What’s the Best Treatment for Fibromyalgia Pain?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Migraines, sensitivity to touch, fatigue and pain all over…that’s what folks with fibromyalgia deal with. For a long time, patients and doctors were frustrated that there were no definitive solutions for this often unbearable condition.

Well, researchers looked into what people were doing to treat their pain—from meditation and exercise to prescription drugs—and published what they found. Here’s what works (and what doesn’t). What have you tried?

 

 

What works for fibromyalgia pain

You might be surprised to know that it’s not medications, but general lifestyle changes and exercise, that are most effective for fibromyalgia pain.

Aerobic exercise

Aerobic conditioning and training (preferably supervised by a trainer or physical therapist) is the best possible treatment of fibromyalgia pain. These include exercises that get your heart rate up like walking, hiking, running, swimming, spinning, dancing and kickboxing.

Improving sleep hygiene 

“Sleep hygiene” is the term used to describe good sleep habits, and anything that affects your quality of sleep can affect how your body experiences pain. Many sleep hygiene tips are self-explanatory (like avoiding caffeine at night), but here’s a quick reminder of some things you can do:

Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy is a form of therapy used to improve mental health, and can be helpful for those coping with chronic pain. Ask your primary care doctor for a referral or look online at the Psychology Today Therapist Finder to find a therapist near you who takes your insurance.

Acupuncture

While the studies for acupuncture and fibromyalgia are somewhat mixed, many suggest that acupuncture has benefits. The downside here is cost as many insurance plans don’t cover acupuncture, but it’s worth calling your plan administrator to check anyway.

Meditation

Meditative exercises like tai chi have been shown to help with fibromyalgia pain. If you don’t have access to an occupational or physical therapist who is trained in tai chi practice, other forms of meditation can help too. Meditation apps like Headspace, Buddhify or Calm have made it easier to learn basic meditation techniques and practice them daily on your own.

 

 

What probably doesn’t work for fibromyalgia pain

Medications commonly prescribed for fibromyalgia pain include Cymbalta (duloxetine), Lyrica (pregabalin), Flexeril (cyclobenzaprine), Savella (milnacipran), low-dose amitriptyline and Ultram (tramadol). But, these should probably not be your first option for treatment. In research studies, they showed little evidence for any benefit.

 

What you should NOT use for fibromyalgia pain

These medications, while sometimes prescribed for pain, should not be used for fibromyalgia. They don’t work for the type of pain that fibromyalgia causes, and could be harmful.

NSAIDs

NSAIDs (non-steroidal anti-inflammatory drugs) like naproxen (Aleve) and ibuprofen (Motrin, Advil) don’t appear to work for fibromyalgia pain.

Opioid narcotics

Opioid narcotics are powerful pain-relieving medications that work for some types of pain, but they don’t work for fibromyalgia. They can also be harmful—and addictive. These drugs include hydromorphone, hydrocodone and fentanyl.

MAO inhibitors

MAO inhibitors are best known as a class of antidepressants, but they’ve also been tested as a form of treatment for fibromyalgia pain. They aren’t really used at all anymore, but include rasagiline (Azilect), selegiline (Eldepryl, Zelapar) and tranylcypromine (Parnate).

 

How do I know if I have fibromyalgia?

The Fibromyalgia Rapid Screening Tool (FiRST) is a self-administered questionnaire developed by the French Society of Rheumatology that can fairly accurately help most people detect whether they have fibromyalgia. FiRST consists of questions covering fibromyalgia symptoms like fatigue, pain characteristics, non-painful abnormal sensations and sleep problems.

 

Dr O.

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