Fibromyalgia Treatments

The Universal Guide to Fibromyalgia TreatmentEverything you ever wanted to know, straight from the experts.

In This Article: Fibromyalgia Basics   |    Medications   |    Nonmedication Treatments   |    Complementary Treatments and Lifestyle

Maybe you’ve been diagnosed with fibromyalgia. Or maybe you think you might have it. All you know is, everything hurts, from the base of your skull all the way down to your knees. You’re exhausted—seemingly all the time. And for weeks, it’s been hard to focus on even simple tasks.

Fibromyalgia is a mysterious disorder, but there are many treatment options available to help reduce your symptoms. Photo Source: 123RF.com.

Sure, it’d be great to pop a pill that makes your illness go away. But that’s not in the cards for someone with fibromyalgia. Because symptoms vary widely and affect both mind and body, a single treatment won’t work to address everything. Instead, the best approach is a combination of therapies.

“This may look different from one person to another,” says Alison Vargovich, PhD, a licensed psychologist and assistant professor in the Department of Medicine, Division of Behavioral Medicine at the University at Buffalo in New York. The goal of all fibro treatments, she explains, “is to help the patient achieve as much relief as possible and improve their quality of life.” For some people, this could mean dancing at a wedding without pain. For others, it could mean the ability to function again.

The good news: There are many fibromyalgia treatments that can help ease your aches, clear your brain fog (sometimes called “fibro fog”), boost your energy, and more.

What Is Fibromyalgia?

Fibromyalgia is a chronic pain condition affecting about 2% of adults in the United States, according to the Centers for Disease Control and Prevention. Women make up the lion’s share of cases. While kids and seniors can be affected, it typically comes on during young or middle adulthood.

Experts think the root cause is a nervous system malfunction, specifically in the part of the brain that processes pain. Research suggests that the brains of people with fibro may create or amplify pain signals.

Fibro isn’t fatal and it won’t cause permanent damage, but it can be tough—sometimes disabling—to live with. Common symptoms include:

• Pain and stiffness in muscles and joints

• Tenderness to touch or pressure
• Severe fatigue
• Problems with memory and thinking
• Severe sleep problems

Some people develop additional symptoms, too, such as depression, anxiety, headaches, bowel and bladder problems, and other distressing health problems. These are less common.

Get the Right Fibromyalgia Treatment

The right treatment for you hinges on an accurate diagnosis. Your primary care doctor may know whether your symptoms add up to fibromyalgia. However, a rheumatologist—a doctor who specializes in autoimmune conditions and disorders of the bones, joints, and muscles—is most familiar with fibromyalgia.

Fibro symptoms can mirror those of other conditions, like rheumatoid arthritis and lupus. You can also have fibromyalgia in addition to these conditions. In order to effectively treat your fibro symptoms, your doctor must make sure other illnesses are ruled out or addressed.

Then, they can coordinate a fibro treatment plan. This may involve other specialists, like a physiatrist or a psychologist. A well-rounded treatment plan should include a mix of medical interventions and self-care approaches.

Medications for Fibromyalgia

Fibromyalgia is often treated with medication or a combination of medications. What works best for you will depend on your symptoms, overall health, and personal preference (and probably drug cost, too).

Fibromyalgia treatment usually starts--but rarely ends--with medication.

Currently, there are three medications approved by the U.S. Food & Drug Administration (FDA) specifically for fibro:

• Pregabalin (Lyrica), approved in 2007
• Duloxetine (Cymbalta), approved in 2008
• Milnacipran (Savella), approved in 2009

These drugs are thought to affect neurotransmitters, brain chemicals that play a role in how you process pain. Other medications may be prescribed off-label, which means doctors use them to treat fibro, but they aren’t FDA-approved for the condition.

Fibro meds generally fall under these categories:

Anticonvulsants

Also called anti-seizure or antiepileptic medications, these drugs can ease pain, calm anxiety, and improve certain sleep issues. Pregabalin and an off-label drug called gabapentin (Neurontin) are two anticonvulsants used for fibro.

Antidepressants

Three kinds of antidepressants may relieve both mental and physical symptoms associated with fibro, such as pain, fatigue, anxiety, and depression.

• Tricyclic antidepressants (TCAs) regulate your levels of the “feel-good” hormone serotonin and norepinephrine, a hormone that influences stress. Amitriptyline (Elavil, Endep) and nortriptyline (Pamelor, Aventyl) are given for fibro.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) also influence serotonin and norepinephrine. Both duloxetine and milnacipran are SNRIs.
• Selective serotonin-reuptake inhibitors (SSRIs) improve mood by increasing your serotonin levels. They aren’t considered as helpful for pain as other antidepressants, though they can be useful for emotional issues. Common choices include fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).

Painkillers

For some people, over-the-counter medication like ibuprofen (Advil, Motrin), acetaminophen (Tylenol) or naproxen (Aleve) may temporarily tamp down pain. For long-term relief, other treatments are typically necessary.

Doctors strongly recommend avoiding opioids for fibro, since the risks outweigh the benefits. Some research even suggests opioids could worsen your pain.

Other drugs

Your provider may use other medications to treat individual fibro symptoms, including:

• Cyclobenzaprine (Flexeril) is a muscle relaxer that can improve sleep.
• Zolpidem (Ambien) is sedative that could also help with sleep.
• Modafinil (Provigil) may ease fatigue.

There are additional options, depending on your needs and symptoms.

Non-medication Treatments for Fibromyalgia

“Like a puzzle with multiple pieces, it takes several different approaches to come together to provide patients with the most relief possible,” says Dr. Vargovich. Medication may be a key part of that puzzle, but other strategies can also make a big difference in how well you function throughout the day.

Exercise

Study after study suggests regular physical activity is key to keeping fibro in check. What’s more, it helps lower your chances of other serious illnesses, including diabetes and cardiovascular disease.

Ask your doctor about activities that will work best for you. Simple stretching is a fibro fixture. “I’m a big believer in stretching and yoga,” says Perry Herman, MD, FPMR, a board-certified physiatrist in Plainsboro, NJ. “It has to be gentle, restorative yoga—very gentle stretching.” He recommends tai chi, too, in part for its emphasis on balance.

Dr. Herman recommends gentle yoga and tai chi.

Strength training and light cardio—such as walking, swimming, and biking—are also vital. Depending on your fitness level and overall health, you may have to start slowly and gradually build up your stamina.

“It could be five minutes walking to the mailbox and back,” explains Dr. Herman. “Then gradually, each time you go out, you add another minute to your walk or add a little bit increased intensity until eventually, you’re working up to 30 minutes three to four times a week at a moderate intensity.”

The most important part of fibro fitness? Sticking with it. Though you may feel more pain when you begin, it should improve with time. Soon, you may even see exercise as a must.

Fibromyalgia Diet

There is no specific eating plan experts recommend for fibromyalgia, but a well-rounded, nutritious diet may boost energy levels, reduce pain, and improve your overall health. Dr. Herman says that when he treats someone with fibro, “we try to have them come off of processed foods and packaged goods, because we want them to shift more towards whole foods that are high in vegetables and lean proteins as well as fruits.”

Physical therapy

To manage pain and improve your ability to move, you may work with a physiatrist or physical therapist.

“If you have a physical therapist who understands fibromyalgia, it can be very helpful,” says Dr. Herman. A good, experienced practitioner can do hands-on work to stretch and relieve sore muscles, he explains, and also show you exercises to help restore your range of motion, “eventually transitioning to strengthening and cardiovascular exercise.”

Occupational therapy

Whether you’re loading a dishwasher or typing at your desk, simple daily function can be complicated by fibro. An occupational therapist will show you how to do everyday home, work and school activities with less pain and stress. This can mean teaching you alternative ways to perform tasks or changing your environments to make working within them a little easier.

Remember, physical therapy is different from occupational therapy. A physical therapist deals with strength, balance, and mobility. An occupational therapist helps you with the specific, must-do tasks of day-to-day living.

Psychotherapy

Living with fibro can be mentally and emotionally challenging. You may have a hard time dealing with the day-to-day, and you could become anxious or depressed.

“As with any chronic, severe illness, it is reasonable to seek psychological help when you feel that it would be helpful—not in lieu of physical treatment, but simply as one more part,” urges Jacob Teitelbaum, MD, author of Real Cause, Real Cure and The Fatigue and Fibromyalgia Solution.

Getting help may not just improve your mental state. It could be crucial to controlling your symptoms, since mood can exacerbate pain, and vice versa.

“Specific therapy that provides patients with additional tools and strategies to manage pain tends to be the most effective,” explains Dr. Vargovich. “These types of treatments help patients to address the psychosocial factors that might make pain feel ‘louder’ or make it more difficult to manage at times.”

Cognitive behavioral therapy (CBT), is often recommended for these reasons. During CBT, you’re taught skills to identify and cope with negative thoughts. You learn to think about your illness and deal with your symptoms in a different, more positive way.

Complementary Treatments

Many people with fibro report success with complementary and alternative therapies, though there isn’t a lot of evidence to back their use. These are some of the best-studied approaches that show promise for symptom relief:

• Massage
• Acupuncture
• Relaxation therapy
• Hydrotherapy

Before starting any alternative treatment, ask your doctor whether it’s safe and could be effective for you. If you get the green light, they may be able to connect you with qualified practitioners.

Lifestyle Can Make a Difference

Managing fibro isn’t just about movement, medication, and therapies. How you live day to day can also improve or worsen your symptoms. The following habits may help you feel better.

• Enhance your nighttime sleep quality. Good sleep is critical to getting a handle on fibromyalgia. It improves fatigue and focus, and can help relieve pain overall.

The average adult under age 65 should get seven to nine hours of sleep nightly, according to the National Sleep Foundation. If you have problems falling or staying asleep, dial your doctor. You may need to get better control of your pain or adopt some (or all) of these good sleep hygiene practices:

• Maintain a regular sleep schedule with a regular wake-up time and bedtime
• Avoid naps during the day
• Get light exercise during the day
• Steer clear of caffeine and alcohol past mid-afternoon
• Avoid spicy or heavy foods before bedtime
• Use your bed only for sleep and sex
• Keep your room cool, quiet, and dark
• Create a nighttime ritual, such as taking a relaxing shower and reading a book

Getting good sleep when you have fibro is difficult, but so important.

• Pace yourself. Fibro can be exhausting even if you’re sleeping well. So, go easy when you can. To avoid a crash or flare-up later, don’t overexert yourself on good days. Space out busy periods, and then balance them with plenty of time for relaxation. If necessary, at work, speak with a human resources contact about changing your hours or physical space.

• Quit smoking: In addition to its well-known risks, smoking can aggravate fibromyalgia symptoms. Research has shown that smokers with fibro report worse quality of life, more sleep problems, and more anxiety compared with nonsmokers with fibro.

• Get support. Speaking openly and honestly with family and friends about fibro can take a load off your mind. If you need a sympathetic ear from other people going through the same thing, support groups can be found online and in-person all over the U.S. Ask your provider or reach out to a fibro advocacy organization for a recommendation.

The Future of Fibromyalgia Treatment

The development of fibro medications has been somewhat successful in recent years. Other therapies have come a long way, as scientists explore different angles of disease management. Among treatments with potential:

• Transcutaneous electrical nerve stimulation (TENS), during which electric currents are used to try to block pain along nerve pathways
• Transcranial Magnetic Stimulation (TMS), during which your brain is stimulated by magnetic fields
• Cannabis-derived products, such as CBD oil
• Medical marijuana
• A class of drugs called NMDA receptors, which include ketamine and memantine

Keep in mind, while these may be promising, more research is needed to prove their effectiveness and safety. In the meantime, the best way forward is up to you and your healthcare team. By working together towards the right treatment plan, you can find a future with less pain.