People who have fibromyalgia often live with chronic widespread pain that prevents them from performing simple tasks many of us take for granted, such as sweeping the floor, taking the dog for a walk, or driving to work.
Fibromyalgia is a chronic disorder characterized by a cluster of symptoms that have no identifiable cause. Its hallmark symptoms are multiple tender-to-the-touch spots (called tender points); persistent fatigue; and pain in the muscles, tendons, and ligaments. These symptoms are often accompanied by depression, anxiety, sleep disturbances or disorders, irritable bowel syndrome, headaches, post-traumatic stress disorder, or memory and concentration difficulties—which can all contribute to poor quality of life.
Fibromyalgia requires a flexible treatment approach aimed at managing symptoms, learning coping techniques, and improving quality of life. Treatment is tailored to each individual’s needs and takes into account the severity of symptoms and whether associated conditions are present. A team of specialists may be assembled to manage overlapping ailments. Treatment often involves a combination of the following strategies:
- Fibromyalgia education. Patients who are more knowledgeable about their disorder have better outcomes than those who are not. Education should focus on the importance of self-care, the effects of co-conditions on symptoms, available treatment approaches, realistic treatment expectations, and awareness that symptoms can wax and wane and some pain and fatigue may persist despite treatment.
- Regular physical activity. Exercise is a cornerstone of fibromyalgia treatment. A 2017 Cochrane review reported that regular moderate exercise improves physical function and decreases pain, fatigue, and stiffness. Pain may temporarily worsen when starting an exercise program. Patients should aim to slowly build up to at least three or more 30-minute sessions a week of low-impact exercise, such as biking, swimming, or brisk walking. Even those who can’t achieve the recommended exercise amount often see some improvement. Some people with fibromyalgia find that tai chi—which combines meditation with slow, graceful martial-arts movements—or other mind-body practices, such as yoga and qigong, are easier to perform than traditional aerobic exercise. Water-based therapy and resistance training may help reduce pain and fatigue, too. Be sure to clear any exercise program with your doctor first.
- Physical therapy. A physical therapist or physiatrist (a doctor who specializes in physical medicine and rehabilitation) can work with individuals who have difficulty exercising by providing a one-on-one approach to improving overall function and reducing pain.
- Sleep hygiene. Trouble sleeping is a hallmark of fibromyalgia. People with fibromyalgia are prone to sleep disorders, especially sleep apnea and restless legs syndrome. Sleep is critical to many aspects of physical, emotional, and cognitive functioning, and so treating sleep disorders and improving sleep habits are essential to managing fibromyalgia symptoms.
- Medication. If exercise alone doesn’t adequately manage fibromyalgia, prescription drugs may help. However, according to some estimates, only 30 to 50 percent of patients will find some symptom relief with medication. A doctor’s choice of medication and dosage is largely based on an individual’s symptoms and overall health, as well as cost. The U.S. Food and Drug Administration (FDA) has approved three drugs to treat fibromyalgia: duloxetine (Cymbalta and generic) and milnacipran (Savella), which are antidepressants, and pregabalin (Lyrica), an antiseizure drug. Another antiseizure drug, gabapentin (Neurontin, Gralise, and generic), although not FDA-approved for fibromyalgia, is sometimes prescribed by doctors off-label. Also, doctors sometimes prescribe off-label tricyclic antidepressants, such as amitriptyline (Elavil, others, and generic)—an older form of antidepressant commonly used before fluoxetine (Prozac and generic) and other selective serotonin reuptake inhibitors were introduced in the 1980s.
All these drugs have potential side effects—including sleepiness, dizziness, nausea, constipation, headaches, fluid retention, and weight gain—and some patients can’t tolerate them. Tricyclics are often not recommended for older adults because of their increased vulnerability to the drug’s side effects, some of which can increase fall and fracture risk.
Pain relievers, such as opioids and nonsteroidal anti-inflammatories (NSAIDs), and steroids have limited short-term effects and work in only about one-third of patients. Opioids may even heighten pain sensitivity and lead to dependence and should be avoided.
When a single medication combined with activity fails to help adequately, doctors may recommend multiple medications. Other drugs may be prescribed to target specific symptoms, such as sleep disturbances or depression.
- Psychological therapy. The most studied psychological intervention for fibromyalgia is cognitive behavioral therapy (CBT), which focuses on how patterns of thinking affect feelings and behavior. CBT teaches patients coping strategies to manage pain and the frustrations of living with fibromyalgia. In clinical trials, CBT has been shown to help improve physical function, mood, and pain.
- Complementary and alternative medicine. Some patients report short-term symptom improvement after partaking in acupuncture, chiropractic treatments, biofeedback, meditation, hypnosis, special diets, or various herbs and dietary supplements, but there’s not enough evidence to establish the effectiveness of such therapies.
This article first appeared in the August 2018 issue of UC Berkeley Health After 50.