Understanding Fibromyalgia: Treatment Options
Fibromyalgia is a chronic illness that causes chronic pain you might feel all over your body; fatigue; and trouble with cognitive functions like thinking clearly and long-term memory. It’s believed to be caused when your nervous system gets stuck in “alarm” mode.
Because there’s no cure, treating fibromyalgia is better envisioned as a journey instead of a one-size-fits-all treatment plan. You can try many therapies, including medications, graded exercise, cognitive-behavioral therapy (CBT) and functional medicine approaches.
There isn’t one single treatment that helps the majority of all people with fibro — treatment will be individualized to what works for you.12 Keep in mind while there are a lot of treatment options available, they might not work for you. In addition, sometimes treatment won’t completely stop your symptoms, but could help you feel at least a little better.
Finding the right treatment approach might be a long journey while you and your doctors find a plan that reduces your symptoms and addresses comorbid conditions.13
Specialists Who May Be Able to Help
Many doctors, including your primary care physician, may be equipped to find a fibromyalgia treatment plan that works. Sometimes, you might want to call a specialist. Specialist fibro doctors are more familiar with the full range of treatment options and resources for fibromyalgia. Depending on where you live, it may be difficult to find even one of these specialists.
Fibromyalgia is officially classified under the rheumatology banner. The American College of Rheumatology (ACR) writes the official criteria used to diagnose fibromyalgia, for example. Rheumatologists also have specialized training in musculoskeletal and autoimmune diseases like rheumatoid arthritis, osteoarthritis, gout and lupus.2
Pain Management Clinics
Not a particular type of doctor per se, but pain management clinics specialize in the challenges of living with a chronic pain condition. There are two types of pain clinics. The first offers comprehensive services that cover everything from medications to physical and occupational therapy, nutrition and psychological strategies to manage your pain. Other pain clinics offer treatments designed to shrink your pain level using injections and nerve blocks.23
Integrative/Functional Medicine Doctors
Integrative or functional medicine doctors often take a whole-body perspective to health. Overseen by the Institute for Functional Medicine, functional medicine doctors combine traditional treatments from the Western world, like medication, with research-backed alternative practices like acupuncture or myofascial release therapy and lifestyle changes.14
Other Health Care Professionals Who Can Help
Other medical professionals could offer additional treatment perspectives. Physical therapists can develop an appropriate graded exercise program to keep your muscles moving but reduce the pain of exercise.
Medications are one avenue of treatment for fibromyalgia that should be used as part of a larger treatment plan that also includes psychological and physical strategies.
There are three medications officially approved as fibromyalgia treatment options: duloxetine (brand name Cymbalta), pregabalin (brand name Lyrica) and milnacipran (brand name Savella). Your doctor may also try other drugs off-label, meaning they will prescribe a drug that’s FDA-approved to treat conditions with symptoms similar to fibromyalgia. Most fibro-approved prescription medications are only helpful to 30 to 50 percent of patients who use them.12
When designing a medication treatment plan with your doctor, you will likely explore several different methods. If you have a doctor who tells you there’s nothing else you can do after trying only one or two meds, look for another doctors or specialist.14 You may need to try six or more medications to find one that works. Often doctors who don’t specialize in fibromyalgia are unaware of other options to try off-label.13
As with any medication, your doctor should explain what the drug does, how to take it and what it’s for. They should let you know how long until you might feel a difference, as well as what side effects you might experience. You may not need medication for life, but pain-reducing drugs can calm the overactive parts of your nervous system related to fibromyalgia pain.13 Bring up any questions or concerns about your medication with your doctor.
Duloxetine (brand name Cymbalta) is a serotonin and norepinephrine reuptake inhibitor (SNRI) that’s commonly used to treat depression and anxiety. In 2008, the U.S. Food and Drug Administration (FDA) approved duloxetine for fibromyalgia pain because of its effectiveness and safety.24 Common side effects include dizziness, drowsiness, insomnia and nausea. Like all antidepressants, duloxetine includes a black box warning because it may increase suicidal ideation. Other serious possible side effects include liver damage, abnormal bleeding and severe skin reactions.7
Pregabalin (brand name Lyrica) was the first drug approved by the FDA to treat fibromyalgia and other nerve pain-related conditions. It’s believed to help calm down your nervous system and reduce your pain and help you sleep better.3 The most common side effects are dizziness and sleepiness, though you may also experience, blurry vision, weight gain, trouble concentrating, swelling in your hands and feet, dry mouth and feeling “high” or euphoric. Pregabalin can increase the risk of suicidal thoughts and may cause serious allergic reactions like any drug.15 However, overall pregabalin is considered a safe medication.3
Milnacipran (brand name Savella) was the third FDA-approved drug for fibromyalgia. It’s formulated as an SNRI, so it works like an antidepressant and increases neurotransmitters like norepinephrine. Research has shown it can help reduce fibromyalgia pain, fatigue and cognitive issues. Because it works like an antidepressant, it can also be helpful if you have symptoms of depression as well.19 The most common side effects are nausea, headaches, constipation, dizziness, insomnia, hot flush, excessive sweating, vomiting, palpitations and increased heart rate, dry mouth and increased blood pressure. It may also increase your risk of suicidal thinking and other serious complications, though these are rare.1
Gabapentin (brand name Neurontin) was approved by the FDA in 1993 as a seizure medication. Its use was later expanded for postherpetic neuralgia, the nerve pain caused by shingles. Beyond these two uses, gabapentin is commonly prescribed off-label for fibromyalgia. The drug works by reducing the amount of chemicals nerve cells release that communicate pain. Gabapentin’s most common side effects include feeling dizzy or drowsy. It may also increase your risk for suicidal thoughts and cause a lack of coordination, nausea and vomiting, swelling in your legs and feet, vision problems and tremors.21
Other Prescription Drugs Your Doctor May Try
If you’ve tried the three FDA-approved drugs for fibromyalgia without any relief, consult a specialist about additional medication options. There are about 10 to 15 other medications your doctor may recommend off-label, especially if you don’t respond to the common fibromyalgia drugs.9
These might include:9, 10, 24
- Amitriptyline (brand name Elavil, an older type of tricyclic antidepressant)
- Bupropion (brand name Wellbutrin, an antidepressant)
- Cyclobenzaprine (brand name Flexeril, tricyclic antidepressant also used as a muscle relaxer)
- Fluoxetine (brand name Prozac, an antidepressant)
- Memantine18 (brand name Namenda, used to treat Alzheimer’s disease and dementia)
- Paroxetine (brand name Paxil, an antidepressant)
- Sertraline (brand name Zoloft, an antidepressant)
- Sodium oxybate (brand name Xyrem, used to treat the sleep disorder narcolepsy)
- Tizanidine (brand name Zanaflex, a muscle relaxant)
- Tramadol (brand name Ultram or ConZip, narcotic for pain relief)
- Venlafaxine (brand name Effexor, an antidepressant)
Low-dose naltrexone (brand name Revia), a medication used for those who have an opioid or alcohol dependence, has been shown in studies to help with fibromyalgia symptoms.14