Treatments for Fibromyalgia

By Mary Anne Dunkin | June 27, 2022

Controlling fibromyalgia requires a multidiscipline approach that should begin with education, physical activity and psychotherapy. If those alone do not provide sufficient relief, medications may be prescribed to help relieve pain and other symptoms. You should work closely with your doctor and health care team to create a treatment plan that works well for you. The goal of treatment for fibromyalgia is to

• Reduce pain and stiffness.
• Relieve fatigue and weakness.
• Improve function and help you continue normal daily activities.

Medications

Three medications — duloxetine (Cymbalta), milnacipran (Savella) and pregabalin (Lyrica) — are approved by the Food and Drug Administration (FDA) specifically for treating fibromyalgia; however, many others are commonly used in its treatment. Many drugs prescribed for fibromyalgia alter brain chemicals and/or block overactive nerve cells, turning down the “pain volume” in the central nervous system. Your treatment plan is likely to include some of the following:

• NSAIDs. Although nonsteroidal anti-inflammatory drugs (NSAIDs) are not highly effective for fibromyalgia pain, people with milder pain may find they provide relief. Two NSAIDs — ibuprofen (Motrin, Advil) and naproxen (Aleve) — are available over the counter (OTC). A dozen or so others are available at higher doses by prescription.
• Analgesics. Over-the-counter acetaminophen reduces pain for some people. Opioid pain relievers are not recommended and might even heighten pain.
• Tricyclic compounds. Two tricyclic compounds — amitriptyline hydrochloride (Amrix, Fexmid), an antidepressant and cyclobenzaprine, a muscle relaxant — relieve depression and nerve pain.
• Antidepressants. In addition to amitriptyline, two classes of antidepressants — selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) — may be prescribed to relieve pain and mental/emotional symptoms of fibromyalgia. SSRIs include fluoxetine (Prozac), paroxetine (Brisdelle, Paxil) and sertraline (Zoloft). SNRIs include duloxetine (Cymbalta), milnacipran (Savella) and venlafaxine (Effexor XR).
• Gabapentinoids (anticonvulsants). Anticonvulsant or anti-epileptic drugs used to treat fibromyalgia include gabapentin (Horizant, Neurontin) and pregabalin (Lyrica).
• Sleep aids. Zolpidem (Ambien, Edluar, Intermezzo) may be prescribed to promote deep, restorative sleep in people who have sleep problems related to fibromyalgia.

Because every medication comes with risks and possible side effects, it is important to speak with your doctor about your medication risks and what to do if you experience side effects.

Physical Therapy and Exercise

Physical activity might feel nearly impossible, but it is proven to be one of the best things you can do to relieve fibromyalgia symptoms and increase your energy level. To avoid over-stressing painful muscles, begin slowly. Low-impact, aerobic activities such as walking, swimming or riding a stationary cycle are good places to start.

A physical therapist can teach you exercises to reduce pain and stiffness, strengthen muscles, increase stamina and improve flexibility to help you feel and function better.   

Counseling and Psychological Therapies

Feeling sad, worried or anxious are all common responses to having a chronic, painful condition. But there is also evidence that emotional distress may worsen or even precede other symptoms of fibromyalgia. Psychotherapy can be an important part of its treatment.

Research has shown that at least one form of psychotherapy — cognitive behavioral therapy (CBT) — can be effective in improving fibromyalgia symptoms, particularly if you experience anxiety and depression. CBT is a short-term talk therapy designed to help you change the way you think about and respond to situations and stimuli. CBT is designed to help modify thoughts, patterns and activities that cause emotional distress or physical pain. It can also help you pace activities to reduce fatigue or promote self-efficacy — the belief in your ability to have control over or alter your condition. Fibromyalgia research shows that higher levels of self-efficacy are associated with lower levels of pain and depression and better outcomes.

Living with Fibromyalgia

Along with exercise, therapy and medication, there are many things you can do on your own to take charge of your health and feel better overall.

• Be Proactive
  • Be an active participant in your treatment decisions — become a good self-manager.
  • Put together your health care team.
  • Keep track of symptoms, medications, side effects and pain levels.
  • Ask questions and share concerns with your health care team.
• Stop Smoking. Research has shown that in patients with fibromyalgia, smoking is a risk factor for cognitive dysfunction, adding to its other health threats. In addition, smokers with fibromyalgia are more likely to report more severe fibromyalgia symptoms, more sleep problems and increased anxiety compared to those who don’t smoke.
• Adopt a Healthy Diet. There is no specific diet for fibromyalgia. However, some people claim that certain foods improve or worsen symptoms. The best diet is one that is rich in vegetables, fruit, fish and healthy fats like olive oil. If you are interested in changing your diet for fibromyalgia, first speak with your doctor or a dietitian to make sure you are getting the proper nutrients.
• Use Self-Help Devices. If pain, stiffness and fatigue limit your ability to do every tasks,  self-help devices can make your daily tasks easier. An occupational therapist can provide individualized advice and assistive devices to help you perform tasks with less stress and pain.
• Communicate with Loved Ones. Fibromyalgia symptoms can affect daily activities — and relationships. Ask for help when you need it and let people in your life know when you aren’t able to do activities you used to. The same is true of sex. Discussing your needs with your partner and finding modifications will help you overcome almost any difficulty.
• Make Workplace Accommodations. Most people with fibromyalgia can continue a productive, active work schedule. But if pain, stiffness and fatigue limit your ability to do certain tasks, simple modifications to those tasks, your schedule or your workspace may help. Following are a few suggestions:
  • Avoid lifting, stooping and remaining in cramped or bent positions.
  • Raise your computer monitor to eye level so your posture is good.
  • Change positions often and move around at least every hour.
  • Use a cushion when sitting to help support your back.
  • Arrange to take short rest periods throughout the day.

Ease Pain and Fatigue

Along with exercise and medications, try these methods to relieve pain, fatigue and anxiety.

• Activity pacing. Lighten your schedule and ask for help when you need to. Take breaks during the day to save energy and protect joints.
• Hot and cold treatments. For some people, a warm shower or bath or warm compresses relax muscles and relieve pain. For others, cold numbs painful areas, providing temporary pain relief. Experiment to find what works better for you.
• Relaxation techniques. Relax your muscles and slow your thoughts. Try deep breathing, guided imagery and visualization.
• Massage. Massage can help reduce pain, improve joint function and ease stress and anxiety.
• Acupuncture.  This ancient practice, inserting fine needles at special points into the body, may help relieve pain.