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Fibromyalgia Treatment Guidelines

Fibromyalgia (FM) is a cluster of symptoms including ongoing and widespread pain in the muscles and connective tissue, increased sensitivity to pain, fatigue, difficulty sleeping, and cognitive and emotional dysfunction. Approximately 10 million Americans, mostly women, have been diagnosed with FM. The syndrome has no cure and can be debilitating in severe cases. However, fibromyalgia treatment guidelines recommended by the National Fibromyalgia Association allow for appropriate, individualized medical protocols that ensure improved quality of life.

  1. Managing Pain

    • Fibromyalgia treatment guidelines require that pain management be addressed. Non-steriodal anti-inflammatory drugs including ibuprofen and naproxen often are prescribed. Tramadol is a non-narcotic pain reliever that has be proven effective in relieving FM pain, sometimes in combination with acetominophen. In some cases, lidocaine injections are used to treat localized pain in muscles.

    Treating Co-Existing Conditions

    • FM patients often present with co-morbid, or co-existing, conditions. Depression and anxiety, for example, are found in about 20 percent of people with FM according to the NFA. Other common co-existing conditions include restless leg syndrome, irritable bowel syndrome, headaches, chronic fatigue syndrome, and rheumatoid arthritis. Treating co-existing conditions often improves FM symptoms as well.

    Sleep Management

    • Disturbed sleep is a common symptom of fibromyalgia. Treatment should include recommendations on lifestyle changes that will help promote a better night's sleep. Patients are generally advised to avoid caffeine and alcohol before bed, to establish a regular time to wake up and go to sleep, and to ensure the environment is comfortable and free from disruptions. When necessary, your doctor may prescribe a low dose of certain antidepressants to help you sleep. Antidepressants increase seratonin, which help lessen pain in addition to promoting sleep.

    Exercise

    • A regimen of gentle stretching and low-impact and non-repetitive exercise has been shown to decrease the symptoms of fibromyalgia. Mayo Clinic suggests developing a regimen that will tone muscles evenly as a means to decrease pain. The NFA recommends walking, using a stationary bike, and pool therapy, but cautions that exercise should be undertaken with the guidance of a physical therapist. Twenty minutes of activity three times weekly is recommended.

    Other Medications

    • Because FM is a cluster of symptoms occurring together rather than a disease with a specific cause, fibromyalgia treatment is individualized to address each patient's specific symptoms. Anti-depressants may be included in the treatment protocol, because they increase seratonin, a neurotransmitter that has been correlated with decreased pain and fatigue and better sleep, in addition to relieving depression symptoms. Muscle relaxants such as cyclobenzaprene lessen muscle tension and also promote sleep. New medications approved by the U.S. Food and Drug Administration to treat FM include Lyrica, Cymbalta, and Savalla.

    Education

    • Central to the fibromyalgia treatment plan is education. Newly diagnosed FM patients should be provided with resources to help understand the condition and cope with chronic pain. Education should also include counsel on appropriate lifestyle changes to improve diet and manage stress more effectively. Therapy or support groups also are recommended to help deal with the psychological distress that often accompanies FM.

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