Fibromyalgia Pain

Managing Fibromyalgia Pain

With an as yet elusive etiology, treatment of fibromyalgia is symptomatic. This includes patient education regarding the nature of the problem, lifestyle modifications (e.g., stress management, exercise programs) and pharmacologic interventions to relieve pain, to improve sleep quality, and to treat concurrent mood disorders.

Nonpharmacologic Management

Clinical trial data support the efficacy of aerobic exercise, cognitive-behavioral therapy (including stress-reduction programs and patient education), hypnotherapy, electromyographic biofeedback, and electroacupuncture in relieving the pain of fibromyalgia.⁶⁰ Physical therapy is commonly employed. Local measures such as heat massage, injection of tender points with steroids or lidocaine, and acupuncture provide only temporary relief of symptoms.⁵⁸ Aerobic exercise and strength training activities improve pain, tender point counts, and sleep disturbance;^64-66 other therapies such as biofeedback, hypnosis, stress management and relaxation therapy may help to varying degrees. Many patients with fibromyalgia will use CAM therapies, but there is no evidence for improved outcomes.⁶⁷

Nonpharmacologic Management Options
Cognitive behavioral therapy Hypnotherapy Biofeedback Relaxation therapy Stress management	Aerobic exercise Physical therapy Strength training Heat massage

Pharmacologic Management

There have been significant advances in the pharmacotherapy of fibromyalgia. Randomized controlled trials have demonstrated the efficacy of tricyclic antidepressants, SNRIs (duloxetine), and SSRIs (paroxetine and fluoxetine). ^68-71 Randomized controlled trials also have been positive for gabapentin and pregabalin, and the dopamine agonist pramipexole.^72-74 NSAIDs and benzodiazepines are often prescribed, and there is a randomized trial demonstrating benefit from the combination of ibuprofen and alprazolam.⁷⁵ Tramadol also has been shown to be effective in controlled trials,⁷⁶ and although other opioids have not been studied and appear to have limited efficacy overall, occasional patients appear to benefit from long-term therapy.