Fibromyalgia is a condition that's often hard to predict. Your symptoms may come and go without any clear pattern. They can also change over time.
Many doctors treat fibromyalgia in stages, which are based on how you feel. But these stages aren't set in stone. It's simply a way to group treatments and help your health team figure out what therapies might work best.
What Are the Four Stages of Fibromyalgia Treatment?
The four stages of fibromyalgia treatment are:
- Non-pharmacological treatments
- Psychological treatments
- Pharmacological treatments
- Daily functioning therapies
What are non-pharmacological treatments for fibromyalgia?
Non-pharmacological treatments are things you can do that don't involve medicines or formal therapies.
Patient education
With patient education, your health provider helps you understand your condition, so you can manage it effectively. When you know more about fibromyalgia, you can take better care of yourself.
Typically, patient education involves these strategies:
- You learn how fibromyalgia affects your body and mind.
- You get tips on how to control stress, pain, sleep problems, and fatigue.
- You become familiar with therapies or lifestyle changes that could help your symptoms.
Some research suggests that these types of education programs can improve pain levels and quality of life in people with fibromyalgia.
Exercise
Gentle movements like walking, biking, swimming, or stretching can lessen pain and stiffness. Regular activity may also boost your energy levels. As a bonus, exercise is good for your overall health.
Guidelines suggest you should aim to get at least 30 minutes of aerobic exercise three times a week.
Diet
Diet changes can improve fibromyalgia symptoms in some people. While there's no standard "fibromyalgia diet," you may feel better if you:
- Cut out sugars, saturated fats, and processed foods.
- Stay away from gluten and dairy.
- Eat whole foods, like fruits and veggies.
- Avoid additives, like MSG and artificial sweeteners.
- Stay hydrated.
- Take certain supplements.
Self-care
It's important to take good care of yourself if you have fibromyalgia. Here are some simple steps that could help you feel better:
Follow a sleep routine. Go to bed and wake up at the same time every day. Try to get seven to nine hours of sleep a night.
Pace yourself. Save your energy for when you really need it. Schedule important tasks for times when you feel your best.
Lower stress. Symptoms often flare up when you're stressed.
Lean on your support system. Connect with family and friends. Or join a support group where you can share about your struggles.
Other non-pharmacological approaches
Some people with fibromyalgia find success when they try complementary or alternative treatments. These therapies aren't scientifically proven, but they may help you feel better.
Examples include:
- Acupuncture
- Chiropractic care
- Yoga or tai chi
- Massage
- Meditation or other relaxation methods
- Hypnosis
- Biofeedback (a treatment that trains you to change how your body reacts to pain)
What are psychological treatments for fibromyalgia?
Psychological treatments are therapies that help you manage how you think and feel. Therapists can give you tools to deal with the pain, emotions, and stress that come with fibromyalgia.
Cognitive behavioral therapy (CBT)
CBT is a type of talk therapy that helps you understand your thoughts, feelings, and actions. Typically, you talk to a therapist about certain issues and ways to cope with them.
Research suggests that CBT can lessen pain, sleep problems, depression, and anxiety in people with fibromyalgia. These benefits are even better when CBT is combined with patient education.
Acceptance and commitment therapy (ACT)
ACT is a type of therapy where you learn to accept your thoughts and feelings, instead of avoiding them. You also take actions that can improve your daily life.
Studies have found that ACT may improve pain and sleep problems. The therapy also can help you cope with negative thoughts and emotions.
What are pharmacological treatments for fibromyalgia?
Pharmacological treatment means you take medicines to manage your fibromyalgia symptoms.
Approved drugs
The FDA has approved three medications to treat fibromyalgia:
- Duloxetine (Cymbalta): an antidepressant that may improve pain in people with fibromyalgia.
- Milnacipran (Savella): an antidepressant that can help with both pain and fatigue.
- Pregabalin (Lyrica): an anticonvulsant that calms overactive nerves, can help lessen pain, and can improve sleep problems if you have fibromyalgia
Though these medicines are the only "approved" treatments, other drugs are commonly used to help people with fibromyalgia manage symptoms. When medicines are prescribed for conditions they aren't approved to treat, it's called "off-label" use.
Pain relievers
Nonsteroidal anti-inflammatory drugs (NSAIDs) can lessen mild pain and help you sleep better. You can buy the NSAIDs ibuprofen and naproxen over the counter (OTC) at many stores. Your doctor can prescribe higher doses if needed. NSAIDs are generally safe but may cause stomach issues, headaches, or dizziness in some people.
OTC acetaminophen may also help relieve pain in some people. This medicine is an analgesic that changes how your body senses pain. Too much acetaminophen can cause liver damage.
It's important to note that doctors don't recommend opioid pain relievers for fibromyalgia. Some data suggests that these strong drugs might actually worsen pain.
Tricyclic compounds
Tricyclic compounds are medicines that balance certain chemicals in your brain. Two drugs in this class – amitriptyline hydrochloride and cyclobenzaprine (Amrix, Fexmid, Flexeril, Tabralol Fuse Paq) – may help relieve symptoms of depression and nerve pain in people with fibromyalgia.
Side effects of these medicines may include nausea, drowsiness, constipation, dry mouth, and tiredness. Amitriptyline hydrochloride also contains a special warning because it may increase the risk of suicidal thoughts and behaviors in young people.
Antidepressants: SSRIs and SNRIs
Antidepressants called selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) may help ease pain and treat mental health concerns in people with fibromyalgia. The FDA-approved fibromyalgia medicines duloxetine (Cymbalta) and milnacipran (Savella) are SNRIs. Doctors also prescribe other SNRIs and SSRIs off-label.
Some common ones used for fibromyalgia are:
- Fluoxetine (Prozac)
- Paroxetine (Brisdelle, Paxil)
- Sertraline (Zoloft)
- Venlafaxine (Effexor XR)
SNRIs and SSRIs can cause side effects like digestive issues, sleep problems, headaches, and changes in sex drive. These medicines also contain special package warnings about a higher risk of suicidal thoughts and behaviors in young people.
Anticonvulsants
Anticonvulsants calm overactive nerves. These medicines, which were made to treat seizures, may also help ease nerve pain in people with fibromyalgia. In addition to the FDA-approved fibromyalgia medicine pregabalin (Lyrica), doctors might prescribe the anticonvulsant gabapentin (Horizant, Neurontin).
Common side effects of these medicines include dizziness, tiredness, headaches, blurred vision, nausea, weight changes, and mood issues.
Sleep aids
The sleep aid zolpidem (Ambien, Edluar, Intermezzo) may help improve sleep issues in people with fibromyalgia. It works to slow activity in your brain, so you can sleep. This medicine contains a special warning because it can cause unusual sleep behaviors that you might not remember the next day.
What are daily functioning therapies for fibromyalgia?
Daily functioning therapies can help you perform everyday activities, even if you have pain or fatigue.
Occupational therapy (OT)
With OT, a therapist teaches you new ways to do everyday tasks. The goal is to help you live independently. You may practice strategies to save energy when you work, clean, get dressed, or cook. Sometimes, you learn how to use assistive devices like walkers, scooters, or supportive chairs to make everyday jobs easier.
Physical therapy (PT)
PT is a type of therapy used to help you move better with less pain. Your therapist might have you do exercises to increase your flexibility, strength, and mobility.
Studies suggest that PT can improve the quality of life in people with fibromyalgia. The therapy may include different techniques, like:
- Stretching and strength training
- Massage
- Hot or cold treatments
- Transcutaneous electrical nerve stimulation (TENS, a device that uses electrical currents to relieve pain)
- Hydrotherapy (water is used as part of therapy)
How Do Doctors Decide on Treatments?
Your treatment will depend on how bad your symptoms are. Some people might see noticeable results with exercise and diet alone. Others might need strong medicines to manage their pain.
Doctors often use the stages of treatment model to suggest a specific therapy. While these stages are helpful, every person is different. You may need both non-pharmacological and pharmacological treatments.
The Bottom Line
Treatments for fibromyalgia can help you feel better and have more energy. There are many options to manage pain, fatigue, and brain fog. Always talk to your doctor before you try any new therapy. Your provider can help you decide what treatments are safe, effective, and right for you.
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
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