How Fibromyalgia is Treated

As people experience fibromyalgia in different ways, treatment plans should be tailored to take into account individual needs and circumstances.

There is no cure for fibromyalgia but there are a number of treatment strategies that can make living with the condition more tolerable. It is important to try and break the vicious circle of sleep disturbance leading to greater pain which in turn leads to more disturbed sleep.

Patient Education

Becoming knowledgeable about this condition is the first step towards coping with it. Patient awareness is especially important given the scepticism of some doctors. There are excellent sources of information on the web, The Fibromyalgia Association UK provides info for both patients and doctors.

Stress Reduction/ Managing psychological distress

Many people find the pain associated with fibromyalgia to be particularly stressful and disheartening. Relaxation techniques can help reduce the stresses of living with this condition. Breaking tasks and activities into more manageable chunks can enable people to retain a sense of control and achievement.

Exercise

Exercise has been shown to be effective in reducing the pain of fibromyalgia. Recent research has shown that water-based exercise is effective for people with fibromyalgia and that strength training has been shown to benefit older adults in particular.

All exercise and stretching routines should begin at a very low level and gradually build up in terms of duration and intensity. Low-impact aerobic exercises such as cycling and walking are effective in helping with pain and sleep problems. Stretching is recognised as the best way to deal with the muscle tightness that is associated with fibromyalgia

Pain management

Tricyclic antidepressants at a low dosage have been shown to ease pain and help with disturbed sleep. Amitriptyline is the most frequently prescribed tricyclic for people with fibromyalgia. 25mg Amitriptyline taken at night together with 20mg fluoxetine taken in the morning has shown to be effective in easing symptoms through the day and ensuring sleep at night.

Recent trials using anti-seizure medication such as gabapentin and pregabalin have shown to be effective in easing pain and promoting sleep.

Treatment of sleep disturbance

Being able to sleep throughout the night and to experience deep or restorative sleep is viewed as important in breaking the vicious cycle of poor sleep followed by a day of fatigue and widespread pain. A considerable amount of work has now been done on sleep hygiene, Stanford University has produced a set of tips to help people with sleep disturbance:

• Sleep only when sleepy. This reduces the time you are awake in bed;
• If you can't fall asleep within 20 minutes, get up and do something boring until you feel sleepy. Sit quietly in the dark or read the warranty on your refrigerator. Don't expose yourself to bright light while you are up. The light gives cues to your brain that it is time to wake up;
• Don't take naps. This will ensure that you are tired at bedtime. If you just can't make it through the day without a nap, sleep for less than one hour, before 3pm;
• Get up and go to bed at the same time every day, even on weekends. When your sleep cycle has a regular rhythm, you will feel better.
• Refrain from exercise for at least 4 hours before bedtime. Regular exercise is recommended to help you sleep well but the timing of the workout is important. Exercising in the morning or early afternoon will not interfere with sleep.
• Develop sleep rituals. It is important to give your body cues that it is time to slow down and sleep. Listen to relaxing music, read something soothing for 15 minutes, have a cup of caffeine free tea or do relaxation exercises.
• Only use your bed for sleeping. Don't use your bed to watch tv, pay bills, do work or reading. So when you go to bed your body knows that it is time to sleep. Sex is the only exception.
• Stay away from caffeine, nicotine and alcohol at least 4-6 hours before bed. Caffeine and nicotine are stimulants that interfere with your ability to fall asleep. Coffee, tea, cola, cocoa, chocolate and some prescription and non-prescription drugs contain caffeine. Cigarettes and some drugs contain nicotine. Alcohol may help you sleep in the beginning as it slows brain activity, but you will end up having fragmented sleep.
• Have a light snack before bed. If your stomach is too empty, this can interfere with sleep. However, eating a heavy meal can interfere as well. Dairy products and turkey contain tryptophan which acts as a natural sleep inducer. Tryptophan is probably why a warm glass of milk is sometimes recommended.
• Take a hot bath 90 minutes before bedtime. A hot bath will raise your body temperature but it is the drop in body temperature that may leave you feeling sleepy.
• Make sure that your bed and bedroom are quiet and comfortable. A hot room can be uncomfortable. A cooler room along with enough blankets is recommended. If light in the early morning bothers you, get a blackout shade or wear a slumber mask. Wear earplugs if noise bothers you in the night.
• Use sunlight to set your biological clock. As soon as you get up in the morning, go outside and turn your face to the sun for 15 minutes.

Sleeping pills are not recommended as a way of dealing with sleep disturbance although the Fibromyalgia Association UK's medical pack does state that- "Benzodiazepines can be useful for initially re-establishing a sleep routine, but should never be used for more than 10-14 days because of a higher risk of psychological and physical dependence with long-term use"

Cognitive behaviour therapy

Cognitive behaviour therapy (CBT) has been shown to be effective in helping patients to reframe their response to the pain and fatigue brought about by fibromyalgia. CBT encourages patients to look at the way in which they respond to certain "triggers" and to replace these responses with more appropriate and healthy behaviours.

CBT has four main components-

1. Coping skills training
2. Self-control training
3. Problem-solving skills training
4. Cognitive restructuring methods

Activity scheduling

Tasks and activities can seem very daunting to people with fibromyalgia. This can best be overcome by tackling tasks (such as housework) in manageable chunks spread throughout the day rather than all at once.

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