Fibromyalgia - Cure and Treatment

What is Fibromyalgia?

Fibromyalgia is a chronic disease with a complex clinical presentation. This disorder can be extremely debilitating and also interfere with normal daily activities. There is no known cure, and the treatment of fibromyalgia primarily focuses on managing symptoms and improving overall health.

Fibromyalgia causes pain, muscle tension in many areas of the body, asthenia and many other symptoms, which can vary in appearance and intensity in each patient: some fibromyalgia sufferers have mild symptoms, and require just as modest treatment, while others have symptoms severe and require a comprehensive therapeutic approach.

The doctor can indicate an individual treatment plan, tailored to the needs of the individual patient suffering from fibromyalgia. Conventional medicine relies on pharmacological treatments to manage symptoms such as pain, asthenia, sleep disturbances and to correct the alterations underlying the disease (particularly serotonin deficiency). Non-pharmacological treatments, such as patient education, aerobic exercise and cognitive-behavioral therapy, can aid in functional improvements and are extremely effective in modifying the autonomic hyperactivity present in fibromyalgia.

Recent studies have shown that it is possible to obtain a better therapeutic result with the combination of different multidisciplinary approaches. In fact, the integrated treatment plans have shown some effectiveness in relieving pain and other symptoms related to fibromyalgia.

Medicines

We can distinguish several classes of drugs used for the treatment of fibromyalgia.
In the treatment of chronic pain and the broader symptoms associated with the disorder, there are three drugs approved by the Food and Drug Administration (FDA) for the treatment of fibromyalgia:

Pregabalin (approved in June 2007);
Duloxetine (approved in June 2008);
Milnacipran (approved in January 2009, but not in Europe).

Antidepressants

In the treatment of fibromyalgia, an initial approach that has been consolidated for many years involves the use of tricyclic antidepressants (for example: amitriptyline and trazodone), alone or in combination with a short-acting benzodiazepine. Low doses of these drugs can be administered to relieve multiple symptoms, partially reducing pain and sleep and mood disturbances. Generally these drugs are combined with muscle relaxant drugs. Furthermore, it is important to remember that serotonin, in addition to being involved in one of the "central" mechanisms of the disease is also implicated in the genesis of some forms of depression, for which most of the drugs acting on serotonin are classified as antidepressants.

Currently, the new selective serotonin reuptake inhibitors (Selective Serotonin Reuptake Inhibitors, SSRI), such as fluoxetine or citalopram, which have been shown to be clinically effective in reducing pain and sleep disturbances, as well as increasing the ability to perform daily activities.
Serotonin and norepinephrine reuptake inhibitors (SSNRIs): they have a selective and specific action on the serotonin and norepinephrine transporters. These drugs, such as venlafaxine and duloxetine, can be effective in improving physical function, pain joint stiffness and muscle tension Serotonin and norepinephrine reuptake inhibitors are mainly used where SSRIs (acting only on serotonin) prove to be ineffective.

Muscle relaxants

In the event that muscle stiffness is predominant, it may be useful to associate a central muscle relaxant, which acts on the "peripheral" manifestation of fibromyalgia by reducing muscle contracture and with it pain. The muscle relaxants that have shown more specific action in fibromyalgia are cyclobenzaprine and tizanidine.

Analgesics

Analgesic drugs can be used to reduce inflammation, although they are often not suitable for reducing pain associated with fibromyalgia.

Acetaminophen can relieve muscle pain and stiffness caused by fibromyalgia. However, its effectiveness varies.
Tramadol is a centrally acting synthetic analgesic drug, which can be prescribed alone or in combination with paracetamol. It possesses some opioid properties and has been shown to be effective in some patients with fibromyalgia.
In combination with other medicines, the doctor may also indicate some non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen sodium; however, the general response to therapy is partial and unsatisfactory, as confirmed by numerous studies.

Antiepileptics

In fibromyalgia patients with refractory pain or hyperalgesia, the addition of a drug designed to treat epilepsy may be indicated, with variable results.
These antiepileptic drugs are useful in reducing certain types of pain:

Gabapentin: it is sometimes useful to treat some symptoms, such as chronic pain states.
Pregabalin: It was the first drug approved by the Food and Drug Administration (FDA) for the treatment of fibromyalgia. Pregabalin is a γ-aminobutyric acid (GABA) analog, approved for the treatment of central and peripheral neurological pain, effective in significantly reducing pain, sleep disturbances, fatigue and quality of life.

Note to drug indications for fibromyalgia

Analgesic drugs must have an "action on the pain centers and must not be simple anti-inflammatory drugs (the effectiveness of which in fibromyalgia syndrome is practically nil).
Administration of NSAIDs is not recommended as first-line therapy.
At the temporal level, it may be necessary:

up to three months to benefit from amitriptyline therapy (antidepressant);
up to six months to achieve maximum response from duloxetine (SSNRI) and pregabalin (antiepileptic).

Some medications can potentially cause withdrawal symptoms when therapy is stopped. For antidepressants and pregabalin, in particular, it is useful to stop treatment gradually.

Physical therapies

Physical therapies (TENS, iontophoresis, thermotherapy, etc.) are often recommended to patients with fibromyalgia; among these the TENS (Transcutaneous Electrical Nerve Stimulator, in Italian "transcutaneous electrical stimulator of the nerves") is the only one to have shown really effective results.

Cognitive-behavioral therapy

Psychological factors related to the disease (decreased work performance, the inability to carry out everyday activities normally, even trivial, etc.) significantly affect the severity of the symptoms of fibromyalgia. Some educational programs help the patient to understand the disease and to learn to live with it. Cognitive-behavioral therapies are treatments often related to drug therapy, which demonstrate a moderate effect in reducing the symptoms of fibromyalgia. The best effect is achieved when these measures are used in conjunction with exercise.

Psychological therapies do not appear to have significant effects on pain, fatigue and sleep disturbances, but they help improve mood disorders and support the patient in self-management of the disease.