treatment

Treatment

One of the most important factors in improving the symptoms of FM is for the patient to recognize the need for lifestyle adaptation. Most people are resistant to change because it implies adjustment, discomfort and effort. However, in the case of FM, change can bring about recognizable improvement in function and quality of life. Becoming educated about FM gives the patient more potential for improvement.

An empathetic physician who is knowledgeable about the diagnosis and treatment of FM and who will listen to and work with the patient is an important component of treatment. It may be a family practitioner, an internist, or a specialist (rheumatologist or neurologist, for example). Conventional medical intervention may be only part of a potential treatment program. Alternative treatments, nutrition, relaxation techniques, and exercise play an important role in FM treatment as well. Each patient should, with the input of a healthcare practitioner, establish a multifaceted and individualized approach that works for them.

Pain management

A number of pharmacological treatments for fibromyalgia are available for prescription. The first to be approved by the U.S. Food and Drug Administration to treat fibromyalgia was pregabalin (Lyrica®); the second was duloxetine (Cymbalta®); and the third was milnacipran (Savella®). Other FM medications are currently in development, and may soon receive FDA approval to treat fibromyalgia. Additionally, healthcare providers may treat patients’ FM symptoms with non-narcotic pain relievers (e.g. tramadol) or low doses of antidepressants (e.g. tricyclic antidepressants, serotonin reuptake inhibitors) or benzodiazepines. Patients must remember that antidepressants are “serotonin builders” and can be prescribed at low levels to help improve sleep and relieve pain. If the patient is experiencing depression, higher levels of these or other medications may need to be prescribed. Lidocaine injections into the patient’s tender points also work well on localized areas of pain. An important aspect of pain management is a regular program of gentle exercise and stretching, which helps maintain muscle tone and reduces pain and stiffness.

Sleep management

Improved sleep can be obtained by implementing a healthy sleep regimen. This includes going to bed and getting up at the same time every day; making sure that the sleeping environment is conducive to sleep (i.e. quiet, free from distractions, a comfortable room temperature, a supportive bed); avoiding caffeine, sugar, and alcohol before bed; doing some type of light exercise during the day; avoiding eating immediately before bedtime; and practicing relaxation exercises as you fall to sleep. When necessary, there are new sleep medications that can be prescribed, some of which can be especially helpful if the patient’s sleep is disturbed by restless legs or periodic limb movement disorder.

Psychological support

Learning to live with a chronic illness often challenges an individual emotionally. The FM patient needs to develop a program that provides emotional support and increases communication with family and friends. Many communities throughout the United States and abroad have organized fibromyalgia support groups. These groups often provide important information and have guest speakers who discuss subjects of particular interest to the FM patient. Counseling sessions with a trained professional may help improve communication and understanding about the illness and help to build healthier relationships within the patient’s family.

Other treatments

Complementary therapies can be very beneficial. These include: physical therapy, therapeutic massage, myofascial release therapy, water therapy, light aerobics, acupressure, application of heat or cold, acupuncture, yoga, relaxation exercises, breathing techniques, aromatherapy, cognitive therapy, biofeedback, herbs, nutritional supplements, and osteopathic or chiropractic manipulation.

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Fibromyalgia Symptoms Management

Fibromyalgia is known for its symptoms of chronic widespread pain. At times these symptoms are disabling, however some days you feel okay. Here is an effective strategy to help manage your symptoms so as to increase the number of “good days” you will experience.

Pacing & Finding Balance:

Pacing doesn’t mean waiting until you are worn out to stop what you are doing. It means setting a schedule of activity and then gradually increasing your activity until you find the right balance between activity and rest. You need to note… You do this for everything you do, even when you feel well. Remember to “pace” even when you have a good day. Often times it’s tempting to just plain overdo it! Then what happens? You CRASH, causing you to spend the next few days in bed or on a reduced schedule. This is not the way to manage your symptoms. Experts agree that learning to pace your activities by alternating between periods of rest and activity is the proper way. The key to this strategy is to pace yourself even when you are feeling good! This way you won’t cause a flare-up by doing too much. Here are some basics you can implement to improve your symptom management through pacing.

1. Start using a stopwatch or timer. Learn to pace your activities by the clock. To start, set your timer for five minutes or longer if you think you can do the activity that long. When the timer rings it’s time to change positions or rest. You can gradually increase the interval of activity and rest as you learn what your endurance level is.

2. Change positions: If you are sitting, stand for few minutes and vice versa.

3. Stretch: At least twice an hour, do a little mild stretching. People with fibromyalgia need to be cautious about overdoing it with stretching. By this I mean “intensity” rather than frequency. Our muscles respond to extreme stretching by contracting even more. The way to avoid this is to stretch mildly – just until you feel the muscle extend. Easy does it is best. Ask your doctor or physiotherapist to recommend some good stretching exercises. (Your can do a lot of stretching while sitting.)

4. Set a schedule: Plan out your activities for the next week. Don’t overbook your schedule. Plan time for rest, personal time, family time, as well as work – if you are still working. Remember, your schedule doesn’t have to be written in stone. You can always change it. Now that you have a schedule, try to stick to it. Some people find it best to create your schedule the night before or first thing in the morning.

5. Prioritize: You may find your schedule was too much to follow. Don’t despair! This is a learning opportunity. Make a list of the things you want to accomplish and assign each task a number according to its importance. Then when you make your schedule you can spread the tasks out over time. Don’t try to do all the tasks together. Plan for rest breaks. Remember, you’re pacing yourself.

6. Split tasks into smaller bits: Do you have to wash all the dishes at once? Do you have to put them all away right after washing? The same with vacuuming. Instead of doing the whole house, do one room each day! Learning to split these jobs up into smaller chunks is an important part of pacing.

7. Learn to delegate: This can be really challenging for some of you. Asking for help is not always easy. But for many people with fibro, it’s a necessary part of symptom management. Try to enlist the help of family members. This might cause some friction at first, so it is vital that you first explain why you need their help. Get some information on fibromyalgia and print out some copies to hand out. Then go through it together. Once they more fully understand the situation, they may be more willing to help.

8. Learn to say NO: This is tough to do, I know. We often feel bad when we have to refuse someone’s request. An easy way to say “no” gracefully is “I’m sorry, but my schedule is really full right now. I don’t like to say yes and then not be able to fulfill my obligation and let you down.” They’ll understand that your refusal is partly because you don’t want to disappoint them and it’s not against them personally.

Yes, managing your symptoms of fibromyalgia through pacing is not always easy, but if done properly you will find that you will actually reduce the amount of “down” time and get more done.


Remember…easy does it!