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Fibromyalgia - Treatment
There are a number of treatments available for fibromyalgia. Unfortunately, since medical science hasn't firmly established its cause, we have yet to find a definite cure. There are, however, some very promising treatments that we are doing at Paragon that have made many patients dramatically better or even symptom-free.
Medications for Fibromyalgia
While depression is much more common in fibromyalgia patients than the general public, these medications have several other effects that greatly help people with FM (although they are used in much smaller doses in non-depressed patients).
Antidepressants
Antidepressants have the specific effect of causing a person to spend more of their night in the deeper stages of sleep, making them very helpful for FM sufferers. They also have a completely different effect in the spinal cord, causing a person to become less sensitive to pain. Many patients find this effect very helpful.
Muscle Relaxants
There are a number of muscle relaxants that have been used in fibromyalgia; the most common one is called Flexeril (cyclobenzaprine). In patients who have a lot of trouble with muscle spasm or tightness, this can be beneficial. Some of its effect may also be due to the fact that its structure is similar to some antidepressants, and it may share some of their effects on pain sensitivity.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Tylenol (acetaminophen)
Aspirin is the prototype NSAID, and many others have been derived from it (ibuprofen, naproxyn, Feldene, Vioxx, Celebrex, etc.). These drugs help pain by relieving inflammation in the tissues and by blocking pain sensation in your brain. (Tylenol has much less anti-inflammatory action.) Since there is minimal inflammation in most cases of fibromyalgia, this effect usually not of much benefit. The pain-blocking effect, however, can greatly help some people.
Strong analgesics
In this class are drugs like Ultram, Darvocet, and the narcotics (Tylenol w/ codeine, Vicodin, Percodan, morphine, etc.). While these medications can be used in severe flare-ups, we discourage their use in fibromyalgia. They tend to be addictive; they cause numerous side effects; and they tend to cause a tolerance, requiring higher and higher doses to get the same effect. Several studies have shown propoxyphene (the primary analgesic in Darvocet) to be no more effective than aspirin as a pain reliever. If any drug from this class is required, we encourage the use of Ultram, since it has the lowest potential to cause addiction or tolerance.
Antifungals
A number of patients with fibromyalgia show signs of having candida hypersensitivity syndrome. If this is present, a very low carbohydrate diet and use of specific medicines to lower the amount of candida (the yeast used to make bread rise) in the body are required. For more information on this condition, see our Links page.
Thyroid hormone therapy
This is one of the most cutting-edge medical treatments we prescribe at Paragon. We have observed that many patients with FM have normal thyroid function tests despite having classic symptoms of poor thyroid function. We are investigating this condition and looking into a variety of ways to treat it. Some patients appear to have a reduced ability to convert the form secreted by the thyroid gland (T4) into the much more active form (T3), which causes most of the hormone's effect. Other patients appear to have an inhibited thyroid receptor (this is the protein in the cells that thyroid hormone binds to in order to cause its effect). In either case, there are treatments available, although they require close supervision by a physician.
There are many other types of medications, vitamins, herbs, etc., recommended for fibromyalgia. While unproven, some of these may provide at least mild benefit.
Myofascial Trigger Point Therapy
The muscular pain in fibromyalgia is often severe and debilitating. The vast majority of fibromyalgia patients also have significant myofascial dysfunction. Whether this is due to the FM directly causing the myofascial dysfunction or if the pain causes tensing of muscles which leads to it is uncertain. In either case, a specific form of hands-on treatment, myofascial trigger point therapy, is unusually successful in helping relieve this pain. By working on trigger points to get them to relax, many patients with fibromyalgia experience significant or complete relief of their pain. Even if a person is currently seeing a hands-on therapist (physical therapist, chiropractor, napropath, masseur, etc.), we encourage them to try this form of therapy - they are often amazed at how effective it is.
Several of the symptoms that fibromyalgia patients often find very troubling are particularly responsive to MFTPT.
Pain
Much of the pain that accompanies FM can be due to either direct muscular pain or referred pain from trigger points. MFTPT is one of the most effective forms of treatment for this pain.
Fatigue and Sleep Disorder
Although there is a specific sleep disorder involved in FM, the muscular pain these patients experience contributes greatly to their problems sleeping.
Stiffness/Spasms
Stiffness is often due to muscular shortening, frequently in response to pain. Patients with this problem can be trained to treat themselves before bed and first thing in the morning using tools to release their trigger points and stretches to retrain their muscles'. This resumes the muscles normal resting length and reduces their stiffness.
Weakness
The presence of trigger points in a muscle causes a reflex in the spinal cord, resulting in inhibition of the muscle's activity. This is experienced as weakness. In many cases, if the trigger point is relaxed, the muscle's strength immediately returns.
Swelling
The lymphatic fluid that bathes our cells is carried back into the bloodstream by lymphatic ducts. If a lymphatic duct goes through a tense, tight muscle, it is squeezed so tightly that it can't carry the fluid, and that area of the body becomes swollen. FM patients often find that localized swelling goes away after their muscles are relaxed by myofascial therapy.
Headaches
Many FM patients report trouble with headaches, and in most cases these are due to referred pain from muscles in the head, neck, and shoulder regions. Relaxing these trigger points often dramatically improves the headache pains.
Psychotherapeutic Counseling
Many patients with fibromyalgia have been dismissed for years with the words, "It's all in your head." For years, medical opinion was that it was a stress-based disease. We at the Paragon Clinic know that this is not true. Like many other diseases (ulcers, migraine, irritable bowel syndrome, etc.), it is aggravated by stress, not caused by it. As a result, learning ways to manage stress can be very important.
Fibromyalgia is a debilitating, painful condition. Living with pain on a daily basis may erode a person's strength and willpower. Life becomes a chore to be endured, not an adventure to be enjoyed. FM patients watch the disease slowly sap their energy until they are no longer able to perform their job, their hobbies, or even the simplest tast. They may be fired, lose friends, or even be left by their spouses. There is some evidence that fibromyalgia may directly cause depression. Even if this were not so, its life effects certainly could. This makes having effective support very important. We strongly encourage any patient suffering with symptoms of fibromyalgia to be active in a support group. In addition, counseling can prove invaluable in helping patients cope. Having the disease is bad enough - having it undermine your lifestyle is something that nobody should have to endure.
Some people with fibromyalgia may carry beliefs that act to worsen their condition. For example, some patients are highly driven and perfectionistic. When confronted with a disease causing pain and profound fatigue, they may continually try to push themselves to their limit, which only worsens their symptoms. Other people may fall into despair, feeling like there is nothing they can do to help themselves, so why bother? They may stop exercising and doing other forms of self-care, which also can cause their symptoms to worsen. These are just a few examples of cases where counseling can help patients to change attitudes that may be interfering with their recovery.
Exercise Therapy
It is well known that FM symptoms respond to conditioning. Movement, stretching, and, eventually, aerobic exercise are among the most effective things a fibromyalgia sufferer can do to improve their life. Not only does it lessen the pain, it also raises energy levels and improves sleep. Few people realize, however, how gently conditioning must be done in fibromyalgia. Many FM patients are highly driven, Type A individuals who push themselves very intensely. Unfortunately, when applied to exercising, this can cause them to seriously overdo it and create a major flare-up of their symptoms.
It's very important for FM patients to start slowly, recognizing how out-of-shape their pain and fatigue may have left them. In many cases, they may be completely unable to exercise, and the most they can reasonably do is stretching and some light walking. In other cases, patients may still be in good shape, pursuing activities like yoga, aerobics, and dancing. The important thing is to identify exactly what each patient is capable of doing, and, starting there, gradually work to improve their activity level, taking care not to precipitate a flare-up by overdoing it. (Though most patients will have some flare-ups at times during their treatment, we train them to treat themselves using compression tools, massage, and stretching.)
Nutrition
The role of nutrition in fibromyalgia is controversial, as well as highly variable from person to person. In general, fibromyalgia patients feel better when they:
- Follow a low-fat diet
- Avoid refined carbohydrates (sugars and starches)
- Avoid food additives (preservatives, coloring agents, monosodium glutamate, etc).
Although somewhat more expensive and inconvenient, a diet based on organic foods may provide a significant improvement in a fibromyalgia patient's quality of life. In addition, some patients may suffer from food allergies, which can be extremely hard to identify (since they may take as long as 36 hours to activate after eating the food causing the allergy). Many patients find a consultation with a nutritionist to be helpful in determining their ideal approach to eating foods that don't aggravate their problem.
Back - What is Fibromyalgia ?
Back - Fibromyalgia - The Nature of the Disease
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