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Fibromyalgia

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of fibromyalgia.

Alternative Names

Fibromyositis; Fibrositis; Myofascial pain syndrome

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

These evidence-based rankings were determined from published clinical trials. However, some treatments have not been as extensively studied as others and have less available published evidence. Doctors' recommendations and individual patients' experiences may differ from clinical trial results.

Preparation for Treatment

Patients must have realistic expectations about the long-term outlook of their condition, and their own individual abilities. It is important to understand that fibromyalgia can be managed, and patients can live a full life. The following tips may be helpful when starting a treatment program for fibromyalgia:

• The goal of therapy is to relieve symptoms not cure them.
• Treatment must be tailored to each patient, and a combination approach is often needed.
• Patients must begin all treatments with the attitude that these treatments are trial and error. There is no clear treatment solution. Patients and doctors need to work together to make the best choices for individual symptoms and concerns.
• Treatments are long-lasting, in some cases life-long, and patients should not be discouraged by return of symptoms (relapses).
• Enlisting family members, partners, and close friends, particularly to help with exercise and stretching programs, can be helpful.
• Becoming involved with support groups of fellow patients also benefits many patients. Support groups may also benefit family members, particularly parents of children with fibromyalgia. One study noted that the severity of the disorder increased in children whose parents were less able to cope with their child's pain.

The definition of improvement is personal. For example, some patients are pleased with only a 10% reduction in pain and other symptoms.

• Review Date: 12/15/2006
• Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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