Fibromyalgia Treatments – A Multidisciplinary Approach
Some experts say the best fibromyalgia treatment is a multidisciplinary approach. That means a team of professionals with different skill and specialties finding what works best for each patient. The suggested team includes:
- Rheumatologist
- Medical psychologist
- Physical therapist
- Massage therapist
- Exercise physiologist
Drugs as Fibromyalgia Treatments
People with fibromyalgia frequently are sensitive to medications and have adverse reactions to them, so experts recommend using the lowest possible dose.
The only medications officially approved as fibromyalgia treatments areLyrica (pregabalin) and Cymbalta (duloxetine). Doctors frequently prescribe other drugs, including antidepressants, analgesics such as Tylenol (acetaminophen) or Tramadol, muscle relaxants and nonsteroidal anti-inflammatories (NSAIDs) such as aspirin, ibuprofen and naproxen. Experts say the combination of Tylenol and Tramadol (sold together as Ultracet) can help reduce FMS pain. Clinic trials have found NSAIDs to be most useful when combined with tricyclic agents such as Elavil (amitriptyline) or Norpramin (desipramine).
It's hard enough to sleep when you're in pain, but the sleep problems that can go along with FMS are more complicated that that. Many FMS suffers also have chronic fatigue syndrome and sleep disorders such as insomnia. Medications frequently prescribed for sleep problems include:
- Antidepressants
- Anticonvulsants
- Nonbenzodiazepine hypnotics
- Muscle relaxants
- Dopamine agonists
Researchers aren't sure whether people with FMS also are often clinically depressed because of their symptoms or because the two conditions have a common physiological cause. It's important to watch for signs of depression and to talk to a doctor if you think you are depressed. You may benefit from antidepressant drugs, counseling, or both.
Other symptoms and general health:
- Vitamins and supplements
- Antioxidants
- Amino acids
- Herbs
Drugs that typically aren't effective:
- Steroids
- Narcotics
- Thyroid hormones
- Melatonin
- Calcitonin
With the possible exception of steroids, these drugs aren't considered detrimental, they're just generally not effective for FMS. It is OK to take them for other conditions. Some people with fibromyalgia have bad reactions to steroids, while others do not.
Trigger-Point Injections as Fibromyalgia Treatment
A trigger point differs from the tender points used to diagnose fibromyalgia. Trigger points are tight, ropy bands of muscle that form when a muscle does not relax properly. They're often formed as a result of physical trauma, but doctors don't yet understand why some people develop them while others do not. The trigger point can irritate or trap nerves and cause what's called referred pain, which is pain felt elsewhere along the nerve. Frequently, you can feel a trigger point just below the skin, and if you push on it you could cause an involuntary twitch.
Trigger-point injections (TPIs) are used to treat these extremely painful areas. The doctor inserts a small needle directly into the trigger point and injects a local anesthetic such as lidocaine or procaine. (Doctors frequently use corticosteroids as well, but these drugs are not recommended for FMS patients.) The injection can cause a twitch or pain that last for up to a few minutes. Patients typically report lasting relief after just a few treatments.
Acupuncture & Bodywork as Fibromyalgia Treatment
Acupuncture is a traditional Chinese technique that has become more popular in the U.S. over the past 20 years. According to the Mayo Clinic, scientists don't fully understand how acupuncture works, but some studies have shown it to be medically beneficial in many ways, including pain reduction. The specific acupuncture technique used to treat pain is sometimes called dry needling and is performed by certified acupuncturists and some physicians.
When performed correctly, acupuncture is considered a low-risk procedure with few side effects, and it can be used either alone or in combination with other treatment methods. Possible side effects include soreness, bleeding or bruising at the needle sites, and feeling tired after a session. In rare cases, an internal organ could be injured.
Several other alternative/complementary treatments are used for treating fibromyalgia as well, including massage, reiki and other types of bodywork. Some of these treatments are supported by scientific evidence, while others are not.
Experimental Protocols for Fibromyalgia
Several doctors and researchers have developed FMS treatment protocols that are backed by little or no scientific evidence. These doctors/researchers and many of their patients claim the protocols work.
Other patients, however, say the protocols weren't successful for them, and some experts say the protocols are little more than placebos and could even harm your health. It's important to involve your doctor in any decisions you make on untested treatments.
Sources:
Healthcommunities.com, Inc., Aug. 8, 2007. All rights reserved. "Trigger Point Injections"
Regina P. Gilliland, MD, Department of Internal Medicine; Division of Rehab Medicine, Mobile Infirmary Medical Center"Fibromyalgia"
Mayo Foundation for Medical Education and Research, June 16, 2006. All rights reserved. "Acupuncture: sharp answers to pointed questions"
