Fibromyalgia: What are the treatment options?

Fibromyalgia is a chronic condition, recognised by the WHO (World Health Organisation) in 1992. This disease causes persistent widespread pain in the muscles, severe fatigue and sleep problems. Its diagnosis has become a subject of controversy in the scientific community, due to great variability of symptoms, reluctance of medical professionals, and the impossibility to detect physical abnormalities using existing medical technologies.

What are the symptoms and causes of fibromyalgia? 

The main symptom of this disease is pain. People affected with fibromyalgia complain mostly of pain all over the body, also called widespread pain. Its intensity may vary, depending on the time of the day, level of stress, emotional state and physical activity.

The most common symptoms are:

• Chronic muscle pain,
  
• Severe fatigue,
  
• Sleep problems,
  
• Cognitive problems (with attention, memory, etc),
  
• Hypersensitivity to touch, noise, light, odours, cold, heat,
  
• Emotional distress (anxiety, depression),
  
• Migraines,
  
• Gastrointestinal and urinary disorders.
  
  

The causes of fibromyalgia are not yet fully understood. No visible lesions in the muscles can explain the pain experienced by patients. The diagnostic criteria are therefore symptom-based and can be assessed according to an 18-point classification. However, certain psychological and physical factors are often considered as triggers, such as the loss of a loved one, stress, accidents, repeated tensions, etc.

As for the hypersensitivity to pain, in people with fibromyalgia it can be explained by the malfunction of the "pain centers" in the brain, which start interpreting pain signals as if they were more intense than they actually are.

While fibromyalgia is not a fatal disease, its impact on daily life is significant. Patients suffer from limited professional opportunities and social interaction, they tend to isolate themselves and are thus prone to depression.

The pain is often difficult to handle, due to lack of rapid and effective diagnosis, and appropriate treatment. So what can be a possible care plan for fibromyalgia patients? How can they be treated? 

What are the treatments for fibromyalgia? 

The aim of the fibromyalgia care plan would be to reduce pain and fatigue, to improve sleep and to minimize the impact of the disease on everyday life. It is necessary to be advised by a specialist in this area, called a rheumatologist.

Due to the diversity of the symptoms, each patient can benefit from a personalised approach to treatment.

Non-pharmacological approach 

Non-drug treatments are particularly recommended, especially an approach called APA, or adapted physical activity. It means practicing a physical activity, adapted to the capacities of each particular patient. This approach is proved to be effective against pain, it improves overall well-being and is free from side effects. Some examples are: stretching, swimming, cycling, etc.

Other physical activities can also be recommended, such as yoga, tai chi, qi gong, etc., followed by meditation, acupuncture and spa treatments. They can have a positive effect on sleep and quality of life.

It is also advised, as a second-line treatment option, to use Cognitive Behavioral Therapy (CBT) in order to reduce pain and level of disability, and to treat mood disorders in the long term.

If the non-drug approach is not effective, drug treatments are the next option.

Drug treatments 

To date, there exists no drug for fibromyalgia.

Medications are therefore prescribed to reduce pain and treat depression. However, their use must remain ad hoc, as their effectiveness is not observed in all patients, and some of the drugs have many side effects such as nausea, vomiting, dizziness, weight gain and in more severe cases, stomach bleeding and ulcers.

Namely, nonsteroidal anti-inflammatory drugs (NSAIDs) are not recommended due to their ineffectiveness on fibromyalgia symptoms.

Analgesics, or painkillers, such as paracetamol combined with codeine or caffeine, or level II analgesics, such as Tramadol® can be taken to reduce pain. However, they should only be used as a last resort and only on the advice of your physician, as there is a risk of addiction.

Antiepileptic drugs for pain relief (pregabalin or gabapentin) such as Neurontin®, Lyrica® or Topamax® can be prescribed for neuropathic pain such as burns, tingling, electric shocks, etc.

Low-dose or dual-acting antidepressants (duloxetine or amitriptyline) such as Cymbalta® or amitriptyline, may be prescribed. They are serotonin, dopamine and norepinephrine reuptake inhibitors. They improve sleep, reduce anxiety, migraines and certain digestive disorders. Other types of antidepressants are not recommended because they are ineffective.

Muscle relaxants such as Flexeril® (not available in the UK),can help relieve muscle pain.

Local anesthetics such as lidocaine are sometimes injected into a particularly sensitive area to reduce pain.

Non-invasive neurostimulation (transcranial magnetic stimulation) is being developed in some pain treatment centers. Additional studies must be carried out to assess its effectiveness, due to the disparity in the results obtained.

How to improve the care plan? 

The management of fibromyalgia should be based on a multidisciplinary approach, that is to say, with the participation of different medical professionals whose main goal should be to improve patient support. A relationship of trust between caregivers and patients should be established in order to allay doubts and concerns, especially for those affected by diagnostic errors and delays.

Patient associations can be helpful, as they allow patients to be listened to, share their experience and find support: Fibromyalgia Action UK, Pain UK, Fibromyalgia Friends Together, UK Fibromyalgia (a list of support groups by area), and of course Carenity.

As for the research on fibromyalgia, there has been considerable progress in this area, and more studies on this not so rare disease are ongoing, in order to find effective treatments.

A French research program named Fibromy'activ led by Dr Stéphanie Ranque-Garnier shows that “physical activity, if it is well adapted, at best will ease pain, and at worst, will not worsen it, but it improves mood, concentration, and reduces fatigue systematically, and almost instantly, at the end of the session.” It helps reduce use of medication and healthcare system involvement, and facilitates the return to work.

Studies are being carried out, and genetic profiles are starting to emerge. For researchers working in fibromyalgia, one of the aims is to have a real biomarker of the disease, in order to be able to objectively judge the effectiveness of a new therapy.