Treatment of Fibromyalgia

Purpose

To examine the different treatment approaches for managing fibromyalgia, including pharmacological and other popular options available in Australia. The article discusses trends, best practices, and treatments that show little evidence of effectiveness.

Conclusions

Most importantly, the author noted that research supports "an individually-tailored, multimodal, multidisciplinary, combining both non-pharmacological and pharmacological for the best outcomes at improving symptoms and quality of life, as spontaneous recovery is unusual."(R. Kwiatek, 2017) Kwiatek argues that any one intervention alone has a small impact on the average, but there are always a small group of people who experience significant improvement. Fibromyalgia is a spectrum disorder, including a range of where in the body one experiences pain, additional symptoms, and the severity of each. Early diagnosis and intervention can help reduce the significance of disability which affects 2% of the Australian population, predominately middle-aged women.

Additionally, there are factors that can aggravate pain:

• Persistent peripheral pain generators (spinal and/ or peripheral arthritis, tendinopathies, and myofascial trigger points)

• Sleep disorders (obstructive sleep apnoea, restless legs, and periodic limb movement disorder)

• Obesity (with consequent pain-sensitizing effects of meta-inflammation)

• Smoking

• Opioid-induced hyperalgesia

• Statin myopathy

• Depression

• Catastrophising cognitive style

• Psychosocial stressors

Effective medical treatments include amitriptyline, duloxetine, milnacipran, or pregabalin, but not pure opioids. Research on combining pharmaceuticals is showing promise. Medical support only gives the patient so much relief, if any. Those with fibromyalgia need to learn self-management. The best results come from education, coping skills, cognitive behavioral approaches, and exercise, all of which require a lot of support and can be challenging to achieve alone, especially with cognitive challenges. Exercise should be started with caution and include medical supervision, particularly physical therapy.

Significance

Demonstrates the need for those with fibromyalgia to try different treatments and combine them. Moreover, they need to be supported to learn to manage their symptoms.

Limitations

The study was limited to Australia, so results cannot necessarily be assumed for other countries. There is a wide range of therapies available, but there doesn't seem to be one that stands out overall.

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