Treatment options for fibromyalgia pain, including a list of common medications, lifestyle modifications, and short description of chiropractic care, are discussed. For more information on fibromyalgia in general, please see the article: “What is Fibromyalgia and why is it painful?”
Why fibromyalgia patients often doubt or delay a fibromyalgia diagnosis
When it comes to fibromyalgia (fibromyalgia syndrome or FMS), it’s common for those with FMS to put off seeking a diagnosis. Some question if they have a condition that can be diagnosed due to the seemingly random fluctuation of symptoms. Others turn to regular use of over the counter painkillers, hoping that the pain will eventually go away. The sudden onset of pain after a minor trauma or illness gives the impression that the fibro symptoms will leave as quickly as they arrived.
Others seek immediate diagnosis, but may be put off by a doctor’s skepticism of their pain experience. In addition to some physician skepticism, it’s not unusual for physicians to misdiagnose FMS. An accurate diagnosis is a challenge for medical providers because the symptoms are very similar to a number of other condition. There are a number of arthritis related illnesses such as hypothyroidism, headache syndromes, chronic fatigue syndrome, whiplash, and even mild-traumatic brain injury (among others) that overlap with fibromyalgia.
In turn patients can be put off by the daunting task of distinguishing between fibromyalgia and other health problems, and may not have the energy or clarity of mind to deal with the challenge.
What comes next after a Fibromyalgia diagnosis?
Since FMS has numerous symptoms that range from mild to severe depending on the patient, it’s unrealistic to find a treatment that can help all people with all of their FMS related challenges. Every FMS patient will need to experiment with a variety of approaches to find out what helps them function: in other words, a holistic, patient-centered approach is best.
A holistic approach is the gold standard in the management of FMS. Treatment strategies should be tailored-made according to the patient’s principal symptoms and concerns.
From my perspective as a chiropractor, the fibro sufferer cannot discount the importance of the brain-body communication, and should always include chiropractic adjustments in their care plan.
What medications are recommended for Fibromyalgia?
The use of medications for the treatment of symptoms is beyond the scope of this practice. I cannot on the effectiveness of these medications, but do provide this list out of convenience for those doing research on fibro pain and other fibro related sympmtoms.
Oral medications may be used in combination with non-pharmacological interventions. However, not all pain relievers are effective. NSAIDs or non-steroidal anti-inflammatory drugs (e.g., ibuprofen, naproxen, mefenamic acid) are seen as ineffective, and is therefore, not recommended for treating FMS, unless the patient is also has pain related to osteoarthritis.
The following medications are often used to relieve fibromyalgia pain (1):
- Analgesic (tramadol, lidocaine, ketamine)
- Tricyclic antidepressants (amitriptyline, cyclobenzaprine)
- Selective serotonin reuptake inhibitors (fluoxetine, citalopram)
- Anti-epileptics (gabapentin, pregabalin)
- Sedatives/hypnotics (zolpidem)
Sleep aids may improve sleep and fatigue but aren’t known to relieve fibromyalgia pain. Some sedatives (sodium oxybate) are not recommended because of a high risk of abuse. A medical provider doctor may suggest a combination of pain relievers if one of these medications doesn’t work.
What lifestyle modifications are recommended for fibromyalgia?
One of the most important non-pharmacologic treatment for fibromyalgia is lifestyle modification. Because only 40% of FMS patients will benefit from FDA-approved medications (3), lifestyle-oriented intervention and alternative therapies are worth considering for everyone with FMS. A general practitioner, therapist, or chiropractor may advise the following to help manage symptoms associated with FMS.
- Physical exercise (including yoga, tai-chi, and chi-gong)
- Cognitive behavioral therapy
- Weight management
- Smoking cessation
- Dietary and nutritional changes
- Improving quality of sleep
What hands-on therapies may be recommended for fibromyalgia pain?
I have personally received reports of fibromyalgia patients improve in their pain levels with the following hands-on therapies from their respective practitioners:
- Acupuncture and Chinese Medicine
- Cranio-sacral therapy
- Dry needling
- Energy work/therapeutic touch
Can chiropractic care help those with fibromyalgia pain?
Chiropractic care has acceptable evidentiary support in the management of fibromyalgia (4), as it’s explained in the medical literature. Some individuals with FMS are often worried about hands-on treatment of muscles and bones because of the constant pain they are experiencing. However manual therapies and chiropractic adjustments of the spine are known to decrease pain and fatigue and help address sleep problems in those with FMS (5).
For example, in one study, resistance training and chiropractic care has been found to improve strength and functionality in a female patient with fibromyalgia. (6)
Chiropractors who improve spinal alignment and spinal balance (vertebral subluxation) will also improve or the pressure, tension, or injury to the nervous system tissue caused by these minor (and sometimes major) vertebral shifts. These vertebral shifts disrupt normal signaling between the brain and body and can contribute to an elevated pain response. As many cases of FMS begin with a physical trauma, chiropractors can help fibro pain sufferers to correct the mechanical injuries that initiated the condition.
In the case of FMS, I personally recommend working with chiropractors who are trained in the upper cervical procedures, due to the influence misalignments in this area can have on the body’s inflammatory and pain regulatory response. Upper cervical chiropractic care is often very gentle and requires less touching than other chiropractic procedures, which some fibromyalgia patients may appreciate.
1. Choy E. Fibromyalgia Syndrome. 2nd ed. New York: Oxford University Press; 2015:38-42.
2. Lawson E, Wallace MS. Fibromyalgia Clinical Guidelines and Treatments.; 2015. http://dx.doi.org/10.1007/978-3-319-15820-4. Accessed January 28, 2019.
3. Arnold LM. Biology and therapy of fibromyalgia. New therapies in fibromyalgia. Arthritis Res Ther. 2006;8(4):212.
4. Perera J, Lawson G, Ko G, Vernon H, Schneider M. Chiropractic Management of Fibromyalgia Syndrome: A Systematic Review of the Literature. Journal of Manipulative & Physiological Therapeutics. 2009;32(1):25-40. doi:10.1016/j.jmpt.2008.08.012
5. Skelly M, Walker H. Alternative Treatments For Fibromyalgia And Chronic Fatigue Syndrome. Alameda, California: Hunter House; 2006:112.
6. Panton L, Figueroa A, Kingsley J et al. Effects of Resistance Training and Chiropractic Treatment in Women with Fibromyalgia. The Journal of Alternative and Complementary Medicine. 2009;15(3):321-328. doi:10.1089/acm.2008.0132.