Fibromyalgia syndrome (FMS) is an illness that causes widespread muscle pain, tender points, poor sleep, and fatigue. It is called a syndrome because it is a collection of symptoms rather than an actual disease. The cause of FMS is not clear, and it can be hard to diagnose and treat. FMS can affect every aspect of your life – your family, work, and social life.
A physical therapist (PT) will ask you to share your personal goals and ask you how FMS affects your life. Together, you and your PT can design a program that meets your needs. A PT can teach you how to move with comfort instead of pain. He or she will help you work toward a new, realistic fitness level. Although it may differ from the fitness level you had before FMS, it will be better for you overall. A PT can also help you slowly and safely increase your flexibility and muscle tone. He or she can develop an exercise plan that will stabilize and gently strengthen your muscles so you will have less pain.
Myofascial release is another tool that is often helpful for people with FMS. Many PTs have special training in myofascial release that can help reduce pain and discomfort. Physical therapists who specialize in edema (swelling) reduction or lymphatic drainage may be helpful in achieving more comfort, less pain and improved function.
Usually a health care provider who specializes in treating FMS has a team that includes a physical therapist. If your health care provider does not know of a PT who regularly treats FMS or chronic pain patients, you may need to find a PT specializing in chronic pain on your own. Go to your local phone book or search on the Internet and make a list of private PT clinics near you. Call each clinic and request an interview.
If you have regularly followed a PT training plan for a while and do not feel that you are getting better, consider changing therapists. There is a vast difference between therapists based on age, interests, setting and training. Choose a therapist who can both inspire and guide you toward well-being and healing. Make sure that you are working with a therapist who understands chronic pain. If the clinic is full of sports medicine patients training for marathons, you may not be in the best setting for your needs.
- Tricyclic anti-depressants – You may be given one of these medicines whether or not you have depression. Research shows that this type of medicine may help you sleep better and feel an overall sense of well-being. Results also show that this medicine can decrease the intensity of pain but not the number of tender spots. Tricyclic anti-depressants are FDA approved but their treatment of FMS is called an off-label use. Some commonly used tricylclic anti-depressants are amitriptyline (Elavil), nortriptyline (Pamelor) and imipramine (Tofranil). Although these medicines can be helpful, you may have a problem with certain side effects. These may include weight gain (especially when taking amitriptyline), dizziness and dry mouth.
- Muscle relaxants – This type of medicine is often used for treating muscle spasm. However when given as treatment for FMS, this medicine may relieve pain and help you sleep better. Muscle relaxants are FDA approved but their treatment of FMS is called an off-label use. Commonly used muscle relaxants are cyclobenzaprine (Flexeril) and carisoprodol (Soma). Cyclobenzaprine is similar to a tricyclic anti-depressant and is sometimes used just at night to improve sleep. These medicines tend to lose their effectiveness over time.
- Pregabalin (Lyrica) – This is one of a few medicines approved by the US Food and Drug Administration (FDA) specifically to treat FMS pain. Lyrica is used to reduce pain associated with fibromyalgia and improve sleep and fatigue. In one study, patients taking pregabalin reported significant improvement in the quality of sleep based on daily sleep diaries and a sleep scale measurement. Also, patients taking pregabalin said they felt less tired and were better able to do their regular activities of daily living. Most common side effects of pregabalin include mild-to-moderate dizziness and sleepiness. It may also impair motor function and cause problems with concentration and attention.
- SNRIs – Serotonin and norepinephrine reuptake inhibitors (SNRIs) are used for both depression and pain management. SNRIs may be used to decrease pain and tenderness in FMS patients with or without depression. They may also help improve your sleep, concentration and moods. Examples of commonly used SNRIs are venlafaxine (Effexor) and duloxetine (Cymbalta). Duloxetine and another medicine called Milnacipran (Ixel) have recently been approved by the FDA specifically for treating FMS. All of these medicines have effects on the serotonin system as well as other neurotransmitters and are helpful in treatment of chronic pain. Side effects may include sleep problems, dry mouth and constipation.
- SSRIs – Selective serotonin reuptake inhibitors (SSRIs) are used for both depression and pain management. Research studies have shown that SSRIs are particularly helpful in treating FMS symptoms in women. These medicines are often given in combination with a tricyclic anti-depressant, as this makes them more effective in treating FMS symptoms. Commonly used SSRIs include fluoxetine hydrochloride (Prozac), paroxetine (Paxil) and sertraline hydrochloride (Zoloft). Side effects may include loss of appetite, anxiety and sleep problems.
- Tramadol – This is sometimes called a “weak opioid” or “narcotic-like” medicine. It works much like a regular opioid in relieving pain but has less severe side effects. It may be used alone or in combination with acetaminophen (Tylenol). Examples are tramadol (Ultram) and tramadol/acetaminophen (Ultracet). Side effects may include dizziness, nausea and constipation.
- Other medications – Trazodone is very effective for sleep and often has fewer side effects than the tricyclic anti-depressant medicines.
Medicines that often are prescribed, but are of questionable benefit include:
- NSAIDs – These are also called non-steroidal anti-inflammatory drugs. These medicines may help decrease inflammation if you have another disorder in addition to FMS. Examples of disorders that cause inflammation are arthritis and lupus. NSAIDs are not helpful if you have FMS alone because inflammation is not a symptom of FMS. NSAIDs are sometimes used as simple pain relievers, although acetaminophen (Tylenol) has less risk of complications and may be a better choice. Examples of NSAIDs are ibuprofen, naproxen and celecoxib (Celebrex). NSAIDs may be helpful for treating FMS pain when given together with other medicines, such as tricyclic anti-depressants.
- Opioids – These medicines are best avoided, but some providers may prescribe them as a last resort if other drugs and non-drug treatments do not help. Examples of commonly used opioids are acetaminophen with codeine, oxycodone (Percocet), morphine and hydrocodone (Vicodin). Long-term use of these medicines does not necessarily decrease pain associated with FMS. They can even contribute to more pain in the long run. More research is needed to learn about the effectiveness of opioids for treating FMS.