromyalgia symptoms when uncontrolled.
Finding the right physician is crucial in treating fibromyalgia. An empathetic physician who understands the diagnosis and treatment of fibromyalgia and is willing to listen to and work with the patient is important. A family physician may send a fibromyalgia patient to a rheumatologist. Patients’ self-education is a key to better results. Individuals are encouraged to keep communication with their physicians open. It may help to make a list of everything that needs to be discussed and bring it along to appointments. All treatment options, including those individuals can do on their own, should be discussed with a physician.
In 2007 the U.S. Food and Drug Administration gave its first approval of a medication specifically to treat fibromyalgia: an anticonvulsant called pregabalin (Lyrica). This drug is also used to relieve diabetic nerve pain, post-shingles pain and some types of seizures.
Other medications may also reduce symptoms of fibromyalgia. These include:
* Antidepressants. Used in lower doses when treating fibromyalgia than when treating depression, unless the patient is also suffering with depression. Even at low doses, side effects are common, including dry mouth, weight gain, constipation and lack of concentration. Tricyclic antidepressants (TCAs) relax muscles and heighten the effects of endorphins and may be taken at bedtime to help promote restorative sleep. Selective serotonin reuptake inhibitors (SSRIs) promote the release of serotonin and may reduce fatigue.
* Analgesics (painkillers). Over-the-counter and prescription drugs can be used to help with the pain associated with fibromyalgia. Stronger narcotic (opioid) preparations are sometimes prescribed in severe cases. These drugs have the potential for tolerance and dependence.
* Nonsteroidal anti-inflammatory drugs (NSAIDs). Usually used to treat inflammation, NSAIDs also help to relieve pain caused by inflammation and may help ease muscle aches in fibromyalgia patients.
* Benzodiazepines. A kind of tranquilizer, which acts on the central nervous system to reduce anxiety, relax tense, painful muscles and stabilize erratic brain waves. They may be administered at bedtime to help with sleep, but there is a potential for dependence in some patients, and they should not be used for long periods of time.
Muscle relaxants may be prescribed, but they are usually not very effective even though sometimes they work by acting as depressants on the central nervous system.
Most medications useful in the treatment of adults with fibromyalgia have demonstrated little or no effect in children, though TCAs have had good results in pediatric patients.
Nutrition may also play an important role in the treatment of fibromyalgia. Proper nutrition ensures that the body has what it needs to function and heal. Fibromyalgia patients have been encouraged to reduce certain foods (e.g., corn, wheat, dairy products, citrus fruits, sugar). Doing so is believed to help improve symptoms of pain, depression, fatigue, headache and digestive tract difficulties.
Remaining active as much as possible is a must for fibromyalgia patients. Regular exercise has been shown to decrease pain and increase endurance and may be essential to managing fibromyalgia, but it must be done correctly. Most fibromyalgia patients will need to modify their old exercise habits. Eccentric contraction (contracting and lengthening at the same time, such as with reaching motions) should be avoided. It is recommended for fibromyalgia patients to start at a low level of exercise and increase gradually, working with low-impact forms of exercise such as walking. The type of exercise activity should be alternated at least every 20 minutes.
Fibromyalgia patients are more likely to experience more intense and longer-lasting pain than healthy individuals. Muscle soreness may be minimized with relaxation, heat, steady breathing and drinking plenty of water. Stretching is important to lengthen muscles and maintain their length, help muscles relax, improve ability to move muscles and decrease pain. Proper exercise has been shown to decrease symptoms of fibromyalgia and reduce severity of symptoms.
Striving for restful sleep is important in the treatment of fibromyalgia. A healthy sleep regimen is crucial to improving sleep and includes:
*Going to bed and getting up at the same time every day
*Avoiding caffeine, sugar and alcohol before bed
*Avoiding eating immediately before bed
*Practicing relaxation exercises while falling to sleep
*Avoiding exercising within three hours of bedtime
*Maintaining a sleep environment that is quiet, free from distractions such as TV and of comfortable room temperature
In some cases, sleep medications may be helpful, particularly when sleep is disturbed by aggravating conditions such as restless leg syndrome.
Many other therapies may be used in the treatment of fibromyalgia. It is important to find therapists specially trained and educated for working with fibromyalgia. A physician may be able to recommend a qualified therapist. Not all therapies are equally efficient and what works for one patient may not work for another. Treatments that have demonstrated benefits for patients with fibromyalgia include:
* Manipulation therapy. For example, massage that progresses slowly during deep muscle work produces results that seem to last a considerable time. Another variation, myofascial release, involves working on tight, contracted muscles and trigger points to release or stretch out the problem areas. Although fibromyalgia is not spinal, some patients have reported that proper chiropractic care by therapists specially trained to work with fibromyalgia helps reduce pain.
* Relaxation techniques. Relaxation may be employed to manage pain and stress. Deep breathing, visual imagery and relaxing audio may be used as effective tools for relaxation.
* Physical therapy. Physical therapists can give instruction in exercise and supply pain-relieving modalities such as heat therapy.
* Occupational therapy. Occupational therapists can offer instruction in conserving energy, simplifying tasks, modifying the home and using adaptive equipment.
* Acupressure. Pressure is used on target points of the body to control symptoms.
* Acupuncture. Needles are inserted into target points of the body to provide pain relief and improve sleep patterns. Controversy remains as to the effectiveness of the use of acupuncture in the treatment of fibromyalgia, but some studies show significant beneficial results.
* Cryotherapy (cold therapy). Cold therapy is used for chronic pain to increase the pain threshold. Too much cold can cause nerve damage.
* Thermotherapy (heat therapy). Heat therapy is usually practiced in rehabilitation to relieve joint stiffness. Moist heat penetrates deeper into the muscle and offers more relaxation than dry heat. Too much heat can cause burns. Heat should not be used on sensitive skin or when using analgesics.
* Cognitive behavioral therapy. This treatment helps individuals change the way they view and think about pain to increase their ability to positively deal with illness. The concept used is that individuals’ perceptions of themselves and their surroundings affect their emotions and behavior.
* Biofeedback. Information about typically unconscious bodily functions (e.g., muscle tension and blood pressure) is used to help gain conscious control over those functions. Electrodes are placed on the muscles to identify which are in use. People can then try to consciously lower muscle tension in that area.
* Injection therapy. Physicians may inject medication into tender points to offer pain relief. These injections are used only when one specific area remains painful and offer only temporary relief. The injection of lidocaine has been shown to reduce pain and improve mood for up to a few days, but the injection of local anesthetics and corticosteroids have shown no proven benefit over injecting local anesthetics alone.
* Spray and stretch technique. Therapists spray a muscle with a topical anesthetic to numb the area and then stretch out the painful, contracted muscle to reduce pain and stiffness. Many therapists use ice instead of the spray, since the spray is costly and ice works just as effectively.
* Stress management. Individuals use stress management techniques to reduce stress. Stress may aggravate symptoms of fibromyalgia.
* Hypnotherapy. Hypnosis may be used to induce a trance-like state of altered awareness and perception during which there may be heightened responsiveness to suggestions to manage stress, induce deep relaxation and reduce muscle pain.
* Magnet therapy. Some individuals use magnets to try to increase blood flow and help symptoms. Although this is one of the most widely used complementary treatments, studies have shown no real benefit.
Patients are advised to consult their physician before considering any complementary or alternative therapy.
Many fibromyalgia patients have trouble coping with their disorder. There are many means to help an individual cope with fibromyalgia or any other chronic illness. Psychological counseling may also help. Fibromyalgia support groups can provide important information, encouragement and positive feelings.
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