Treatment for Fibromyalgia
The goal of treatment for fibromyalgia is to reduce pain, improve sleep, and relieve associated symptoms. Fibromyalgia treatment is tailored to the individual patient. During treatment, some patients experience significant relief of symptoms, some find moderate improvement, and others report little or no relief. Complete symptom relief occurs in only about 5% of fibromyalgia patients. Most fibromyalgia treatment plans include medication, lifestyle changes, exercise, physical therapy, and behavior modification.
Medications that may be used to treat fibromyalgia include duloxetine hydrochloride (Cymbalta®) and pregabalin (Lyrica®). These drugs can reduce pain and improve function in some patients.
Common side effects of Cymbalta include constipation, diarrhea, dry mouth, and nausea. Cymbalta also may cause dizziness and hot flashes, and can increase the risk for depression, other psychiatric disorders, and suicidal thoughts in some patients. Side effects associated with Lyrica include dizziness, excessive sleepiness (somnolence), blurred vision, and weight gain. Patients should notify a physician if severe side effects occur.
In 2009, milnacipran (Savella®) was approved by the U.S. Food and Drug Administration (FDA) to treat fibromyalgia. This medication should not be used in patients who are taking a monoamine oxidase inhibitor (MAOI; e.g., isocarboxazid [Marplan®], phenelzine [Nardil®], rasagiline [Azilect®]). Side effects of Savella include excessive sleepiness, mood changes, and thoughts of suicide. Patients who are taking this drug should avoid drinking alcohol.
Another class of antidepressants that may be used to treat fibromyalgia is selective serotonin-reuptake inhibitors (SSRIs). These drugs boost the level of the neurotransmitter serotonin in the brain, which modulates mood, but do not improve physical symptoms. Fluoxetine (Prozac®) is a commonly prescribed SSRI.
Antidepressants usually are prescribed at the lowest possible dosage and then gradually increased, if necessary. The overall benefit of these medications appears to be limited, as far as relieving pain, fatigue, and sleeplessness. Many patients are unable to tolerate antidepressant side effects, even at low doses, and stop taking them. Side effects include nausea, loss of appetite, and insomnia.
Small doses of aspirin or acetaminophen may provide some pain relief and relieve muscle stiffness. Nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen), narcotics, and corticosteroids (e.g., prednisone) have not proven to be effective. Due to potenially severe gastrointestinal and cardiovascular side effects, NSAIDs should only be used as instructed.
Trigger point injections involve injecting a local anesthetic, such as lidocaine, and/or a corticosteroid into a tender point and then stretching the involved muscle. Local anesthetic increases blood flow to the muscle and corticosteroids reduce inflammation. The injections can be painful, and it may take 2 to 4 days for improvement.