Fibromyalgia.
Last updated Wednesday, December 22, 2004
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Management and treatment
Treatment
As with most chronic illnesses, the treatment should be tailored to meet your individual needs.
Some people with fibromyalgia have mild symptoms and need very little
treatment once they understand what fibromyalgia is and what worsens
their condition. Most people do benefit from a comprehensive care
program. Some treatment strategies include:
- Education about the illness and reassurance that it is not usually disabling
- Progressive exercise programs that involve stretching and cardiovascular fitness
- Relaxation techniques and other measures to help you relax tense muscles and release stress
- Non-narcotic medications that diminish pain and improve sleep
- Treatment of depression or other mood disorders if present
- Counseling if needed
- Continued involvement in the enjoyable and productive aspects of life
Exercise and therapy
Two principles of treating fibromyalgia are to increase
cardiovascular (aerobic) fitness and to stretch and mobilize tight,
sore muscles. You may be reluctant to exercise if you are already in
pain and feel tired. Low or non-impact aerobic exercises such as brisk
walking, biking, swimming or water aerobics are generally the best way to start such a program. Exercise
on a regular basis, such as every other day, and gradually increase to
reach a better level of fitness. Some people can greatly reduce their
symptoms with exercise.
Gently stretch your muscles and move your joints through an adequate
range of motiondaily and before and after aerobic exercise. Physical
therapy may be helpful and couldinclude techniques such as: heat, ice,
massage, whirlpool, ultrasound, and electrical stimulation to help
control pain. Physical therapists may also be consulted to design a
specific exercise program to improve posture, flexibility, and fitness.
Medications
The anti-inflammatory medications used to treat arthritis and many
rheumatic conditions do not have a major effect in fibromyalgia.
However, modest doses of aspirin, ibuprofen, or acetaminophen may help
to provide some pain relief and lessen stiffness. Narcotic pain
relievers, tranquilizers, and cortisone derivatives have been shown to
be ineffective and should be avoided because of their potential side
effects.
Medications that promote deeper sleep and also relax muscles help
many people with fibromyalgia. These include amitriptyline (Elavil),
doxepin (Sinequan), cyclobenzaprine (Flexeril), and related
medications. Although these medications are also used to treat
depression, in people with fibromyalgia they are generally used in very
low doses and only at bedtime. Thus, they are not specifically used as
antidepressants or tranquilizers in the treatment of fibromyalgia but
may relieve pain and improve sleep.
Although many people sleep better and have less discomfort when they
take these
medications, the improvement varies greatly from person to person. In
addition, the medications may have side effects such as daytime
drowsiness, constipation, dry mouth, and increased appetite. These side
effects are rarely severe, but can be disturbing and may limit the use
of these drugs. Therefore, a number of different medicines may need to
be tried and doses adjusted in consultation with a doctor.
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