Jerry Newman asked:




The first step in fibromyalgia treatment is to fix the sleep disturbance or problem of the patient with the use of tricyclics.  Amitriptyline (10–50 mg), nortriptyline (10–75 mg), and doxepin (10–25 mg) are the commonly used tricyclics. A similar drug based on pharmacology, cyclobenzaprine (10–40 mg), taken one to two hours before bedtime will put the patient’s sleep at stage 4, resulting in clinical improvements. Patients are given these drugs at a minimum dose but if needed, dose given is increased slowly. Patients should be informed of these drug’s side effects such as stomach and intestinal problems, dry mouth, gaining weight, sleepiness, and difficulty in thinking. Trazodone is also given, as well as zolpidem, as these improve the quality of sleep.

If the patient complains of restless leg syndrome, clonazepam may be effective. For depression and anxiety, duloxetine has shown benefit. It is a serotonin norepinephrine reuptake inhibitor (SNRI) drug. Fluoxetine, sertraline, paroxetine, citalopram, or other newer selective serotonin reuptake inhibitors can be used as antidepressants. Other useful antidepressants are trazodone and venlafaxine. Alprazolam and lorazepam are effective for anxiety. Sometimes, a psychiatric counseling is advised.

Regular aerobic exercises, which are started after patients begin to have improved sleep and less pain and fatigue, are beneficial. Exercise is started at a low impact and low level type. After the patient has tolerated it, s/he should be exercising 20–30 min, 3–4 days a week. Regular stretching exercises are also very important.

Other fibromyalgia treatments include heat, massage, injection on tender sites with steroids or lidocaine, and acupuncture. These, however, provide only temporary relief of symptoms. Newer therapies that may help to varying degrees include biofeedback, cognitive-behavioral therapy, hypnotherapy, and stress management and relaxation response training.

Biofeedback is a treatment procedure in which patients are going to learn to improve their health by own identification of signals from their own bodies. It helps patients to cope with their pain. One commonly used type of machine picks up electrical signals in the muscles and translates it into a form that patients can detect such as a flashing light bulb or a beeper.  If patients become tensed and wanted to relax muscles, they try to slow down the flashing or beeping.

Cognitive-behavioral therapy assumes that maladaptive or faulty thinking patterns cause maladaptive behavior and negative emotions. In the course of therapy, the patient is taught of changing his/her thoughts and attitudes about going to bed as well as his/her behavior on establishing a better nighttime routine.

Hynotherapy puts the patient in an extremely relaxed state to be able to use the therapist’s power of suggestion to trigger changes in the brain that are believed to improve both physical and mental health. This has helped people with refractory fibromyalgia.

Stress management and relaxation response training help reduce the amount of stress an individual experiences that may be related to the chronic pain associated with fibromyalgia. Stress does not cause fibromyalgia but it can contribute to worsen the case. Eliminating stress and allowing relaxation can lessen fibromyalgia’s symptoms and give a patient an overall better quality of life.

Patients may benefit from a multidisciplinary team approach. Group therapy may be more encouraging for the patient to undergo combination therapies. Patients should be taught to realize the importance of self-help in their condition.



Taking Fioricet