Nonpharmacological approaches, including cognitive behavioral therapy, adequate sleep, and regular exercise, remain the most effective for the long-term management of fibromyalgia (FM), according to a recent review study.
The report, “Fibromyalgia in Primary Care,” published in the journal Primary Care: Clinics in Office Practice provides an overview of management challenges, up-to-date diagnosis criteria and current treatment options available to the primary care provider.
While the cause of fibromyalgia is still unknown, and a cure has yet to be found, adequate management can provide patients with a satisfactory quality of life.
With proper diagnosis and initial education, most fibromyalgia patients can improve their well-being and use healthcare services less.
Optimal management requires a multidisciplinary approach, which can combine education, nonpharmacological treatments, medication, and management of other conditions.
Out of all the approaches, nonpharmacological management, including education, cognitive behavioral therapy, adequate sleep practices, and regular aerobic exercise, is the most important in the long term.
It is also important that the healthcare provider gain the patient’s confidence, give reassurance that the condition or symptoms are not imagined, and educate the patient on harmful and excessive approaches and advertised promises of a cure that remains unproven.
Cognitive behavioral therapy can help to better educate patients and teach them techniques on how to adapt and deal with fibromyalgia symptoms, while gaining the support of other patients who face the same challenges.
Exercise has remained a mainstay of fibromyalgia management. In fact, it is the only therapy strongly recommended by the European League Against Rheumatism (EULAR).
Generally, aerobic exercise is preferred over weight-based exercise, and it should start at low intensity and increase gradually over time. One example is tai chi, which is a form of mind-body therapy rooted in traditional Chinese medicine that has been shown to improve fibromyalgia symptoms.
Quality of sleep, or sleep hygiene, is another central practice to manage fibromyalgia. Patients often experience poor-quality sleep, and in some cases, physicians may want to do an examination to rule out more serious problems such as sleep apnea.
In general, medications can help as add-on treatments, but benefits are variable, and side effects are frequent.
“Writing a prescription for FM may seem the fastest disposition in the busy clinic environment but, especially if used without other management techniques, is often doomed to failure. More than 50% of FM prescriptions are abandoned by the patient because of inefficacy or side effects,” the researchers wrote.
Researchers caution that nonsteroidal anti-inflammatory medications (unless there is another illness causing pain), corticosteroids, opioids, selective serotonin reuptake inhibitor (SSRI) antidepressants, and the anti-epileptic topiramate are not effective or don’t have any specific benefits for fibromyalgia.
There are only three treatments approved by the U.S. Food and Drug Administration for fibromyalgia: antidepressants Cymbalta (duloxetine), by Lilly, and Savella (milnacipran), by Allergan, and the anti-epileptic Lyrica (pregabalin), by Pfizer.
But common off-label medications — such as Elavil (amitriptyline) and Flexeril (cyclobenzaprine) — may be even better for reducing pain, according to a 2016 study. However, fibromyalgia patients are particular sensitive to side effects, especially sedation, from these medications, so they need to be given in very low doses.
To achieve the best medication regimen, patience and persistence are often needed to find the best therapeutic and dose combination for each patient; educating patients in realistic expectations of treatment goals is also important, the researchers say.
For healthcare providers, researchers recommend EULAR’s most recent guidelines on the management on fibromyalgia.
“The challenges of management can be discouraging to the patient and PCP [primary care provider] alike, but persistence and patience can be highly rewarding,” the researchers concluded.
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