There’s no cure as yet for fibromyalgia, but there are ways of managing your symptoms. Your doctor will be able to suggest treatments and therapies to tackle specific aspects of the condition. These may include drug treatments but physical and other therapies are just as important or even more so.
Physical therapies for fibromyalgia
Your doctor may refer you to a physiotherapist or occupational therapist for further treatment and advice.
Physiotherapy can help you to improve your posture, physical function and quality of life, and gradually become more active. Physiotherapists can also advise you on relaxation techniques.
Occupational therapy can help you to manage your everyday activities without increasing your pain or wearing yourself out. Your occupational therapist may suggest specific pacing approaches, changing the way you work or using labour-saving gadgets. If you're struggling at work your therapist can recommend adjustments that will help.
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Pain clinics and pain management programmes bring together the skills of a wide range of professionals including:
A pain specialist may suggest specific treatments which can help reduce pain so that you can begin rehabilitation therapies offered by other members of the team.
Pain clinics often offer a pain management programme, usually on an outpatient basis, over several days or weeks. The programme may not take the pain away but it can help lessen the impact on your life. Group sessions may include people with other long-term pain conditions. The sessions are often led by psychologists who can help you develop ways of coping with the pain and the anxiety it can cause.
Pain is never a purely physical experience, especially if it lasts a long time. Pain can affect your mood, making you feel sad, anxious, frustrated, angry or afraid. Your emotional response to pain can affect your behaviour. For example, fear that movement will increase your pain may lead you to avoid activity. This, in turn, can affect aspects of your physical health – for example as your muscles become weaker through lack of use.
Psychological approaches to pain management aim to address the emotional aspects of pain. When thoughts, habits (behaviour), physical sensations and emotions are so closely linked it can be overwhelming. Therapies such as cognitive behavioural therapies (CBT) often focus on separating out these different aspects of your experience of pain, breaking the problem down into more manageable chunks.
Making a small change in one area, for example behaviour, can often improve both your emotional well-being and your physical health so that you can get more out of life. Many people feel doubtful about this approach at first but it has produced some good results.
Psychological therapies also include techniques for relaxation, coping with stress, accepting that you can’t always do the things you want to, and not being too hard on yourself (self-compassion) even if you do feel frustrated. You probably won’t need to see a psychologist as other members of the healthcare team are often trained in these techniques.
Drugs for fibromyalgia
Your doctor can prescribe medications to help with pain, sleep disturbance or depression associated with fibromyalgia. Drug treatments won't cure fibromyalgia and usually won't completely get rid of the pain. However, they can be helpful in reducing the symptoms to a level that will enable you to start some gentle physical activity and rehabilitation therapies.
As with all drugs, some people will have side-effects so it's important to discuss the pros and cons with your doctor. As a general rule, drug treatments should be stopped unless they are giving continued benefit.
Paracetamol can ease pain for some people but doesn't work for everybody. Some people find drugs like co-codamol or co-dydramol useful. These contain paracetamol plus a low dose of a stronger opioid painkiller such as codeine. Drugs containing codeine or dihydrocodeine can cause side-effects such as constipation and are recommended for short-term use only (usually no more than three days) because of a risk of dependency.
Opioid drugs are painkillers used for moderate to severe pain, although there's little research evidence that they're helpful overall for fibromyalgia. Opioids should be used sparingly, if at all, in chronic pain because of the risk of long-term side-effects and because they may cause dependence and can be difficult to stop. There are a few small studies showing benefit for some people with a drug called tramadol, which works partly like an opioid and partly like an antidepressant. The prescribing of tramadol is regulated and is best used for short-term flare-ups only.
Capsaicin gel or non-steroidal anti-inflammatory gels rubbed into the painful areas may help you, but there’s no convincing evidence that they’re effective in most people with fibromyalgia, and they may not be practical if you have widespread pain.
Antidepressant drugs such as low-dose amitriptyline can reduce pain and help you sleep. They need to be taken 2–3 hours before bedtime. Your doctor will gradually increase the dose to an effective level. Antidepressants can help with low mood and certain types including duloxetine have also been shown to help pain and other symptoms in some people. They may not work straight away, so you may need to try them for a few months to see whether they help.
Drugs such as pregabalin and gabapentin are used to treat nerve pain and have been shown to help people with fibromyalgia. They are usually started at low dose and then gradually increased depending on how you respond to them. It may take six weeks to assess whether they’re helpful. They can cause side-effects such as dizziness and weight gain.