Fibromyalgia

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Treatment

The goal of treatment is to reduce pain, improve sleep, and relieve associated symptoms. Treatment is tailored to the individual. Some patients experience significant relief of symptoms, some find moderate improvement, and others report little or no relief. Only about 5% of fibromyalgia patients become symptom free. Most treatment regimens include medication, lifestyle changes, exercise, physical therapy, and behavior modification.

Medication

Antidepressant agents known as tricyclics relieve sleep disorders, reduce muscle pain, and treat depression. The tricyclic drug most commonly prescribed for fibromyalgia is amitriptyline (Elavil®).

Another class of antidepressants used in fibromyalgia is selective serotonin-reuptake inhibitors (SSRIs). They boost the level of the neurotransmitter serotonin in the brain, which modulates mood, but do not improve physical symptoms. Fluoxetine (Prozac®) is a commonly prescribed SSRI.

Taking two types of antidepressant may be more effective. A low dose of Prozac combined with Elavil is more effective than either medication used alone.

Antidepressants are first taken at the lowest possible dosage and then gradually increased, if necessary. Their overall benefit appears to be limited, as far as relieving pain, fatigue, and sleeplessness. Many patients are unable to tolerate the side effects of these drugs, even at low doses, and stop taking them. Side effects include nausea, loss of appetite, and insomnia.

Small doses of aspirin or acetaminophen may provide some pain relief and relieve muscle stiffness. Nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen), narcotics, and corticosteroids (e.g., prednisone) have not proven to be effective. Due to potenially severe gastrointestinal and cardiovascular side effects, NSAIDs should only be used as instructed.

In June 2007, the FDA approved pregabalin (Lyrica®) to treat fibromyalgia. This drug reduces pain and improves function in some patients. Side effects include dizziness, excessive sleepiness (somnolence), blurred vision, and weight gain.

Trigger point injections involve injecting a local anesthetic, such as lidocaine, and/or a corticosteroid into a tender point and then stretching the involved muscle. Local anesthetic increases blood flow to the muscle and corticosteroids reduce inflammation. The injections can be painful, and it may take 2 to 4 days for improvement.

Fibromyalgia, Fibromyalgia Treatment reprinted with permission from neurologychannel.com
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