Characterized by pain, tenderness and fatigue, fibromyalgia is not easy to treat. When you have this disorder, known for so-called tender points on your body that hurt when pressure is applied, your primary doctor or your rheumatologist will rely on a number of treatments to reduce your pain. There's no cure for fibromyalgia, but medications and better self-care can help you manage your symptoms.
Less Pain and Better Sleep
Doctors often begin treatment for fibromyalgia with medication to help manage your pain, says Dr. Carey Dachman, a rheumatologist with Pain Therapy Associates in Schaumburg, Illinois. Among the newer options are Cymbalta (duloxetine), Lyrica (pregabalin) and Savella (milnacipran). There are also older drugs for fibromyalgia that help treat pain, including Elavil (amitriptyline) and Flexeril (cyclobenzaprine). If you're considering medication, though, always talk with your doctor about the risks and side effects.
Dachman says the best approach for his patients has been to take duloxetine in the morning and pregabalin at night. The pregabalin helps stimulate your endorphins—the feel-good hormones that are lacking when you have fibromyalgia—and can reduce nerve irritation in your neck area, he says. The duloxetine can increase your adrenaline. Both help fight against pain.
An added benefit of the pain medications is that they may help you sleep better. Sleep problems are common among people with fibromyalgia.
Drugs like ibuprofen and naproxen, part of a class of medications called nonsteroidal anti-inflammatory drugs (NSAIDs), are commonly used to treat headaches and muscle pain, but they also may help your fibromyalgia-associated muscle aches. However, using NSAIDs too often can cause side effects like high blood pressure and liver, kidney and heart problems. They're available over the counter, but make sure to talk with your doctor about how often you should use them.
With fibromyalgia, you’ll probably also see a physical therapist to manage the neck pain common with this condition. In addition, a psychologist can help you learn the techniques of cognitive behavioral therapy so you can better cope with your pain.
Some people with fibromyalgia also find relief with alternative therapies like biofeedback and acupuncture.
Taking better care of your physical health with exercise, stretching or yoga may also provide relief.
Plus, there are things you can do on your own to improve your sleep quality. For instance, try to go to bed and wake up at the same time each day. Limit your intake of caffeine and stop smoking. Not only is smoking bad for your health, but nicotine is a stimulant, which makes it harder to sleep.
When Typical Treatments Don’t Work
If your pain isn’t well-controlled with these common fibromyalgia treatments, then your doctor might use a cervical epidural to treat your pain. An epidural is a special kind of injection in the spine. Before trying this approach, you would have an MRI to confirm that you have neck arthritis, Dachman says.
Some doctors offer Ketalar (ketamine), a kind of anesthetic that's given via an infusion for about an hour.
“We’ve had great success with it,” Dachman says. “It helps reset the brain. It’s like shutting off a computer when it’s stuck.”
Ketamine is an NMDA receptor antagonist, and researchers are continuing to look at medications that target NMDA receptors to help treat fibromyalgia pain, Dachman says. In addition, studies also are underway to better understand the pain associated with fibromyalgia so that researchers can develop more targeted treatments.