Fibromyalgia Treatment

The treatment of FMS is frustrating for both patients and their physicians. In general, drugs used to treat musculoskeletal pain, such as aspirin, non-steroidals and cortisone are not particularly helpful in this situation. As in any chronic pain condition, education is an essential component that helps patients understand what can or can't be done as well as teaching them to help themselves.

It is important for a patient's physician to discover whether there is a cause for sleep disturbances. Such sleep problems include sleep apnea, restless leg syndrome and teeth grinding. If the cause for a patient's sleep disturbance cannot be determined, low doses of an anti-depressive group of drugs, called tricyclic anti-depressants or short acting sleeping medications such as zolpidem (Ambien), may be beneficial. Patients need to understand these medications are not addictive when used in low dosages (eg., Amitriptyline 10 mg at night) and have very few side effects. In general, routine use of sleeping pills such as Halcion, Restoril, Valium, etc. should be avoided as they impair the quality of deep sleep. Ambien (zolpidem), is claimed to avoid this problem.

There is increasing evidence that a regular exercise routine is essential for all Fibromyalgia syndrome patients. This is easier said than done because increased pain and fatigue caused by repetitive exertion makes regular exercise quite difficult. However, those patients who do get into an exercise regimen experience worthwhile improvement and are reluctant to give up. In general, FMS patients must avoid impact loading exertion such as jogging, basketball, aerobics, etc. Regular walking, the use of a stationary exercycle and pool therapy utilizing an Aqua Jogger (a floatation device which allows the user to walk or run in the swimming pool while remaining upright) seem to be the most suitable activities for FMS patients to pursue. Supervision by a physical therapist or exercise physiologist is of benefit wherever possible. In general, 20 minutes of physical activity, 3 times a week at 70% of maximum heart rate (220 minus your age) is sufficient to maintain a reasonable level of aerobic fitness.

Drugs such as aspirin and Advil are not particularly effective and seldom do more than take the edge off FMS pain. Narcotics ( propoxyphene, codeine, morphine,oxycodone, methadone) may provide a worthwhile relief of pain in a small subgroup of severely afflicted patients, but Fibromyalgia patients seem especially sensitive to opioid side effects (nausea, constipation, itching and mental blurring) and often decide against the long term use of these drugs. Narcotic painkillers have usually been avoided by most physicians for fear of addiction. However recent research has shown that addiction seldom occurs when these medications are use in chronic pain states. It is important to understand the difference between addiction and dependence which occurs with all these drugs in the majority of patients .

Particularly painful areas often may be helped for a short time (2-3 months) by trigger point injections. This involves injecting a trigger point with a local anesthetic (usually 1% Procaine) and then stretching the involved muscle with a technique called spray and stretch. It should be noted the injection of a tender point is quite painful (indeed, if it is not painful the injection is seldom successful). After the injection, there is typically a 2-4 day lag before any beneficial effects are noted. Other techniques which directly help the tender areas on a transient basis are heat, massage, gentle stretching and acupuncture.

About 20% of FMS patients have a co-existing depression or anxiety state which needs to be appropriately treated with therapeutic doses of anti-depressants or anti-anxiety drugs often in conjunction with the help of a clinical psychologist or psychiatrist. Basically, patients who have a concomitant psychiatric problem have a double burden to bear. They will find it easier to cope with their FMS, if the psychiatric condition is appropriately treated. It is important to understand Fibromyalgia syndrome itself is not a psychogenic pain problem and that treatment of any underlying psychological problems does not cure the Fibromyalgia.

Most FMS patients quickly learn there are certain things they do on a daily basis that seem to make their pain problem worse. These actions usually involve the repetitive use of muscles or prolonged tensing of a muscle, such as the muscles of the upper back while looking at a computer screen. Careful detective work is required by the patient to note these associations and where possible to modify or eliminate them. Pacing of activities is important; we have recommended patients use a stop watch that beeps every 20 minutes. Whatever they are doing at that time should be stopped and a minute should be taken to do something else. For instance, if they are sitting down, they should get up and walk around or vice versa.

Patients who are involved in fairly vigorous manual occupations often need to have their work environment modified and may need to be retrained in a completely different job. Certain people are so severely affected, that consideration must be given to some form of monetary disability assistance. This decision requires careful consideration, as disability usually causes adverse financial consequences as well as a loss of self esteem. In general, doctors are reluctant to declare Fibromyalgia patients disabled and most FMS applicants are automatically turned down by the Social Security Administration. However, each patient needs to be evaluated on an individual basis before any recommendations for or against disability are made.

Common Sense: Individuals with Fibromyalgia can make a meaningful contribution to their own treatment by learning as much as they can about how their bodies respond to Fibromyalgia. For example, do certain activities (especially those involving repeated or prolonged muscle use) tend to exacerbate Fibromyalgia? How can such activities be modified or replaced and thus be better tolerated? Do certain types/levels of activity cause delayed pain reactions a day or two later? Also crucial is learning to pace oneself, take frequent breaks, and/or say "No" to requests that simply cannot be accommodated on a particularly bad Fibromyalgia day. If certain commitments cannot be avoided, is it possible to get extra rest before and after to aid in recovery? While these ideas sound simple in theory, they are often difficult to implement.

Because successful FMS treatment can involve a variety of medical professionals, patients usually benefit from a coordinated, team approach to disease management. Ideally, all medical practitioners treating a given patient work with the patient toward a positive outcome. Just because someone starts out with severe Fibromyalgia symptoms doesn't mean that (s)he cannot find worthwhile improvement with a skillfully devised and comprehensive treatment program. According to rheumatologist and Fibromyalgia specialist Russell Rothenberg, M.D., "Patients need to know that medication, judicious rest, exercise, physical therapy, and good diets can do more than just control the symptoms of Fibromyalgia; they can control the disease process as well. There is no cure for Fibromyalgia, but people do get better! Hopefully, as better medications that are more specific for Fibromyalgia are developed, and people are diagnosed earlier in their illness, more individuals with Fibromyalgia will go into remission, or at least partial remission, and feel better."