Fibromyalgia - Treatment

Treatment

Fibromyalgia is a mysterious condition whose causes are still largely unknown, as is how it inflicts damage. There is no strong evidence that any single treatment (or combination of treatments) has any significant effect for most patients. Treatment must involve not only relieving symptoms but also changing the patients' attitudes about their disease. Treatment should also teach patients behaviors that help them cope.

Treatments usually use a trial and error, many-sided approach:

• Patients may start with physical therapy, exercise, stress reduction techniques, and cognitive-behavioral therapy.
• If these methods fail to improve symptoms, an antidepressant or muscle relaxant may be added to the treatment. Doctors usually prescribe these drugs for their effects on the central nervous system, which helps improve pain tolerance.
• Patient education and programs that encourage coping skills are an important part of any treatment plan.

According to a 2005 study published in the Clinical Journal of Pain, a combination of non-drug therapies works just as well as drug therapy in improving pain, depression, and disability. This combination includes exercise, stress management, massage, and diet. In 2004, the Journal of the American Medical Association published an evaluation of various fibromyalgia treatments. Based on clinical trial data reported in medical journals, the researchers assessed and ranked the evidence supporting the usefulness of these treatments.

Non-Drug Treatments:

• Treatments with the strongest evidence for usefulness: Cardiovascular exercise, cognitive-behavioral therapy, patient education groups, and combinations of these treatments

• Moderate evidence: Strength training, acupuncture, hypnotherapy, biofeedback, balneotherapy
• Weak evidence: Chiropractic, massage therapy, electrotherapy, ultrasound therapy
• Treatments with no evidence of usefulness: Trigger point injections, flexibility exercise

Drug Treatments:

• Strongest evidence: Amitriptyline, cyclobenzaprine
• Moderate evidence: Tramadol, fluoxetine, venlafaxine, milnacipran, duloxetine, pregabalin
• Weak evidence: Growth hormone, 5-HT, tropisetron, SAMe

• No evidence: Opioids, corticosteroids, NSAIDs, benzodiazepine and non-benzodiazepine hypnotics, melatonin, calcitonin, thyroid hormone, guaifenesin, DHEA, magnesium