Fibromyalgia Treatments: Living Well with A Chronic Condition

Learning you have fibromyalgia can be a relief at first. It might be comforting to know your symptoms aren't all in your head. And that there's a name for your condition. But you may also be wondering, what next? What can you do to feel better and get on with life? Here's a look at a variety of effective treatments.

Psychological support such as cognitive-behavior therapy (CBT) can be beneficial in the treatment of fibromyalgia. Today's telehealth options can bring a therapist into your home on days you're too fatigued to go in person.

LIVING WELL WITH FIBROMYALGIA 

From medications to complementary therapies, a wide range of treatments can help you live with less pain, reduce brain fog and fatigue, and enable you to get a more restful night of sleep.

Some of these treatments involve making healthy lifestyle changes that are recommended for everyone, regardless of whether or not they have fibromyalgia.

Fibromyalgia is best managed by a team of doctors—typically your primary care provider, a rheumatologist, a physical therapist, and a psychologist. With the diagnosis behind you and so many options available today to relieve your symptoms, you take your first steps toward feeling better and living your best life depsite having a chronic condition.

FIBROMYALGIA MEDICATIONS, EXPLAINED 

Medication is often the first treatment your doctor will recommend, and there are now a number of options. Years ago, there were no prescription medications specifically for fibromyalgia. Fortunately, that’s no longer the case.

Three prescription medications are available now, according to the American College of Rheumatology.  In 2007, the US Food and Drug Administration (FDA) approved pregabalin (Lyrica) as the first drug to treat fibromyalgia. In 2008, duloxetine (Cymbalta) was approved and Milnacipran (Savella) was approved in 2009.1

Cymbalta and Savella are anti-depressants that change the brain chemicals known as serotonin and norepinephrine in order to control pain levels. Lyrica is an anti-epileptic drug that works to block the overactivity of nerve cells that are responsible for the body’s pain transmissions. Older off-label medications such as amitriptyline (Elavil) and the muscle relaxant cyclobenzaprine (Flexeril) may be used to treat fibromyalgia as well.

Some of these medications may help with relieving anxiety and with sleep difficulties, but they are not without side effects. Since everyone has a different reaction, you should find out from your doctor the various risks, benefits, and side effects of each medication. You also may work with your doctor to see how effective a particular medication has been once you have been taking it for awhile.

As for over-the-counter medications, some that may help with your pain are generic pain relievers like acetaminophen (Tylenol and generics) non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin and generics), and naproxen sodium (Aleve and generics).

Since some medications should not be taken with others, consult with your doctor before trying something new. “No one should start a medication without seeing their physician,” says Mohab Ibrahim, MD, PhD, an associate professor in the department of anesthesiology and pharmacology and director of the chronic pain clinic at Banner-University Medical Center at the University of Arizona. “How medications interact depends in part on what other medications or supplements you are taking and your medical and genetic profile.”

Non-pharmacological Treatments

 Prescription drugs aren’t the only option when it comes to feeling better.

“Non-medicinal pain management plays a huge role in managing your pain and improving your quality of life,” says Jessy Warner-Cohen, PhD, MPH, a senior psychologist at Northwell Health in Lake Success, NY. “There are so many strategies that can help, and you and your provider need to figure out a plan that works best for you and your needs.”

Exercising and getting enough sleep are the two most important components of a treatment plan for fibromyalgia, says Jawad Bilal, MD, a rheumatologist at the University of Arizona College of Medicine-Tucson, and associate director of the Rheumatology Fellowship Program. “If you can’t fix your sleep and if you don’t exercise, your fibromyalgia symptoms are not going to get better,” he says.

Get Moving!

Exercise has many benefits, from boosting your energy and strengthening your muscles to improving your mood and promoting restorative sleep. It’s hardly surprising that it’s beneficial for individuals living with fibromyalgia, too. Aerobic exercise in particular can be effective at treating fibromyalgia.1 Swimming, water aerobics, walking, and biking have all been shown to help, Dr. Bilal says.

Choose an activity that you like so you will continue doing it and not give up due to boredom after the first week. If you can’t stand the thought of dragging yourself out of bed to go swim in an indoor pool in the winter, sign up for a tai chi class or take regular walks with a friend. “If you are having trouble getting motivated, find someone to exercise with you,” Dr. Ibrahim says. “It really helps if you exercise with a friend.  When you have two people and one pushes the other, it can work much better.”

Walking is ideal for someone living with fibromyalgia, and you can begin gradually and build up, says Dr. Warner-Cohen. “Try walking for 10 minutes, and if that seems easy, then increase the walk to 20 minutes,” she says. “You can walk for five minutes and then turn around and walk back. Gradually, you will build up. Remember, the goal here isn’t perfection. It’s improvement.”

 Research shows that people who live with fibromyalgia can benefit from low-impact aerobic exercises such as tai chi or yoga.1 One study of women with fibromyalgia found that yoga was effective at helping them with pain, fatigue, mood, and also was useful at helping them develop coping strategies.2

 Whatever form of exercise you choose, start off slow—especially if it’s been awhile since you have exercised.  

Finding Psychological Support

Cognitive-behavioral therapy (CBT) can be beneficial in the treatment of fibromyalgia.1

CBT is based on the idea that how you feel and behave can influence your thoughts, and that your thoughts can influence how you feel and behave. The idea is that if you can change the way you think, you can change the way you act and feel.

 “Cognitive behavioral therapy can help you change your negative thoughts and modify your response to negative feelings,” says Traci Speed, MD, PhD, an assistant professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine. “It can help you replace maladaptive thoughts and find new coping skills.”

There are various other forms of counseling that are worth looking into, too. And if you have a session with a trained counselor, you can learn various techniques and skills that will help you control your symptoms 3

Support groups are another option worth looking into as they can provide you with the opportunity to reach out to others who are going through the same thing,  and help you manage the day-to-day symptoms. Here how to find a support group.

More Fibromyalgia Resources for You

Complementary Therapies to Consider

Complementary therapies can also be helpful. Among the ones to try are physical therapy, therapeutic massage, water therapy, light aerobics, acupuncture, relaxation exercises, breathing techniques, aromatherapy, and biofeedback.1  

Physical therapy can be very effective at relieving fibromyalgia pain for some patients, Dr. Ibrahim says.  “And it is most effective when it is moderate intensity rather than low intensity,” he says. “You should sweat a little but not exert yourself to the point of being out of breath.”In physical therapy, you can learn how to do certain exercises on your own that can improve your strength, stamina, and flexibility.

Acupuncture can be an effective and a safe treatment for fibromyalgia, per one study.4

For traditional Chinese acupuncture, an acupuncturist stimulates certain points in the body by penetrating the skin with sterilized, hair-thin needles and then manipulating them by hand. The thinking is that acupuncture can trigger the feel-good hormones called endorphins. These hormones, which are natural painkillers, may help decrease the perception of pain.

Get Virtual Help

One “silver lining” of the pandemic has been the rise of telehealth, says Dr. Warner-Cohen. “You can use telehealth to access resources that you may not have had before, especially if you have geographical restrictions,” she says. “Telehealth can also help you remotely assemble a care team that can help you with multiple aspects of your care.”

Want to learn relaxation exercises without leaving the house? There are various free apps that can help you learn how to reduce stress and anxiety, both of which can be making your fibromyalgia worse, Dr. Warner-Cohen says. Muscle relaxation training is one effective technique, she says, and you can learn how to do it by using an app on your phone.

One that Dr. Warner-Cohen recommends, Breathe2Relax, was originally designed for the military community but can be beneficial to anyone trying to lower stress and reduce anxiety. The app trains users on the belly-breathing technique, which confers overall mental health benefits.5

Dr. Warner-Cohen also recommends the COVID Coach app, created for everyone, including veterans, to promote good mental health during the pandemic. The free app includes tools for self-care and to improve your emotional well-being, along with education about coping during the pandemic, and graphs to visualize your progress over time.

Researchers are finding that online CBT can help with your fibromyalgia symptoms.6  Finding a provider to treat you online allows you to get therapy without ever leaving the house.

If you’d prefer not to go to in-person classes in tai chi or yoga classes, you will find plenty of online free classes in both.  If you decide to try exercise classes online, Dr. Speed suggests that you take one in-person class to learn the techniques and to have the instructor check to make sure you are performing the exercises correctly. Then you can have a more effective workout when you go virtual for the rest of the sessions.

Lifestyle Changes that Help

In addition to practicing relaxation and reducing stress, getting good sleep and eating well can help your fibromyalgia symptoms.1

Work on your sleep. “Sometimes an underlying cause of fibromyalgia can be poor sleep hygiene,” says Nilanjana Bose, MD, a rheumatologist with the Rheumatology Center of Houston. “If you are having unrefreshed sleep, I recommend a sleep study. If it turns out that you have a sleep disorder, consulting with a sleep specialist can be helpful.”

There are some easy things you can try to improve the quality of your sleep. Go to bed and get up at the same time every day, and make sure your bedroom is quiet, free from distractions, and is at a comfortable temperature. Avoid caffeine, sugar, and alcohol before going to bed, and don’t eat just before you turn in. As you fall asleep, try practicing some relaxation exercises.6

Pace yourself. It can seem like such a simple strategy, but it’s hard to put into practice. Try not to wait until you are worn out and about to crash to take a break, as this can mean spending the next few days in bed to recover. Instead, set a schedule of activity for yourself and move between periods of rest and activity. And do this when you are feeling good, too, as this can help you avoid the flare-ups that come when you overdo.7

Eat right.  “I tell my patients to modify their diet and to avoid too much sugar,” Dr. Bose says. “It’s best to follow a Mediterranean-style diet.”

To follow a Mediterranean-style diet, cut back on highly processed foods and begin eating more fruits and vegetables, whole grains, olive oil, and fish, especially fatty fish like salmon.

Take Charge of Your Care

When it comes to fibromyalgia, you play a crucial role in your care. “I tell my fibromyalgia patients that they are in charge,” says Dr. Bilal. “It is not like other diseases that are only about medication. The patient has to do a lot of things herself. You need to exercise, do physical therapy, work on your sleep. When you are exercising and you have good sleep hygiene, you will feel better.”

And make sure that you have a voice in your own care, says Dr. Warner-Cohen. “Of course there are people who have expertise in a specific area, like pain management, but you are the expert on you,” she says. “Find balance by trying the things that your care team suggests. Be open to changes in your care, but realize that this is not an all or nothing situation. It’s about finding the right strategy that combines different methods, and that works for you.”

 

Updated on: 12/10/20
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Mental and Emotional Therapy for Fibromyalgia
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