Fibromyalgia Treatment
Fibromyalgia is a condition causing body pain, fatigue, and trouble sleeping. Scientists don't really know what causes it, but it's known that if you have a heightened sensitivity to pain, you're more likely to have fibromyalgia. Scientists think that fibromyalgia may be due to a change or rewiring of the pathways in your brain that transmit pain signals from continual nerve stimulation.
Genetic factors (meaning someone in your family has fibromyalgia) or environmental factors (you already have an autoimmune disease like rheumatoid arthritis or lupus) can increase your chances of getting fibromyalgia.
Other symptoms of fibromyalgia are:
- Muscle or joint stiffness
- Numbness or tingling in the arms and legs
- Tenderness when touched
- Problems with concentrating or thinking clearly
- Heightened sensitivity to light, sounds, smells, and temperature.
- Digestive problems, such as bloating or constipation
- Depression and anxiety
How to treat fibromyalgia
There's no one cure-all pill for your fibromyalgia since there are so many symptoms. But you've got lots of treatment options to choose from.
Exercise/physical therapy. Many studies have shown that regular exercise helps people with fibromyalgia reduce pain and depression. Aerobic exercise and strength training do the most to relieve symptoms, but yoga, tai chi, Pilates, swimming, and Nordic walking also work. The idea is to start at a low intensity and work up to a moderate one. Be gentle when you begin. It may take about 6 weeks before you see any benefit. A physical therapist can help you get started with an exercise program or advise you on which activities to try.
Talk therapy. Talking with a counselor or psychologist can help you to deal with your stress. Cognitive behavioral therapy (CBT) is a type of talk therapy that teaches you how to change your thoughts to lessen emotional distress. Research shows that a higher belief in your ability to complete a task or goal is linked to lower levels of pain and depression.
Diet changes. A review of studies on diets and fibromyalgia found that several diets, including the Mediterranean diet, the low-FODMAP diet, the gluten-free diet, and vegetarian diets all appeared to reduce symptoms of fibromyalgia. But it cautioned that many of the studies were small and didn't track whether participants stuck to their assigned diets or if the positive effects lasted over time. It also pointed out that simply losing weight might reduce inflammation and improve your quality of life if you have fibromyalgia.
Some people swear they feel better following an anti-inflammatory diet or avoiding nightshade foods like tomatoes and potatoes. You may have to try different diets to see if they have any effect on your symptoms. In general, you'll want to eat a healthy diet with lots of fruits, vegetables, whole grains, and healthy oils like olive oil. Taking vitamin D, magnesium, iron, and probiotics might also help. Talk with your doctor or nutritionist for help in designing the right eating plan.
Medications. Some drugs ease the aches and pains, while others boost your energy or improve your sleep. You may need to take more than one fibromyalgia medication to find relief. Each fibromyalgia drug has its own side effects, ranging from mild to serious. You and your doctor will work together to figure out the right medicine to keep your symptoms under control.
Fibromyalgia Drugs
The FDA has approved three drugs to treat fibromyalgia: the antidepressants duloxetine (Cymbalta) and milnacipran (Savella), plus the anti-seizure medicine pregabalin (Lyrica). But your doctor may prescribe other drugs that aren't specifically approved for fibromyalgia. Medicines like these are sometimes called "off-label" medications.
Savella
Milnacipran (Savella) works by increasing the activity of certain chemicals in the brain involved in regulating mood and pain. These chemicals are norepinephrine and serotonin. Milnacipran belongs to a class of drugs called serotonin-norepinephrine reuptake inhibitors (SNRIs). This antidepressant was approved by the FDA to treat fibromyalgia in 2009.
Cymbalta
Duloxetine (Cymbalta) is another SNRI that works in the same way as Savella. The FDA approved it for treating fibromyalgia in 2008.
Lyrica
Pregabalin (Lyrica) works by lessening the number of pain signals that damaged nerves in your body may send out. It also improves sleep. The FDA approved this drug is treat fibromyalgia in 2007. It's also used to relieve nerve pain from diabetes and epilepsy. It belongs to a class of drugs called anticonvulsants.
Antidepressants for Fibromyalgia
Even if you're not depressed, these drugs can ease pain and other fibromyalgia symptoms. Antidepressants raise levels of chemicals such as serotonin and norepinephrine that help control pain.
Serotonin and norepinephrine reuptake inhibitors (SNRIs)
They can help with pain, sleep problems, fatigue, and sad moods. The two main SNRI medicines for fibromyalgia are duloxetine (Cymbalta) and milnacipran (Savella). They may increase the risk of suicidal thoughts in some people. Other possible side effects include nausea, dry mouth, headache, fatigue, high blood pressure, racing heart, increased sweating, constipation, and dizziness.
Selective serotonin reuptake inhibitors (SSRIs)
These are not as effective for fibromyalgia pain as SNRIs, but they're good for treating depression and other emotional symptoms of the disease. These work by increasing the activity of serotonin. Your doctor may suggest one of these:
- Citalopram (Celexa)
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Fluvoxamine (Luvox)
- Paroxetine (Paxil, Pexeva)
- Sertraline (Zoloft)
SSRIs tend to have less side effects than SNRIs, but they do include nausea, sexual dysfunction (like loss of sex drive or difficulty keeping an erection), weight gain, and sleep problems.
Tricyclics
They're an older form of antidepressant. Amitriptyline (Elavil) is one of them. Low doses of these drugs relieve pain and fatigue, relax muscles, and improve sleep. But you may get side effects like drowsiness, dry mouth, constipation, and weight gain.
Anti-Seizure Medicines
Drugs that treat epilepsy seizures may also help ease your fibromyalgia pain. These medications prevent sensitive nerves from sending too many pain signals to the brain.
This fibromyalgia medicine curbs your pain and can help your fatigue and sleep problems. Side effects include:
- Dizziness
- Tiredness
- Headache
- Dry mouth
- Nausea/vomiting
- Constipation
- Unsteadiness
- Memory problems
Gabapentin (Neurontin)
Research shows this drug lessens pain and fatigue and improves sleep. It's similar to pregabalin and works in the same way.
If you take one of these drugs, you may get side effects like:
- Blurry vision
- Dizziness
- Drowsiness
- Weight gain
- Swelling of your hands or feet
Fibromyalgia Pain Relievers
These medications for fibromyalgia can ease its aches and pains:
Over-the-counter medicines
These include acetaminophen and NSAIDs like aspirin, ibuprofen, and naproxen.
Check with your doctor before taking NSAIDs regularly. Over a long period of time, they may raise your chances of getting a heart attack or stroke. They may also cause ulcers and bleeding in the stomach or intestines.
Acetaminophen has fewer side effects, but it's important to stick to the dose your doctor recommends. Taking too much of the drug can lead to liver damage.
Opioids
While opioid painkillers can relieve some kinds of pain, they usually aren't recommended for fibromyalgia. Studies show they don't work and may even make the pain worse. But for serious cases, your doctor may prescribe tramadol (Ultram). Because tramadol can be addictive, you'll usually only take it for a short period of time. It can also lead to stomach pain, constipation, nausea, and trouble concentrating.
Muscle Relaxants for Fibromyalgia
Although experts aren't sure why, muscle relaxants can treat a variety of fibromyalgia symptoms.
Cyclobenzaprine (Flexeril)
This drug is reported to have a "modest benefit in patients with fibromyalgia and is used as a standard therapy for muscle pain," according to the Institute for Clinical Systems Improvement. Cyclobenzaprine works in the central nervous system to relieve muscle spasms, nerve pain, and depression. Very low doses of this medication may help you sleep more soundly. It can also ease your fatigue and pain.
Some of the side effects are dizziness, dry mouth, sleeplessness, constipation, and weight gain.
Tizanidine (Zanaflex)
This is another muscle relaxant used for fibromyalgia treatment that works similarly to cyclobenzaprine. It's mainly used to manage muscle spasms due to conditions like muscular sclerosis, stroke, and spinal cord injury, but it's sometimes used to treat fibromyalgia as well. It also improves sleep. Headaches, chest pain, nausea, and fever are some of the side effects of this drug.
Experimental Medications
There are a number of experimental drugs and alternative treatments out there:
IMC-1. This combines the anti-inflammatory drug celecoxib (Celebrex) with the antiviral drug famciclovir. In clinical trials it seemed to reduce fibromyalgia-associated pain and fatigue. A study showed that suppressing the latent herpes virus (HSV-1) improved fibromyalgia symptoms. The FDA has given the go-ahead for phase III clinical trials.
Flupirtine. This targets a part of the brain called the NMDA receptor. The NMDA receptor is involved in making pain signals stronger, and flupirtine seems to block these pain signals. Although used in many countries to treat fibromyalgia and other pain conditions, flupirtine is not approved by the FDA. The European Medicines Agency restricted its use to no more than 2 weeks in 2013 because it can cause liver problems.
Ketamine. This drug works in a similar manner to flupirtine. Ketamine is only approved by the FDA as an anesthetic for patients having surgery. (It's also used in low doses as a recreational drug). Still, many doctors prescribe it off label to treat pain, depression, fibromyalgia, and other conditions. The FDA has warned about using compounded ketamine products and says they should only be used under the care of a health care provider as they have serious side effects like disassociation.
Sodium oxybate. The FDA has approved this only as a narcolepsy treatment, though it's used off label for fibromyalgia. Sodium oxybate improves fragmented and disturbed sleep in people with narcolepsy, and studies show it can improve sleep quality and reduce pain in people with fibromyalgia. The FDA didn't approve it because there's potential for misuse and abuse.
Cannabis. Its main active ingredients, THC and CBD, have been studied as treatment for fibromyalgia with mixed results. Medical marijuana is well-known for treating other types of pain, but more research is needed before concluding it can help people with fibromyalgia.
Takeaways
Since fibromyalgia has many symptoms, it requires many types of treatment, including exercise, drugs, and talk therapy. Three medications are approved by the FDA for treating fibromyalgia: duloxetine, milnacipran, and pregabalin. But other drugs, like muscle relaxants and anti-seizure medicines, are used off-label to help treat this condition.
Fibromyalgia FAQs
How do you find out if you have fibromyalgia?
The main factor is having widespread pain in your body for at least 3 months. The pain should be in different parts of your body at the same time, like in your shoulders, arms, hips, buttocks, legs, neck, chest, back, or stomach. Your doctor will also order other tests to rule out other reasons for your pain.
What is the life expectancy for a person with fibromyalgia?
Fibromyalgia itself doesn't shorten your life, but a study linked it with a 27% heightened risk of death due to an increased risk of accidents (due to fatigue and lack of sleep), infections, and suicide (due to mental health issues).
What is the No. 1 treatment for fibromyalgia?
The American College of Rheumatology says it is exercise, specifically low-impact aerobics, yoga, or tai chi.
