Fibromyalgia: Breaking the Cycle of Pain

Q: What is the best and safest painkiller I can use for the long-term treatment of fibromylagia? I have severe headaches, muscle and joint pain, as well as back pain.

A: Unfortunately, there is not a single "best and safest" painkiller for fibromyalgia because what may be best for one individual may prove less than helpful, and possibly harmful, to another. That said, the "best" treatment may be one that incorporates patient education (about his or her condition), behavioral modification (stress reduction, sleep hygiene), integrative therapy (acupuncture, others), and physical therapy, along with medications (prescription or non-prescription) on an as-needed or consistent basis. This holistic approach may go a long way to safely relieve the pain and discomfort caused by your rheumatologic condition.

Fibromyalgia is a persistent illness that is thought to be a disorder of the central nervous system (and not of the joints, as is common in rheumatologic disorders). From the central nervous system, pain signals are processed in a pattern that has the potential to trigger a wide spectrum of symptoms. For instance, while muscle stiffness and joint pain may affect some people, others may experience tender spots (a combination of areas that include the head, neck, upper back, chest, elbows, hips, and knees), headaches, and fatigue. And, even though the exact cause is not known, the following factors may increase the risk for this condition:

• Gender (more common in females)
• Family history of fibromyalgia
• Having a medical condition such as lupus, rheumatoid arthritis, and hypothyroidism
• Impaired sleep pattern (sleep apnea, restless leg syndrome, etc.)
• Injury to the upper spinal region
• Hormonal changes
• Lack of physical exercise
• Infections

For those with fibromyalgia, the degree of pain or discomfort may be influenced by the following factors:

• Stress
• Fatigue
• Nutrition (poor diet may increase symptoms)
• Physical activity (high intensity lifting may increase the pain)
• Exposure to weather changes (cold, windy, damp)
• Time of day

Additionally, symptoms such as depression, difficulty with concentration, mood changes, anxiety, and even temporomandibular joint dysfunction may be related to or associated with fibromyalgia. Needless to say, every person needs to have a treatment approach aimed at reducing his or her particular symptoms. The person's family doctor, rheumatologist, or other healthcare provider may manage this condition in conjunction with a team of health professionals.

Let's take a look at some options, keeping in mind that "one size does not fit all," meaning that fibromyalgia's spectrum of symptoms may require a varied treatment approach.

For starters, empower yourself to change what you can. This would include lifestyle modifications as follows:

• Regular and low-impact exercise (aqua therapy, walking, biking, carefully planned muscle strengthening, etc.)
• Good sleep hygiene (going to bed at the same time each night, no caffeine for at least six hours prior to sleep time, dark and calm bedroom environment)
• Good nutrition (well-rounded diet including fruits, vegetables, whole grains, etc.)
• Stress reduction (meditation, biofeedback, taking walks in nature, scheduling time for yourself, re-discovering hobbies, socializing with friends, family, others)

Next, explore activities that would gently stretch your muscles (this may be hard at first), as well as improve your range of motion and aerobic conditioning. Exercises such as adaptive yoga (certified instructors who gently adopt forms and techniques to your physical abilities) and tai chi may be options.

There are also integrative approaches (visit a practitioner who is skilled and experienced in treating fibromyalgia) that complement and/or replace pills, patches, or creams. These include osteopathic manipulative therapy (utilizing gentle techniques that may lessen headache, muscle and point tenderness), acupuncture, physical therapy, chiropractic care (utilizing gentle techniques) and massage therapy, as well as cognitive behavioral therapy (modifying thought and behavioral patterns that may contribute to your condition).

Medications are often utilized to help ease the burden of symptoms. Some are muscle relaxers (cyclobenzaprine, often given at bedtime), antidepressants (amitriptyline, duloxetine, others) and pain relievers (acetaminophen, tramadol, etc.), as well as gabapentin and pregabalin (the last one is FDA approved for the treatment of fibromyalgia).

Additional pharmaceutical approaches include but aren't limited to:

• Beta adrenergic-receptors blockers such as pindolol (also used for heart disease and high blood pressure)
• Topical pain relievers such as 5 percent doxepin cream and menthol creams
• Transdermal (applied directly to the skin) patches containing medications such as fentanyl or 5 percent lidocaine
• Guaifenesin (ingredient often found in cough syrups)

Needless to say, there are many treatment options to consider. The key is to use a multi-targeted approach, be flexible, and don't give up. If one medication doesn't work, another drug, or a combination of others may be the right solution that  can improve your quality of life.

For further information, please speak with your physician. Also, visit the Arthritis Foundation (www.arthritis.org) and the National Center for Complementary and Alternative Medicine (ww.nccam.nih.gov) as well as Fibromyalgia Symptoms (ww.fibromyalgia-symptoms.org)

More Pain Management Advice From Dr. Rob:

• Chronic Pain: Can Acupuncture Work?  
• Pain That Spreads  
• Sitting in Pain  

Do you have a health question you'd like to ask Dr. Rob? Send e-mail to experts@microsoft.com. Please include Ask Dr. Rob in the subject line.

Each of our experts responds to one question each week and the responses are posted on Mondays on MSN Health. We regret that we cannot provide a personalized response to every submission.

Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)