» New Approaches to the Treatment of Fibromyalgia Syndrome
New Approaches to the Treatment of Fibromyalgia Syndrome

There have been some significant breakthroughs in our understanding (and therefore treatment) of fibromyalgia syndrome (FMS). Today's modern approach to is multimodal, meaning many different treatment options are pursued at the same time. Combining medications with exercise, behavioral counseling, and alternative medicine have made it possible to live a more normal life for those who suffer with this condition.

What exactly is fibromyalgia syndrome (FMS)? FMS is a group of symptoms that tend to occur together either at the same time or in close proximity to one another. The most common symptom is widespread pain throughout the body, with especially tender spots near certain joints.

Pain and stiffness concentrate in spots such as the neck, chest, shoulders, elbows, knees, buttocks, and lower back. The tender spots don't seem to be inflamed. The pain stops people with fibromyalgia from functioning normally, partly because they feel exhausted most of the time. Most tests show nothing out of the ordinary in the anatomy of people with fibromyalgia.

At one time, there was a strong suspicion that the symptoms of fibromyalgia were psychosomatic -- the result of stress and "all in the head" of affected individuals. But scientists have come a long way since then in unraveling the mystery behind this complex condition.

Right now, the main theory is that FMS occurs when something goes hay wire in the nervous system. That something may be what's called central sensitization syndrome. It means the nervous system is ramped up to react too soon, too often, and for too long.

With a dysregulation of the central nervous system, there appears to be some kind of mistake within the nervous system in how it recognizes and transmits pain messages. Somehow, the nervous system seems to think even the simplest touch is a noxious (painful) stimulus. It's like a ten-alarm fire signal is sent to the brain when a breeze blows by the barn.

Nervous system dysregulation of this type is likely caused by biochemical abnormalities, altered brain blood flow, and problems with the pain processing mechanisms. Sufferers have lower pain thresholds and lower levels of serotonin, a brain chemical involved in pain, sleep, and mood.

Many people with fibromyalgia also have anxiety disorders, depression, panic disorders, and phobias that are chemically induced and/or the result of abnormal central (nervous system) processing. It's these chemical changes that have prompted drug companies to look for a way to treat the problem with pharmaceuticals (medications).

There isn't one magic pill patients can take to wipe away the pain, improve sleep, improve brain function, or restore energy. Instead, a wide range of medications are available that can act on the nervous system in a variety of ways. These include tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), selective serotonin-norepinephrine reuptake inhibitors (SSNRIs), and anticonvulsants (also known as antiepileptics).

And for the first time, there are some medications now FDA approved from these categories specifically for fibromyalgia (e.g., pregabalin, duloxetine, milnacipran). In the past, many of the medications were used off-label. This means the medications were intended for something else (like seizures or depression) but were found to be effective for fibromyalgia.

Two of the drugs now approved in the U.S. for fibromyalgia are antidepressants (duloxetine and milnacipran). Studies have shown that these medications don't work because they improve the person's mood (reduce depression). The chemical pathway of the drug seems to impact pain signals directly.

Neither one of these drugs works to improve sleep. They do improve energy levels, physical functioning, and cognitive function -- probably because they reduce pain, a symptom that can level a person in all these areas.

Pain relievers, whether over the counter or prescription, are generally not effective by themselves. Many pain medications are addictive and should be used with caution. Mild pain medications may help in combination with other treatments. Opioid (narcotic) pain relievers, corticosteroids, and nonsteroidal antiinflammatories (NSAIDs) are no longer recommended.

Other drugs under continued investigation for the treatment of fibromyalgia include tizanidine (normally used to control muscle spasticity in patients with multiple sclerosis or stroke), growth hormone, 5-HTP, and tropisetron. The last two drugs seem to improve tenderness, stiffness, anxiety, and sleep.

Medications are only used in conjunction with other treatment such as exercise, meditation, hypnosis, acupuncture, nutritional counseling, biofeedback, massage, and behavioral counseling. A new treatment approach involving electromagnetic wave therapy is being tested for pain control by modifying brain activity in a noninvasive way without drugs or surgery.

If you are someone with fibromyalgia, it can be easy to feel overwhelmed by all of these choices. Which one is right for you? In what order should you try them? Who can help you manage all your symptoms and improve function on a day-to-day basis? It takes a team of specialists to accomplish this but working together, your physician, pharmacist, Physical Therapist, and counselor can form a powerful support team to guide you along the way.

Reference: Philip Mease, MD, et al. Fibromyalgia Update: Emerging Pharmacological Treatments. In The Journal of Musculoskeletal Medicine. October 2010. Supplement. S10-S20.