Can we prevent fibromyalgia?

The cause of fibromyalgia has not been formally identified, no way to prevent it is recognized.

Let us only mention that it is recommended not to be overweight, because it accentuates pain in the joints and muscles². Calculate your body mass index (BMI) and your waistline.

What are the medical treatments for fibromyalgia?

There is currently no formally proven effective treatment for fibromyalgia. Medicine can only help manage pain better. Although there is no known treatment to cure fibromyalgia, there is support.

Recommended drugs

Because we still know little about the mechanisms involved in fibromyalgia, the medical treatments offered to patients are based on the blocking of the mechanisms involved in pain and sleep disorders. 

To reduce pain, one of the best results is obtained with Tramadol. The analgesics or strong painkillers, such as morphine, reduce pain, but obviously cannot be used for prolonged periods. Tramadol (Ralivia®, Zytram®), from the family of opiates (like morphine), has however been shown to be effective in several recent trials carried out in patients with fibromyalgia. It is recommended for the treatment of fibromyalgia by many experts, alone or in combination with acetaminophen. However, this medicine should only be used as a last resort, when other treatments have been shown to be ineffective. Its use must be done under close supervision of the doctor because of the risk of dependence.

The nonsteroidal anti-inflammatory drugs (NSAIDs), for example ibuprofen (such as Advil® or Motrin®), naproxen and acetaminophen (Tylenol®) sometimes help reduce muscle pain and stiffness. Their effectiveness varies from person to person. They are especially useful when fibromyalgia appears in a person with an inflammatory disease, such as rheumatoid arthritis. In “simple” fibromyalgia, they are rarely recommended.

Warning. In the long term, the use of drugs such as NSAIDs can cause serious side effects: stomach pain and bleeding, stomach ulcers, kidney damage and high blood pressure.

To restore a restorative sleep, if sleep disorders are in the foreground and also in the event of anxio-depressive background, we can use some IRS antidepressants at doses half as strong as in the case of depressive syndrome.

All of this Antidepressants, such as low dose serotonin reuptake inhibitors are the most widely used treatments for fibromyalgia. They have an effect on many chronic pains, including fibromyalgia pains, and are therefore frequently used even in the absence of depression. In addition, they increase the amount of serotonin in the brain. However, low levels of serotonin are linked not only to depression, but also to migraines, digestive ailments and anxiety, which are among the symptoms of fibromyalgia.

Amitryptiline (Élavil®) is used in people with fibromyalgia as a pain reliever and for its effects on sleep disorders and fatigue. It is the treatment most often used, in first intervention 68. The duloxetine (Cymbalta®) can also be used, as can fluoxetine (Prozac®) or moclobemide, which will often be added as an additional treatment. Finally, another antidepressant, milnacipran, has shown promising results against fibromyalgia and is being evaluated in Canada.

Low-dose antidepressants seem to be the best long-term treatment for muscle pain in fibromyalgia. However, not everyone finds relief in this.

The anticonvulsants or anti-epileptics – first designed to treat epilepsy – are also effective for chronic pain. These include gabapentin (Neurontin®), pregabalin (Lyrica®) and topiramate (Topamax®). Some of these anticonvulsants improve the quality of sleep (especially gabapentin, and to a lesser extent pregabalin). Lyrica® even obtained, in 2009 in Canada, an indication for the treatment of pain associated with fibromyalgia.

Sedatives are sometimes prescribed to facilitate sleep, but their long-term use is generally not recommended by doctors (for example, Imovane®). In addition, most of the drugs listed above also have a sedative effect.

Muscle relaxants can also help relieve pain. The only effective muscle relaxant for fibromyalgia is Flexeril®, whose action is similar to that of amitriptyline (Laroxyl®).

To note. Corticosteroids (like prednisone) have not been shown to be effective in treating fibromyalgia.

Non-drug management

Medications alone do not sufficiently improve the quality of life of people with fibromyalgia. Management must therefore be multidisciplinary.  complementary approaches, allowing in particular to relax and learn to manage your pain, are probably the most effective methods for living better with fibromyalgia today. In case of severe pain, the hot water baths, with or without muscle exercises, can also provide quick relief58.

Balneotherapy

In case of severe pain, the hot water baths, with or without muscle exercises 58, can also provide rapid relief. Care in a rehabilitation center with balneotherapy, in a spa center with a hot water swimming pool have shown some effectiveness.

Aerobic exercises

L’physical exercise is an integral part of the basic treatment. It causes the body to produce endorphins, hormones that provide well-being and calm pain. Several study summaries6,7,55, including one published in 200864, concluded that supervised aerobic exercise reduced symptoms of fibromyalgia and improved sleep and physical performance. Stretching and strengthening exercises are also thought to improve some symptoms, but there is less evidence for this.

One should not be afraid of worsening his illness by exercising, since the fibromyalgia is not a problem of muscle origin1. Moreover, it is known that poor physical condition contributes to generating fatigue and anxiety. However, it is important to start gradually, with a adapted program to his physical condition.

The aerobic exercises practiced in a swimming pool, preferably in hot water, can be a good starting point to get back into action. According to 2 clinical trials published in 2006, the exercises ofaquafitness (walking or running in water, for example) are effective in relieving pain caused by fibromyalgia and improving feelings of well-being8,9. They must be adapted to the capacities of the person affected, and their intensity must be gradually increased.

Methods for letting go and managing stress and pain, such as relaxation, ericksonnian hypnosis, or music therapy have been shown to be effective in this disease. They allow you to live better with pain and fatigue.

Psychotherapy

Psychotherapy can have significant benefits for people with fibromyalgia. The cognitive behavioral therapy (TCC) is particularly effective. See the Complementary Approaches section.