Chronic Pain Treatment for Fibromyalgia

While there is no cure for fibromyalgia, a combination of treatments can help manage symptoms. These may include:

Medications

Pain relievers: Over-the-counter pain relievers like ibuprofen or acetaminophen may be helpful for some people. In more severe cases, prescription pain relievers or low-dose antidepressants like duloxetine or amitriptyline may be prescribed.

Antidepressants: Certain antidepressants can help relieve pain and improve sleep.

Anti-seizure drugs: Medications like pregabalin (Lyrica) and gabapentin (Neurontin) are often prescribed to help control nerve pain.

Physical Therapy

Tailored exercises and stretches can help improve mobility, strengthen muscles, and reduce pain. Gentle aerobic exercises, such as walking or swimming, can also be beneficial.

Cognitive Behavioral Therapy (CBT)

This type of therapy can help individuals cope with the emotional and psychological aspects of fibromyalgia, such as stress, anxiety, and depression.

Lifestyle Modifications

Sleep hygiene: Establishing a regular sleep schedule and creating a calming bedtime routine can help improve sleep quality.

Stress management: Techniques like deep breathing, meditation, and mindfulness can help manage stress.

Diet: While no specific diet has been proven to cure fibromyalgia, maintaining a balanced diet and avoiding food triggers (such as caffeine or processed foods) may help with symptom management.

Exercise: Regular, low-impact exercise (such as walking, swimming, or cycling) can help with muscle strength and reduce pain.

Trigger Point Injections

Trigger point injections involve injecting a local anesthetic (and sometimes a corticosteroid) directly into tender, tight muscle areas—called “trigger points.” These injections can help reduce muscle pain, relax tight muscles, and improve overall comfort.

Benefits: Trigger point injections are used to relieve localized muscle pain associated with fibromyalgia. They can offer quick relief, especially in areas of the body with significant muscle tension, such as the shoulders, neck, and lower back.

Limitations: While effective for short-term relief, trigger point injections typically do not provide a long-term solution. They can be repeated, but they do not treat the underlying causes of fibromyalgia.

First-Line Pharmacologic Treatments

Pain Relievers: Non-steroidal anti-inflammatory drugs (NSAIDs) or over-the-counter pain relievers (like acetaminophen) may be used, although they tend to be less effective in fibromyalgia compared to other conditions with inflammatory components.

Antidepressants: Duloxetine (Cymbalta) and milnacipran (Savella) are selective serotonin-norepinephrine reuptake inhibitors (SNRIs) that have FDA approval for treating fibromyalgia. These medications help not only with pain relief but also address symptoms of depression and anxiety, which commonly co-occur with fibromyalgia. Amitriptyline (a tricyclic antidepressant) is sometimes used to help with sleep disturbances and pain.

Anti-seizure Medications: Pregabalin (Lyrica) and gabapentin (Neurontin) are both approved by the FDA for treating fibromyalgia-related pain. These medications work by modulating nerve signals and reducing nerve-related pain.

Advanced Pharmacologic Treatments

For patients whose symptoms are more severe and do not respond to first-line treatments, the following options may be considered:

Opioids: Generally not recommended due to their addictive potential and lack of efficacy in fibromyalgia. However, they may be prescribed cautiously in rare cases for short-term use, if other options are not effective.

Muscle Relaxants: Drugs such as cyclobenzaprine may be used to reduce muscle tension, especially if spasms are prominent.

Complementary Therapies

Acupuncture: Some individuals find that acupuncture helps alleviate pain and improve overall wellbeing.

Massage therapy: Regular massage may help reduce muscle tension and pain.

Chiropractic care: While results may vary, some people find chiropractic adjustments helpful for managing pain.