Fibromyalgia

Currently, there is no cure for fibromyalgia, but there are many steps you can take to understand your condition and manage your symptoms. Treatment is focused on managing pain, fatigue, depression, and other symptoms common in fibromyalgia in an attempt to break the cycle of increased sensitivity to pain and decreased physical activity. Every person may respond to a different combination of treatments.

Treatment may include:

• Medicines to help you sleep better, relax muscles, or relieve muscle and joint pain. Medicines your doctor may suggest include tricyclic antidepressants, SSRIs, SNRIs, muscle relaxants such as cyclobenzaprine (Flexeril), anticonvulsants (also called antiepileptics) such as pregabalin (Lyrica), mixed (or dual) reuptake inhibitors or, less often, nonprescription pain relievers.
• Exercise therapy to relieve sore muscles and increase energy.
• Cognitive-behavioral therapy to help you learn to manage your pain.

Home treatment is also a vital part of managing fibromyalgia. Your efforts to get regular exercise, improve your sleep habits, and reduce stress are as important to your treatment as any medicine your doctor may prescribe.

Initial treatment

If you have just been diagnosed with fibromyalgia, your initial treatment goals might include:

• Starting a program of regular physical exercise. Getting consistent exercise, especially cardiovascular exercise, is one of the best ways to manage fibromyalgia. Pool exercise has been found to be particularly effective for many people.⁴ It's important to progress your exercise program slowly so you don't get sore muscles that cause you to want to stop exercising; working with a physical therapist familiar with fibromyalgia may be helpful.¹
• Identifying sleep problems, if you have them, and learning about ways to get more restful sleep.
• Relieving pain and stiffness with medicines and heat.
• Identifying "triggers" that seem to make your symptoms worse and learning to avoid or manage them. A trigger can be anything you've noticed that increases your symptoms. Triggers may relate to the weather, particular activities, stressful events, or lack of sleep.
• Starting a program of cognitive-behavioral therapy to help you learn to relax, reduce stress, and manage your pain. This can help decrease pain and fatigue, and it can improve your mood and ability to function.⁴

With some guidance and instruction, you will be able to start working on most of these goals at home. You may have a team of health professionals to help you. The team may include your family medicine doctor, a rheumatologist or endocrinologist, a physical therapist, and a psychologist.

Ongoing treatment

Exercise, sleep, and stress reduction can be extremely helpful in controlling your symptoms. Symptoms of fibromyalgia come and go repeatedly, so it is important to maintain your home treatment efforts over the long term.

Prescription medicines can be helpful for certain symptoms, including pain and sleep problems. Talk with your doctor if you think the medicines you are taking are not helping. There may be other alternatives. Remember that your need for medicine may change over time.

Another important part of ongoing treatment for fibromyalgia is, when possible, avoiding or limiting your exposure to "triggers" or "stressors" that make your symptoms worse. Cold or damp weather, poor sleep, fatigue, physical or emotional stress, and overexertion seem to be common stressors for people with fibromyalgia. It may not be possible to avoid these things completely, but you can learn ways to reduce stress, practice better sleep habits, and avoid overexerting yourself.

Watch for signs of depression or anxiety; they are common in people with fibromyalgia and can make problems with sleep and feelings of pain even worse.¹ These can often be successfully treated as long as you recognize them and discuss them with your doctor.

Many people with fibromyalgia have other joint or muscle diseases (such as rheumatoid arthritis or lupus) that need to be treated as well. Make sure you report any new symptoms or worsening problems to your doctor.

Treatment if the condition gets worse

Fibromyalgia is not a progressive disease and causes no permanent physical damage. But the symptoms can be debilitating, and you may experience periods of time when you feel worse than usual.

If new symptoms develop or if existing symptoms get worse, discuss your concerns with your doctor. He or she may need to reassess your treatment. Your doctor may need to adjust your medicines or prescribe different ones. Or perhaps you are exercising too much or not enough.

It's also possible that new or worsening symptoms could be related to a condition other than fibromyalgia. Your doctor can evaluate this possibility as well, but only if you let him or her know that you are having problems.

What To Think About

Although exercise seems to help most people with fibromyalgia, no one particular treatment stands out as the most effective. The kind of treatment you need or want may be based on:

• The severity of your symptoms.
• Whether the condition is disrupting your daily life.
• What kinds of changes in your life you are willing and able to make.

Because the symptoms of fibromyalgia can come and go, you may find it difficult to judge whether a particular treatment is really working. Different people may respond differently to each type of treatment. It can take time, and you may have to try several different treatments, to find an approach that works for you.