Fibromyalgia; Treatment

NWHRC Health Center - Fibromyalgia, June 8, 2005

Treatment of fibromyalgia syndrome (FS), a chronic disorder characterized by widespread musculoskeletal pain, fatigue, multiple tender points and poor sleep, involves a comprehensive, multidisciplinary approach, along with self-management strategies. Among the most effective techniques are exercise, sleep management, positive attitude and sticking to a daily routine.

Aerobic exercise is essential because it strengthens the muscles; greater strength translates into improved ability to handle everyday activities without the strain that can worsen symptoms. You will probably want to avoid high-impact activities, however. Some patients also benefit from physical therapy and stretching exercises.

Exercise can improve mood and outlook, decrease pain, increase flexibility, improve the heart and blood flow, maintain weight, and promote general physical fitness. It is also inexpensive and, if done correctly, has few negative side effects. Note: Be sure to discuss any plan to start a new exercise program with a health care professional.

Exercise may seem an impossibly tall order--after all, if you're in pain, how are you supposed to work out? Resting seems a more natural course of action. But if you don't regularly get aerobic exercise, your muscles will become weaker, making them even more susceptible to pain when doing everyday tasks. It is also harder to sleep well if you don't exercise. You have to build and maintain strength and muscle tone to minimize pain over the long run. Studies have shown that aerobic exercise, such as swimming and walking, improves muscle fitness and reduces muscle pain and tenderness in FS. Be sure, however, to choose a low-impact program.

Changing your attitude also can help improve your physical health. Several studies have shown the benefits of cognitive therapy for women with fibromyalgia. The three major research findings are:

* Negative thinking adds to stress.

* Thoughts affect the emotional perception of pain.

* Learning to control negative thoughts can have a major effect on symptoms.

The key is not so much to "think positively," but to "think non-negatively." When you have negative thoughts, put them to the test of reason and usefulness. Ask yourself: "Does this thought benefit me in any way--does it improve the way I feel, advance my goals, or improve a relationship?"

Strategies for dealing with negative thoughts include the following:

* Alternative interpretation. You might start with a fairly neutral thought such as "I am tired today." From there, it's easy to go negative--"I feel lousy. I won't get anything done today." An alternative, non-negative interpretation: "What strategies can I try for sleeping better, so I won't be so tired?"

* Anti-catastrophic reappraisal. This technique consists of challenging negative thoughts. You might have a catastrophic thought such as, "This fatigue is never going to get better. I'll never wake up with any energy." Try asking yourself: How likely is it that the fatigue will never get better? Have you ever been more fatigued than you are today?

* Coping statements. Try telling yourself you can handle the symptoms and reminding yourself of strategies you've used in the past to cope with or alleviate symptoms.

* Label shifting. The way we describe things influences our overall mood and physical sense of well being. You might describe someone who double-checks her work as either obsessive (negative) or careful (positive/neutral). Discarding a habit of negative labeling can boost your mood.

Changing the way you think, of course, is not easy. A cognitive therapist can guide the transition to a less-negative outlook.

As for medications, the drugs usually prescribed for muscular pain--nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, ketoprofen and naproxen, as well as aspirin--are not as effective at treating fibromyalgia, but can be somewhat helpful in taking the edge off of pain. In April 2005, the FDA issued a public health advisory that included important changes and additional warnings for prescription NSAIDs as well as for over-the-counter (OTC) NSAID products. Manufacturers of these products are being asked to revise their labels to include a boxed warning highlighting the potential for increased risk of cardiovascular (CV) events and gastrointestinal (GI) bleeding associated with their use. It is important to ask your health care professional for information about these recalls and safety information associated with pain relievers with your personal health in mind.

A newer type of NSAID, known as a COX-2 specific inhibitor, approved to reduce the pain and inflammation caused by arthritis in adults and for treating acute pain, is another option for relieving fibromyalgia-related pain. Cox-2 specific inhibitors are designed to cause fewer GI side effects (such as ulcers and bleeding) than other types of NSAIDs. Celecoxib (Celebrex) is an example of this type of NSAID.

Rofecoxib (Vioxx), another Cox-2 specific inhibitor, was voluntarily withdrawn from the market in September 2004 by its manufacturer after data from a study involving Vioxx indicated an increased risk for heart attack and stroke in patients participating in the study. Following the recall, the FDA began closely monitoring other drugs in this class of medications for similar side effects. In early April 2005, the FDA asked the manufacturer (Pfizer) to withdraw valdecoxib (Bextra) from the market because the overall risk versus benefit profile for the drug was found to be unfavorable. Pfizer has agreed to suspend sales and marketing of Bextra in the U.S., pending further discussions with the FDA. The FDA has also asked Pfizer to include a boxed warning about potential health risks in the celecoxib (Celebrex) label.