Treatment of the Fibromyalgia Syndrome

SUMMARY

Pharmacological treatments: Clinical trials reveal that amitriptyline [AM] and cyclobenzaprine [CB] are effective in fibromyalgia. “N-of-1” trials show that one-third of patients benefited from AM. In a double blind, placebo controlled crossover design CB improved evening fatigue and total sleep time while pain intensity, pain thresholds [PT] over fibrositic tender points [FTPs], and mood ratings did not change. Fifty percent of patients reported a 30% improvement taking alprazolam in combination with ibuprofen in a placebo controlled, randomized, double blind protocol. Regional sympathetic blocakage reduces the number of FTPs in the affected extremity. Other studies show mixed results with imipramine, doxepin, fenfluramine and non-steroidal anti-inflammatory drugs. Prednisone and naproxen are no more effective than placebo. Non-pharmacological treatments: Improvements in PT measurements over FTPs, physician and patient global assessment scores have been noted in those receiving cardiovascular fitness training when compared with patients treated with flexibility exercises alone. Fifteen sessions of electromyography [EMG] bio-feedback over a five week observation period resulted in improvements in the number of FTPs, present pain intensity and morning stiffness persisting for up to six months after treatment. Another study using a sham biofeedback comparison group revealed improvements in pain scores, morning stiffness, and a number of FTPs in the true EMG biofeedback group. Several studies have showed significant improvements in pain severity, affective distress and decreased pain interference after cognitive behavioral therapy.

Control and mastery over life circumstances are also enhanced. An intervention algorithm based on these studies and the patient's initial outcome measures is presented.

KEYWORDS:

• Fibromyalgia
• treatment
• medications
• exercise
• review