Treatment
Fibromyalgia is a mysterious condition whose causes and basic disease mechanisms are still largely unknown. There is no strong evidence that any single treatment or combination has any significant effect for most patients. Treatment must involve not only relieving symptoms but also changing the patients' perceptions of their disease and helping them to develop behaviors that enable them to cope.
Therapies generally employ a trial and error, multi-faceted approach:
- Patients may start initially with physical therapy, exercise, stress reduction techniques, and cognitive-behavioral therapy.
- If these fail to improve symptoms, antidepressants, either those known as tricyclics, serotonin reuptake inhibitors (SSRIs), or a combination may be effective. Any medications are added to the initial therapies, not used as substitutes.
- Possible alternative treatments that may help include chiropractic therapy, hypnosis, or acupuncture.
- Some investigative medications may prove to be useful for specific symptoms, including newer antidepressants, gabapentin (Neurontin) or tramadol (Ultram) for pain, and trazodone (Desyrel), zolpidem (Ambien), or zaleplon (Sonata) to improve sleep. (In general, however, few studies have been conducted on these agents in fibromyalgia patients.)
- If these measures fail to control pain, then physicians should consider prescribing opioids.
One study found that interdisciplinary treatment programs were effective in significantly easing pain in 42% of patients. After treatment stopped, improvements in pain, depression, and other symptoms and a renewed sense of physical capability persisted for at least six months, although patients tended to become fatigued again. The effectiveness of the treatments tended to depend on how depressed the patients were, the sense of their own disability, personal support networks, and whether the cause was known. The severity of the pain at the start of treatment had little to do with outcome.
Studies vary over which combinations are most helpful and individuals will probably need to try many different variations to find one that fits their needs. Examples of results from different programs include the following:
- One study compared three treatment options, biofeedback and relaxation techniques, exercise, and a combination of the two, with a passive educational approach used as a control. After two years, the combination approach proved most beneficial; with the passive control approach the least.
- One program of 20 hours of relaxation and movement training helped reduce pain and improve function and health.
- Another program reported benefits from cognitive-behavioral strategies, exercise, relaxation, and information about chronic pain.
Preparation for Treatment
Patients must have realistic expectations about the long-term outlook and their own individual capabilities. It is important to understand that the condition can be managed and patients can live a full life. The following tips may be helpful in embarking on a treatment program for fibromyalgia:
- The goal of therapy is to allay symptoms, not to cure them.
- Patients must begin all treatments with the attitude that they are trial and error. No physician, even an expert, has a clear treatment solution, because little significant research has been conducted on this disorder. Patients and doctors need to work together to make the best choices for individual symptoms and concerns.
- Therapies are prolonged, in some cases life-long, and patients should not be discouraged by relapses.
- Enlisting family, partners, and close friends, particularly with exercise and stretching programs, can be helpful.
- Becoming involved with support groups of fellow-patients has also benefited many patients. Support groups may also benefit family members, particularly parents of children with fibromyalgia. One study noted that the severity of the disorder increased in children whose parents were less able to cope with their childs pain.
- Improvement is subjective, and some patients are pleased with only a 10% reduction in pain and other symptoms.
|
