Treatment

Medications
Anti seizure
Lyrica (pregabalin) is the first and only treatment approved by the FDA for the management of Fibromyalgia.
Neurontin (gabapentin) can be helpful to treat pain.

Analgesics
Analgesic medications like Tylenol (acetaminophen) or NSAIDS (like motrin, aleve, advil, ibuprofen) or ultram or Ultracet (ultram/acetaminophen) may used to treat the pain of fibromyalgia.

Antidepressants
1. Tricyclic Antidepressants like amitriptyline (Elavil), nortriptyline (Pamelor) or doxepin (Sinequan) can be helpful to treat sleep and depression.
2. Selective serotonin reuptake inhibitors (SSRIs) antidepressants like fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa) are very effective in treating depression.
3. Other antidepressants like duloxetine (Cymbalta) or venlafaxine (Effexor) may also be helpful in fibromyalgia.

Muscle relaxants
Muscle relaxants cyclobenzaprine (Flexeril) or methocarbamol (Robaxin) are used to treat the muscle pain and spasm associated with fibromyalgia. They tend to work better during acute flares, rather than with chronic use. Tizanadine (Zanaflex) may help both muscle spasm and pain.

Dopamine agonist
Pramipexole (Mirapex) has been shown to help some patients with fibromyalgia.

Other medications
Medications like benzodiazepines, narcotics, and steroids (like prednisone) have a limited role in treating fibromyalgia and have not shown long term benefits. Benzodiazepines and alcohol can affect quality of deep sleep. Some people believe that guaifenesin helps with their pain. 

Trigger point injections
These are injections into painful areas in your muscles. This can be safely performed in your doctor’s office. They may use medications such as lidocaine or steroids. These injections usually provide temporary relief.

Nonpharmacologic treatment and Self-management
Education and counseling: This is very important for persons with fibromyalgia to have the information they need to help manage their disease over a lifetime. This helps improve outcome, outlook, and coping with chronic issues.

Biofeedback and Cognitive behavioral therapy: These interventions have been shown to decrease pain, depression, sense of disability, and improve self-esteem.

Exercise: Studies have shown that regular aerobic exercise can improve strength, mobility, physical function, aerobic capacity, and depression in persons with fibromyalgia.  It can also help prevent bone loss associated with inactivity.  

Nutrition and Diet: A well-balanced diet is recommended for all persons with fibromyalgia. There is no proven nutritional supplement for persons with fibromyalgia. Some patient report decreased symptoms and feeling better when they follow a low carbohydrate diet.

Stress reduction: It is important to have a stress reduction plan. You must integrate these techniques into your daily life and practice them. This involves planning time to relax and rest. You must individualize this program for yourself. 

Sleep: It is very important for persons with fibromyalgia to have good sleep hygiene. This means a nightly routine that includes relaxation, a regular bedtime, and allowing at least 8-10 hours for sleep. More sleep may be needed during acute flares. Some persons may benefit from a nap during the day.

Prayer and Spirituality: Research suggests that interaction between minds, body, and spirit have effects on our health.

Rehabilitation Treatment
Basic principles
Rehabilitation refers to the process of helping a person return to as much normal function as possible. There are many ways to help improve function. 

Rehabilitation professionals
Rehabilitation is provided by many different professionals depending on your symptoms or problems. Often, these professionals work as a team to help coordinate the care they provide.

Physical Medicine and Rehabilitation (PMR) physician or Physiatrist: A doctor who focuses on overall function and symptom complex to suggest treatment and make appropriate referrals for therapy.

Physical therapist (PT): A therapist who focuses on mobility and adaptive equipment used for mobility like canes, walkers, wheelchairs; exercise and modalities to treat pain and improve or maintain function.

Occupational therapist (OT): A therapist who focuses on activities of daily living (ADLs) or ability to perform certain tasks like dressing, cooking, bathing; energy conservation; and adaptive equipment.

Speech therapist (ST): A therapist who focuses on cognition, language skills, voice and swallowing.
 
Orthotist: A professional who makes splints and braces.

Neuropsychologist: A professional who focuses on in-depth evaluation of brain and brain functioning, including administering extensive testing. They also provide treatment and support counseling to adjust and cope with your situation.
 
Therapy program
An individualized therapy program is very important for persons with fibromyalgia. Therapy programs are divided into skilled therapy treatment and maintenance home exercise program. Therapy is available in various settings including in the hospital, inpatient rehabilitation unit, outpatient clinic, or at home with home health services. A course of therapy with a skilled therapist can improve mobility and ability to perform activities of daily living. Your doctor will need to write a prescription and refer you for therapy. It is usually covered by your health insurance. A therapy program seems to give patients a greater sense of control which is helpful in dealing with the psychological effects of having chronic symptoms and improves their sense of well being. Education is a big part of the treatment plan. Patients should be referred for evaluation and should have periodic reevaluation as their clinical course changes or progresses. Inactivity results in deconditioning and therapy and exercise can reverse the weakness associated with lack of use. It is important to find the right balance between rest and activity.

Energy conservation and pacing
A physical or occupational therapist can instruct you in an individual program of pacing yourself. This means scheduling and managing activity and tasks so that you do not over-do-it on good days and then have increased symptoms. It also includes breaking big tasks up into smaller jobs or adapting the way you do something.

Exercise
A general exercise program is beneficial for a person with fibromyalgia. A complete program should include aerobic, strengthening, and stretching exercises. Exercise is important for maintaining and even improving mobility, flexibility, balance, and range of motion. It can also help with depression. An exercise program addresses the problems of decreased flexibility, muscle atrophy, decreased strength, difficulty using hands, and aerobic deconditioning. Certain exercises like swimming, walking, low-impact aerobics, yoga, Pilates, and Tai-chi may help reduce joint pain and stiffness.

Stretching
Stretching is critical to maintaining flexibility and range of joint motion. Loss of joint range of motion or tightness in the muscles can lead to increased pain.

Massage
Massage may offer temporary relief of muscle pain and spasm. Massage may have the secondary benefit of offering stress relief.

Aquatic therapy
A therapeutic exercise program can be based on land, in the water, or both. An aquatic program may be helpful for persons with fibromyalgia. The warm water also helps joint and muscle pain and stiffness.

Weight reduction
It is very important for person with fibromyalgia to maintain ideal body weight. Excessive weight can lead to pain and decreased function.

Support groups
For many people, supports groups can be very helpful. They provide education, support, and advice for living with the disease and opportunities to meet others who have similar experiences. These groups can be a source of practical information for living better with fibromyalgia. These groups offer additional benefit to persons with fibromyalgia since the disease is not well understood and dealing with the medical community can be frustrating.

Orthotics
Temporary bracing or splinting may be used to treat a specifically painful area.

Assistive devices
These are devices to improve walking or mobility and a consult with a physical therapist will help you select the most appropriate mobility aid for you. There are many gadgets to improve activities of daily living (reacher, sock aid, button hook, jar opener, book holder) and a consult with an occupational therapist with help you with individual needs.

Modalities
Hot and cold modalities have been used for many centuries (if you have poor circulation, consult your doctor before using cold or heat). In chronic conditions, both are very helpful and usually patient preference determines whether hot or cold is used. These should be used carefully to avoid injury or burns. Most applications should be limited to 20 minutes at a time but can be applied multiple times in a day.

Cryotherapy
Cold treatment with ice, cold water, and biofreeze.

Hot treatment
1. Moist: bath or shower
2. Dry: heating pad
3. Superficial: paraffin, whirlpool, hot packs
4. Deep: ultrasound, diathermy.

Transcutaneous electrical nerve stimulation (TENS): This device is used to treat pain. A therapist can provide a trial of a TENS unit for a patient, and if beneficial, instruct the patient in use of the device at home. A doctor’s prescription is required.

Acupuncture: Performed by a licensed acupuncture therapist. This may be beneficial for some patients for treatment of their pain. The number of treatments and frequency of treatment are variable.

Chiropractic care has offered some patients with fibromyalgia relief.

Osteopathic Manipulation has offered some patients with fibromyalgia relief.

Medical Specialists
There are many different medical specialists that need to be involved in your care to maximize symptom management and improve quality of life.

Physical Medicine and Rehabilitation physician (Physiatrist)
A physician who specializes in treatment of conditions that affect mobility, self care, and interfere with the ability to perform given roles at home, work, and in the community.

Rheumatologist
A physician who specializes in diseases of the musculoskeletal system. They can be experts in diagnosis and treatment of fibromyalgia.

Pain Specialist
There are physicians who specialize specifically in the treatment of pain.

Neurologist
A physician who specializes in conditions of the nervous system.
 
Internist
A physician that provides general health care to adults.

Psychiatrist
A physician who specializes in the treatment of conditions that affect emotional well-being and cognitive disturbances. They are experts in treating depression and are very knowledgeable in medication and medication side effects. They can be helpful for persons experiencing chronic pain.