Most experts in the field of fibromyalgia recommend a multi-faceted, tailored treatment program incorporating both pharmacologic and non-pharmacologic therapy (i.e., education, physical therapy, and cognitive behavioral therapy) (Tits 2011; Goldenberg 2004). Since the experience of fibromyalgia and the reaction to therapy is largely shaped by a complex interaction of physical, psychological, and social factors, most experts suggest a multidisciplinary approach, which involves a team of clinicians from a variety of medical disciplines (e.g., family practice, physical therapist, and mental health specialists) (Carville 2008; Hassett 2009). An appropriate fibromyalgia management program should be aimed at symptomatic treatment of pain, fatigue, and sleep quality, as well as improving physical capacity and emotional balance (de Miquel 2010).
Conventional Pharmacologic Therapy
Traditional pharmacotherapy for fibromyalgia includes the wide variety of medications listed below (Traynor 2011):
- Pain relievers (e.g., opioids; nonopioid analgesics; local anesthetics)
- Sleep Aids
- Anti-inflammatories (e.g., nonsteroidal anti-inflammatory drugs (NSAIDs)) Antidepressants
- Botulinum toxin (Botox®)
- Muscle relaxants
While all the above medications are commonly used to treat fibromyalgia, the FDA has only approved 3 specific drugs for this indication. In June 2007, pregabalin (Lyrica®), an anticonvulsant drug, became the first to be approved. A year later duloxetine (Cymbalta®), an antidepressant, became the second. The most recent addition to this list is the antidepressant milnacipran (Savella®), which was FDA approved in January 2009.
Unfortunately, none of these medications are effective for the entire scope of symptoms and disabilities associated with fibromyalgia (Argoff 2002). Furthermore, many patients either fail to respond or develop significant side effects to these drugs, especially since they are required to be on them long-term (Braz 2011).
Pharmacotherapy is typically initiated only after less invasive strategies have failed. Since fibromyalgia patients often present with dissimilar symptoms and different symptom severities, there is no universally applicable drug treatment algorithm available. Therefore, physicians generally direct treatment at the most bothersome symptoms, organize potential therapies by mechanism of action, and start with drugs that carry the lowest side effect profile (Traynor 2011).
Conventional Non-Pharmacologic Therapy
Education concerning the diagnosis and treatment of fibromyalgia is not only effective, but also one of the cheapest and least invasive interventions (Luciano 2011). Educational interventions are particularly beneficial for fibromyalgia patients that have lived with the syndrome for many years, all the while believing that the symptoms were completely psychological (Goldenberg 2004). This not only leaves individuals with fibromyalgia feeling rejected by the medical community, but also induces significant stress, potentially worsening symptoms. Therefore, becoming informed about the disorder can not only ease the fear of the unknown, but produce a significant therapeutic effect as well (Pfeiffer 2003).
Cognitive behavioral therapy (CBT) and relaxation techniques have been shown to reduce pain and improve sleep (Glombiewski 2010). Lifestyle modifications such as exercising regularly, eliminating tobacco use, and reducing excess alcohol consumption should also be considered, as they are strongly associated with decreased pain and fatigue. Although regular aerobic fitness and strength training are significantly beneficial interventions, numerous patients are unwilling or unable to adhere to these regimens (due to pain) (Crofford 2001).