What is the treatment for fibromyalgia?

There is no cure for fibromyalgia. Treatments aim to reduce symptoms as much as possible. Over the years a range of different treatments have been advocated with variable rates of success.

In 2007, a team of experts from 11 countries got together. They looked at the evidence (from research trials, review papers, etc) to determine which treatments should be recommended. Their recommendations were based on the results of research trials that had shown when a treatment had been beneficial to at least some people with fibromyalgia. They published a guideline called ‘EULAR evidence-based recommendations for the management of fibromyalgia syndrome’. A number of recommendations were made, and each is briefly mentioned below.

But note: each person is different and has different circumstances and degrees of symptoms. Also, not all treatments help in all cases, and not all treatments may be locally available. Your doctor is likely to discuss the pros and cons of the various options, and help you to decide which is the best option, or options, to try. Indeed, the guideline pointed out that optimal treatment requires a combination of treatments: treatment without medication and treatment with medication. Also, that treatment should be tailored to the individual according to pain intensity, function, and whether such features as depression, tiredness and sleep problems are also present.

Exercise

Exercise does not always help, but studies have shown that it improves symptoms in a good number of cases. If you are able, consider gradually building up to more and more exercise. Aerobic exercises which cause little pounding, such as walking, cycling and swimming, are thought to be the best form of exercise to improve symptoms. Stretching exercises such as yoga may also help. A doctor or physiotherapist can advise on a suitable programme for your particular circumstances. The aim is to exercise safely and without increased pain. A typical goal to aim for is to build up exercise to 4-5 times a week for at least 20 to 30 minutes a session. However, it may take months to build up to this level.

For example, one study published in the British Medical Journal describes how people with fibromyalgia were prescribed an exercise class – mostly walking on treadmills, or using exercise bicycles. Each person was encouraged to gradually increase the amount of exercise. When people first started they usually did two sessions of exercise per class lasting about six minutes. By three months some people had increased to doing two sessions in each class lasting 25 minutes. At three months, about 1 in 3 people who did the exercise programme rated themselves as much, or very much, better.

Note: pain and stiffness can get worse for a short while when you first start on an exercise programme.

Heated pool treatment with or without exercise

Heated pool treatment (balneotherapy) has been shown to improve symptoms in some cases. Some trials that looked into this included exercise in addition to heated pool treatment, and some did not. Both with and without exercise seemed to help in some cases.

For example, in one study of 42 fibromyalgia patients, half received 20 minutes’ bathing, once a day, five times per week, for three weeks (total of 15 sessions). Half did not have this treatment. The patients were evaluated by the number of tender points, and symptom severity (mainly pain). The evaluation was initially straight after the therapy, and then after six months. The results showed that, on average, the treated group had significantly less tenderness and pain – even six months after the treatment had finished.

Your doctor or physiotherapist may recommend a locally based heated hydrotherapy pool. However, if none is available, a heated swimming pool, or jacuzzi may suffice, or simply lying in a warm bath for 20 minutes per day may be of benefit.

Cognitive behavioural therapy (CBT)

CBT may be of benefit to some people with fibromyalgia. CBT is one type of talking treatment (psychotherapy). It is used as a treatment for various mental health and physical problems. Unlike other types of psychotherapy it does not involve ‘talking freely’, or dwelling on events in your past. CBT tends to deal with the here and now – how your current thoughts and behaviours are affecting you now. CBT is problem-focused and practical. CBT may actually help to ease pain symptoms. But it can also help you to take control of the extent to which pain, tiredness, or other symptoms interfere with your life.

Other therapies

The guideline recommended that other therapies may be useful, depending on the individual person’s needs. The therapies thought to be useful included relaxation, physiotherapy, acupuncture and psychological support.

Are there any medicines that can help improve fibromyalgia symptoms?

Painkillers
Painkillers such as paracetamol, anti-inflammatory painkillers such as ibuprofen, orstronger painkillers such as codeine may help to ease pain. However, they often do not work very well in fibromyalgia.

Tramadol is a stronger painkiller and is recommended if the above painkillers are not helpful. Research studies have shown the benefit of tramadol in people with fibromyalgia.

Very strong opiate painkillers such as morphine are not recommended. This is because fibromyalgia is a long-term condition. It is unwise to take strong opiates long-term, due to problems with medication dependence.

Antidepressants
An antidepressant medicine is a common treatment for fibromyalgia. Research studies have confirmed that antidepressants are often helpful for easing pain and improving overall function. They may also help with disturbed sleep. Although they are called antidepressants, they are not used in fibromyalgia to treat depression. Tricyclic antidepressants ease pain separately to their action on depression. Antidepressant medicines are used to treat various conditions apart from depression.

There are various antidepressants and your doctor will advise on one, if needed. A trial of 4-6 weeks is often advised, and continued if found to be helpful. Low doses are often used (compared to a dose that may be used to treat depression). However, if you have depression in addition to fibromyalgia, then a full-strength dose would be appropriate to treat both the pain of the fibromyalgia and the depression.

Other medicines
Medicines called pregabalin and gabapentin have been shown to help some people with fibromyalgia.

Other treatments

Some people try complementary or alternative treatments such as aromatherapy, massage, etc. There is little evidence that such treatments relieve the core symptoms of fibromyalgia. However, some people find that certain treatments help them to relax, feel less stressed, and feel better in themselves, which helps them to cope better with their condition.

Note: sleeping tablets are not often used, as they do not help with fibromyalgia, and can be addictive. See separate leaflet called Insomnia (Poor Sleep) which gives tips on getting a good night’s sleep and may be of benefit if you have difficulty sleeping.

Fibromyalgia does not shorten expected lifespan. The outcome is very variable. In some cases, symptoms ease or go after a few months. However, in many cases it is a persistent (chronic) condition which tends to wax and wane in severity. Quality of life can become affected.