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What Really Works for the Treatment of Fibromyalgia?

by Dr. Sharon Orrange on January 26, 2017 at 5:06 pm

Generalized pain, migraines, increased sensitivity to light touch, fatigue, not waking up feeling rested . . . that’s what folks with fibromyalgia are dealing with. For years patients have asked: what really works for fibromyalgia? Primary care doctors and their patients are frustrated there are no quick solutions and options for treatment.

Well, the Annals of Rheumatic Diseases just published a review of what works, and what doesn’t work for the treatment of fibromyalgia. Here goes.

Strong evidence this works:

  • Supervised aerobic exercise training. Walking, hiking, running, spinning, dancing, swimming, kick boxing, etc. Aerobic conditioning and training (preferably one that is supervised by a trainer or physical therapist) has the best results for the treatment of fibromyalgia.
  • Sleep hygiene habits. This is the term used to describe good sleep habits. You may think you know these, but take a look at one of the best resources for sleep hygiene tips.
  • Cognitive behavioral therapy (CBT). 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.

Go Eastern:

  • Acupuncture. While the studies for acupuncture and fibromyalgia are somewhat mixed, many suggest benefit. Cost is the downside here as many insurance plans don’t cover acupuncture.
  • Tai Chi. This form of meditative exercise has been shown to help with fibro aching. If you don’t have access to an occupational or physical therapist adept in this, there are many Tai Chi resources online.
  • Meditation. Meditation apps like Headspace, Buddhify, or Calm have made it easier to learn basic meditation techniques and practice these daily on your own.

Evidence is weak—don’t waste much time on these:

  • Cymbalta (duloxetine)
  • Lyrica (pregabalin)
  • Flexeril (cyclobenzaprine)
  • Savella (milnacipran)
  • Low-dose amitriptyline
  • Ultram (tramadol)

Recommendation AGAINST. Doesn’t work, and could be harmful:

  • NSAIDs don’t appear to work for fibromyalgia. Non-steroidal anti-inflammatory drugs (NSAIDs) include naproxen (Aleve) and ibuprofen (Motrin, Advil).
  • Opioid narcotics. These include hydromorphone, hydrocodone, fentanyl, etc. They don’t work for fibro and could be harmful—and addictive.
  • MAO inhibitors. These aren’t really used at all anymore but they include rasagiline (Azilect), selegiline (Eldepryl, Zelapar) and tranylcypromine (Parnate).

How do I know if I have or don’t have Fibromyalgia?

The Fibromyalgia Rapid Screening Tool (FiRST) is a self-administered questionnaire developed by the French Society of Rheumatology. It can quickly detect fibromyalgia with a sensitivity of 90.5% and a specificity of 85.7% in the general population.

FiRST consists of questions covering: fatigue, pain characteristics, non-painful abnormal sensations, sleep problems, and so on. Each question requires only a “yes” or “no” answer, with a “yes” being worth one point and a “no” worth zero points. The highest possible score is 6, with a cutoff of 5 or more associated with the highest sensitivity and specificity for fibromyalgia.

Dr O.

References
Macfarlane GJ, Kronisch C, Dean LE, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2016 Jul 4. [Epub ahead of print]


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