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Fibromyalgia Treatment: Medication, Lifestyle Changes, and More
Fibromyalgia is a chronic condition that causes musculoskeletal pain and tenderness throughout the body, along with fatigue; sleep, memory, and mood can also be affected. Its cause is still unknown, but experts believe it’s possible that mutations in genes that produce neurotransmitters (chemical messengers) in the brain that send and receive pain signals in the body may cause people to develop the condition, which makes them more sensitive to pain.
There’s no known cure for fibromyalgia. But a range of medications, lifestyle measures, complementary therapies, and other approaches are often effective at relieving symptoms and enhancing quality of life.
Medication
Medication can reduce the severity of symptoms in some people with fibromyalgia.
Currently, there are four drugs approved by the U.S. Food and Drug Administration (FDA) to treat fibromyalgia:
- Duloxetine (Cymbalta) and milnacipran (Savella), which are often used as antidepressants, are believed to work by increasing certain neurotransmitters that control pain.
- Pregabalin (Lyrica), which is believed to work on a nerve cell protein that causes increased pain sensitivity, can reduce pain and help with sleep and fatigue.
- Cyclobenzaprine hydrochloride (Tonmya), which has long been used in higher doses to treat muscle spasms, is thought to work by improving sleep quality and reducing pain sensitivity, though its exact mechanism of action is unknown. It’s a tablet that you dissolve under your tongue at bedtime.
Sometimes, medications are used together for a better effect. “Combinations of several drugs at lower doses may help in many patients,” says Daniel G. Arkfeld, MD, a rheumatologist and associate professor of clinical medicine at the Keck School of Medicine at the University of Southern California in Los Angeles. “This leads to trying combinations of medications both from the FDA approval list as well as other, nonapproved meds.”
For instance, Dr. Arkfeld says low-dose naltrexone and certain sleep medications are often prescribed off-label for some people with fibromyalgia. Additionally, other antidepressants and lidocaine patches, gel, or cream are used to relieve pain.
Some people with fibromyalgia also take over-the-counter pain relievers to ease their discomfort, including acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin), and naproxen (Aleve), though NSAIDs are not necessarily effective for most fibromyalgia pain.
Lifestyle Changes
While medication is available to treat fibromyalgia, these treatments aren’t effective for everyone.
“I think fibromyalgia is many different conditions lumped into one diagnosis, making it tricky to compare somebody who can barely function versus a high-level executive working full-time,” says Arkfeld. “Thus, treatment requires very different approaches, depending on severity.”
This means that, often, lifestyle measures are important to treat and manage fibromyalgia. Beneficial behaviors for fibromyalgia include the following.
Developing Better Sleep Habits
Getting enough sleep may help you combat the fatigue that often accompanies fibromyalgia.
Research also suggests that poor sleep can lead to more pain. Scientists think this correlation exists because sleep deprivation weakens pathways that are crucial for controlling and coping with pain.
“Sleep can be improved by simple techniques, like sleep hygiene, or more sophisticated approaches, like cognitive behavioral therapy for insomnia or medications that promote deep sleep,” says Daniel J Clauw, MD, a professor of anesthesiology, rheumatology, and psychiatry at the University of Michigan Medical School in Ann Arbor.
Sleep hygiene strategies include going to bed and getting up at about the same time each day, including on weekends. Try to avoid long naps or naps in the late afternoon as well, since this can interfere with your ability to fall asleep at night.
If maintaining a consistent sleep schedule and practicing other sleep hygiene tactics, like making sure your bedroom is dark, quiet, and cool, aren’t enough to help you get quality sleep, you may need to see a sleep medicine specialist to evaluate your need for other treatments. Nonrestorative sleep is a hallmark of fibromyalgia, but there are medications your doctor may have you try.
Exercising
“I think the most important aspects of treating fibromyalgia are to get people sleeping better and moving more,” says Dr. Clauw.
Physical exercise is the single most effective treatment for fibromyalgia, according to the American College of Rheumatology. The organization recommends yoga, tai chi, and low-impact aerobic exercise for people with fibromyalgia.
At first, exercise may be painful or difficult, but regular physical activity can help improve your symptoms and make exercising easier. “A variety of movement therapies can get people more active,” says Clauw.
You may also want to try walking, biking, swimming, or water aerobics, which are all low-impact workouts.
Many doctors recommend stretching and strength training. Strength training can include using free weights, weight machines, exercise bands, or your own body weight for resistance.
Strenuous exercise can worsen fibromyalgia symptoms, so make sure to stay within your window of tolerance when it comes to physical activity. Your doctor can help you develop an exercise routine, or refer you to someone who can help.
Losing Excess Weight
Although it’s unclear exactly why, people with obesity have a higher risk of developing fibromyalgia, and obesity is also associated with more severe illness. Research shows that generally speaking, a higher body mass index (BMI) is connected with fibromyalgia, and the illness itself can also cause you to gain weight by altering your metabolism.
Higher BMI is also connected to more pain sensitivity, according to research. Studies have shown that, in people with obesity, weight loss is associated with significant improvements in depression, sleep quality, the number of tender points, and overall quality of life. Additionally, losing weight can also reduce levels of inflammatory chemicals in the body, which reduces pain sensitivity.
Reducing Stress
Chronic stress can worsen pain and other symptoms of fibromyalgia.
Take time to learn coping techniques for dealing with inevitable life stresses, and try to limit stress in your daily routine.
One way to do this is to practice mindfulness — a technique that involves nonjudgmental present moment awareness. Breathing exercises can also be helpful for reducing stress.
Eating Well
When you have fibromyalgia, it’s important to eat healthy, whole foods. Talk to your doctor or a registered dietitian (which insurance often covers) about creating a healthy meal plan.
Some people with fibromyalgia report improved symptoms when they make certain dietary changes. In fact, one study of people with fibromyalgia who followed an anti-inflammatory diet for three months showed a 30 percent reduction in pain and fatigue.
It may be helpful to limit your consumption of refined sugars, red meat, saturated fats, and processed foods, which can all promote inflammation.
Instead of eating these types of foods, experts suggest consuming more whole grains, lean protein sources, low-fat dairy products, and fruits and vegetables. You should also drink plenty of water.
Pay attention to how you feel after eating different foods. Avoid any food that seems to worsen your symptoms.
Quitting Smoking
Research indicates that people with fibromyalgia who smoke experience more pain than those who don’t.
In addition to its other known health risks, research has found that smoking puts people with fibromyalgia at risk for cognitive dysfunction. Smokers with the condition are also more likely to report more sleep problems and higher anxiety levels than nonsmokers.
Rehabilitation and Therapy
Some people with fibromyalgia may benefit from certain therapies, such as:
- Physical Therapy A therapist teaches you specific moves to improve strength, flexibility, and energy.
- Occupational Therapy This type of therapy is focused on helping you learn how to function better in your home and work environments.
Complementary and Integrative Approaches
Some complementary therapies can help people manage fibromyalgia symptoms. These may include:
- Acupuncture
- Mindfulness meditation
- Massage therapy
- Heat therapy
- Transcutaneous electrical nerve stimulation therapy
- Brain stimulation using electrical currents
- Dietary supplements, like magnesium or vitamin D
While many people claim that these approaches help them personally, more studies are needed to confirm their effectiveness.
Mental Health Treatment
Mental health conditions are common in people with fibromyalgia. In fact, research suggests that about half of people with fibromyalgia report symptoms of depression and anxiety.
Some treatments that could help include:
- Cognitive behavioral therapy, a form of talk therapy (psychotherapy) that focuses on how to change thoughts and behaviors to better manage your condition.
- Acceptance and commitment therapy, a type of talk therapy that aims to help people accept what they can’t control and commit to making positive changes.
The Takeaway
- There’s no cure for fibromyalgia, but different treatments can ease pain and improve poor sleep related to the chronic condition.
- Medications, therapies, and lifestyle changes can improve your symptoms and quality of life.
- Your doctor can help you determine which approaches can best treat your pain and fatigue.
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