What are Some Treatments for Fibromyalgia?

Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and multiple tender points. "Tender points" refers to tenderness that occurs in precise, localized areas, particularly in the neck, spine, shoulders, and hips. People with this syndrome may also experience sleep disturbances, morning stiffness, irritable bowel syndrome, anxiety, and other symptoms.

Unfortunately, at this time, no single medication alleviates all of a fibromyalgia patient's pain and accompanying symptoms. This makes it very important for physicians to keep updated regarding results of ongoing FMS research and current changes in recommended fibromyalgia treatments.

Because different symptoms accompany each FMS patient, the doctor needs to know what problems are specific to each individual. For instance, non-restful sleep is almost always a major concern for fibromyalgia sufferers. Small doses of antidepressant medication seem to help many FMS people. However, other sufferers with restless legs syndrome may need a different approach to settle themselves into a good night’s rest. Always check with your doctor to find a treatment that is right for you.

Prescription Medications

You may also be put on prescription medication to help you cope with insomnia. Antidepressants are commonly prescribed for fibromyalgia patients primarily to reduce sleeplessness and muscle pain; treating depression is a secondary benefit for those suffering from both depression disorder and fibromyalgia. The tricyclic drug most commonly used for fibromyalgia is amitriptyline (Elavil, Endep). Other tricyclics include desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), amoxapine (Asendin), trazodone (Desyrel), and nortriptyline (Pamelor, Aventyl). Side effects are fairly common with these medications, although generally only small doses are necessary for relief of fibromyalgia. Side effects most often reported include dry mouth, blurred vision, sexual dysfunction, weight gain, difficulty in urinating, disturbances in heart rhythm, drowsiness, and dizziness. Blood pressure may drop suddenly when sitting up or standing. Like all medications, tricyclics must be taken as directed; overdose can be life threatening.

Estrogen Therapy

Because fibromyalgia often develops when a woman reaches menopause, some experts believe that estrogen replacement therapy may have special benefits for fibromyalgia patients, in addition to protection against heart disease, osteoporosis, and, possibly, Alzheimer's disease. Women who take estrogen therapy seem to fall asleep faster, have longer periods of REM sleep, have fewer wakeful periods, and sleep longer than those not taking estrogen. Taking estrogen shortly before going to bed is most helpful.

Pain Relievers

For relief of pain, acetaminophen (Tylenol) is recommended. Anti-inflammatory drugs, such as corticosteroids and nonsteroidal anti-inflammatory drugs, which include aspirin ibuprofen (Advil), and others, are less useful for the pain of fibromyalgia, because the pain is not caused by muscle inflammation. A number of patients are prescribed opioids such as codeine or codeine combinations for pain relief. One study indicated that many doctors prescribe opioids primarily because of the patients' expressions of pain not from any objective criteria, such as cause, duration, pain severity, and physical findings. Physicians are urged to take a careful medical and psychological profile of the patient before prescribing them and periodically evaluate the patient for continuing pain relief, side effects, and indications of abuse.

Diet and Lifestyle Changes

One of the easiest and most helpful self-care techniques is the monitoring of food and diet. Identify food allergies, such as dairy, wheat, eggs, chocolate, citrus fruits, corn, and MSG. These are all common food allergens, and have been found to intensify with fibromyalgia. By following elimination diet (eliminating one possible food allergen for 2 weeks), problem foods can be identified and subsequently avoided. It is advisable to avoid sugar as much as possible.

Evaluate the acid/alkaline content of your diet. High acid foods consumed over time can lead to a weakened immune system. Eat more vegetables; it appears that a vegetable-based diet offers relief to fibromyalgia patients.

Add more fish to your diet as a great source of protein and nutrients. Fish also contains anti-inflammatory essential fatty acids.

Exercise to tolerance. Exercise cannot be overestimated in improving FMS symptoms. Extreme exercise, however, may cause muscle pain. Make sure that you also get enough rest and relaxation. Stress reduction may be the most important factor in improving the overall well being of fibromyalgia patients. Meditation and massage may also help.

Nutritional Supplements

Always check with your doctor before taking any nutritional supplements. Magnesium and Malic Acid. Magnesium relaxes the muscles. It can help alleviate muscle pain, strain, rigidity, and spasms. Most people with fibromyalgia are deficient in magnesium. Malic acid is important in the citric acid cycle, which helps with the overall transport of magnesium through cell membranes. Recommeded Dose: Magnesium, 400 to 600 mg/day; malic acid, 600 to 1200 mg/day.

B-Vitamin Complex. All of the B vitamins can play a leading role in energy production, rejuvenating nerve cells, protecting nerve coverings, and metabolizing proteins, carbohydrates, and essential fatty acids. Dose: 25 mg of vitamins B1 and B2, 50 mg of vitamin B6 and inositol, and 100 to 200 mcg of vitamin B12 b.i.d.

Calcium. It should be given in conjunction with magnesium (approximately a 2:1 ratio). Calcium deficiency can cause muscle cramps. Recommeded Dose: 1,000 to 1,500 mg elemental calcium/day.

Vitamin C (ascorbic acid) and Quercetin. Vitamin C is an antioxidant, an anti-inflammatory, and an anti-allergic. Vitamin C and quercetin can decrease histamine levels. Recommended Dose: vitamin C, 1 to 3 g/day; quercetin, 400 mg t.i.d.

EFAs (Essential Fatty Acids) - fish oil and evening primrose oil. EFAs are natural anti-inflammatories that can help with muscle and bone inflammation. Recommended Dose: 1 to 3 g/day. Evening primrose oil should be standardized to contain 8 percent gamma linolenic acid.

Proanthocyanidins (grape seed, Pycnogenal). Proanthocyanidins act as antioxidants, protecting against degenerative diseases. They also have anti-inflammatory and circulatory benefits. (Maffei Facino et al) Recommended Dose: 100 mg/day.

St John's Wort (Hypericum perforatum). If depression and anxiety accompany or trigger fibromyalgia episodes, St. John's Wort may be helpful. It is not to be used in conjunction with antidepressant drug therapy. Recommended Dose: 300 to 900 mg standardized to 0.3 percent hypericin.

Conclusion

Fibromyalgia, although painful, is not untreatable. Because symptoms vary from patient to patient, it is important to not give up hope for relief. FMS research reveals something new every year, and there are millions of people living functional lives with FMS. Don’t give up hope. Contact the Arthritis Foundation for more self-care measures by looking them up in your local phone book.