How Is Fibromyalgia Treated?

Can Be Difficult to Treat

Fibromyalgia can be difficult to treat. Health care professionals who can treat fibromyalgia include:

  • many family physicians
  • general internists
  • rheumatologists (doctors who specialize in arthritis and other rheumatic conditions)

Fibromyalgia treatment often requires a team approach, with your doctor, a physical therapist, possibly other health professionals, and most importantly, yourself, all playing an active role.

It can be hard to assemble this team, and you may struggle to find the right professionals to treat you. When you do, however, the combined expertise of these various professionals can help you improve your quality of life.

You may find several members of the treatment team you need at a clinic. There are pain clinics that specialize in pain and rheumatology clinics that specialize in arthritis and other rheumatic diseases, including fibromyalgia.


Pregabalin (Lyrica) was the first medicine FDA-approved to treat fibromyalgia. More fibromyalgia drugs are in development. Doctors also treat fibromyalgia with a variety of medications developed and approved for other purposes.

What Else Can You Do?

Besides taking medicine prescribed by your doctor, there are many things you can do to minimize the impact of fibromyalgia on your life. People with fibromyalgia also may benefit from:

Get Enough Sleep

Getting enough sleep and the right kind of sleep can help ease the pain and fatigue of fibromyalgia. Even so, many people with fibromyalgia have problems that interfere with restful sleep such as:

  • pain
  • restless legs syndrome
  • brain-wave irregularities


Though pain and fatigue may make exercise and daily activities difficult, it's crucial to be as physically active as possible. Research has repeatedly shown that regular exercise is one of the most effective treatments for fibromyalgia. People who have too much pain or fatigue to do vigorous exercise should begin with walking or other gentle exercise and build their endurance and intensity slowly. Although research has focused largely on the benefits of aerobic and flexibility exercises, a NIAMS-supported study is examining the effects of adding strength training to the traditionally prescribed aerobic and flexibility exercises.

Make Changes at Work

Most people with fibromyalgia continue to work, but they may have to make big changes to do so; for example, some people:

  • cut down the number of hours they work
  • switch to a less demanding job
  • adapt a current job

If you face obstacles at work, such as an uncomfortable desk chair that leaves your back aching or difficulty lifting heavy boxes or files, your employer may make adaptations that will enable you to keep your job.

An occupational therapist can help you design a more comfortable workstation or find more efficient and less painful ways to lift.

Eat Well

Although some people with fibromyalgia report feeling better when they eat or avoid certain foods, no specific diet has been proven to influence fibromyalgia. Of course, it is important to have a healthy, balanced diet. Not only will proper nutrition give you more energy and make you generally feel better, it will also help you avoid other health problems.

Complementary / Natural Therapies

Many people with fibromyalgia also report varying degrees of success with complementary and natural therapies, including:

  • massage therapy
  • movement therapies (such as Pilates and the Feldenkrais method)
  • chiropractic treatments
  • acupuncture
  • various herbs and dietary supplements for different fibromyalgia symptoms

Though some of these supplements are being studied for fibromyalgia, there is little, if any, scientific proof yet that they help. The FDA does not regulate the sale of dietary supplements, so some information may not be well known including:

  • potential side effects
  • the proper dosage
  • the amount of a preparation's active ingredient may not be well known

If you are using or would like to try a complementary or alternative therapy, you should first speak with your doctor, who may know more about the therapy's effectiveness, as well as whether it is safe to try in combination with your medications.

On June 21, 2007, Lyrica (pregabalin capsules CV) was approved by the U.S. Food and Drug Administration (FDA) for the treatment of fibromyalgia. The approval of Lyrica was long-awaited because it's the first medicine that is FDA-approved to treat fibromyalgia. More fibromyalgia drugs are in development. Doctors also treat fibromyalgia with a variety of drugs developed and approved for other purposes.

Below are some of the most commonly used categories of fibromyalgia medications. In 2008, Cymbalta was FDA-approved to treat fibromyalgia.


Analgesics are painkillers. They range from over-the-counter drugs, such as acetaminophen, to prescription drugs, such as tramadol, and even stronger narcotic drugs. For a subset of people with fibromyalgia, narcotic medications are prescribed for severe muscle pain. However, there is no solid evidence showing that narcotics actually work to treat the chronic pain of fibromyalgia, and most doctors hesitate to prescribe them for long-term use because of the potential that the person taking them will become dependent on them.


NSAIDs (nonsteroidal anti-inflammatory drugs) are used to treat inflammation. Although inflammation is not a symptom of fibromyalgia, NSAIDs also relieve pain.

NSAIDs include:

  • aspirin
  • ibuprofen
  • naproxen

NSAIDs work by inhibiting prostaglandins, which play a role in pain and inflammation. These drugs, some of which are available over-the-counter, may help ease the muscle aches of fibromyalgia. They may also relieve menstrual cramps and the headaches often associated with fibromyalgia.


Perhaps the most useful medications for fibromyalgia are several in the antidepressant class. Antidepressants elevate the levels of certain chemicals in the brain, including serotonin and norepinephrine. Low levels of these chemicals are associated not only with depression, but also with pain and fatigue. Increasing the levels of these chemicals can reduce pain in people who have fibromyalgia. Doctors prescribe several types of antidepressants for people with fibromyalgia.

Tricyclic Antidepressants

When taken at bedtime in dosages lower than those used to treat depression, tricyclic antidepressants can help promote restorative sleep in people with fibromyalgia. They also can relax painful muscles and heighten the effects of the body's natural pain-killing substances called endorphins.

Tricyclic antidepressants have been around for almost half a century. Some examples of tricyclic medications used to treat fibromyalgia include:

  • amitriptyline
  • cyclobenzaprine
  • doxepin
  • nortriptyline

Selective Serotonin Reuptake Inhibitors (SSRIs)

If a tricyclic antidepressant fails to bring relief, doctors sometimes prescribe a newer type of antidepressant called a SSRI. As with tricyclics, doctors usually prescribe these for people with fibromyalgia in lower dosages than are used to treat depression.

By promoting the release of serotonin, these drugs may reduce fatigue and some other symptoms associated with fibromyalgia. The group of SSRIs includes:

  • fluoxetine
  • paroxetine
  • sertraline

SSRIs may be prescribed along with a tricyclic antidepressant. Doctors rarely prescribe SSRIs alone. Because they make people feel more energetic, they also interfere with sleep, which often is already a problem for people with fibromyalgia.

Cymbalta (duloxetine) is a selective serotonin and norepinephrine reuptake inhibitor (SSNRI) that is also showing promise.

Mixed Reuptake Inhibitors

Some newer antidepressants raise levels of both serotonin and norepinephrine, and are therefore called mixed reuptake inhibitors.

Examples of these drugs include:

  • venlafaxine
  • nefazodone

Researchers are actively studying the efficacy of these drugs in treating fibromyalgia.


Benzodiazepines help some people with fibromyalgia by relaxing tense, painful muscles and stabilizing the erratic brain waves that can interfere with deep sleep. Benzodiazepines also can relieve the symptoms of restless legs syndrome, which is common among people with fibromyalgia. Restless legs syndrome is characterized by unpleasant sensations in the legs as well as twitching, particularly at night. Because of the potential for addiction, doctors usually prescribe benzodiazepines only for people who have not responded to other therapies. Benzodiazepines include:

  • clonazepam
  • diazepam
  • triazolam
  • temazepam

Other Medications For Fibromyalgia

Doctors may prescribe other medications, depending on a person's specific symptoms or fibromyalgia-related conditions. For example:

  • Tegaserod and alosetron are FDA approved for the treatment of irritable bowel syndrome.
  • Gabapentin is being studied as a treatment for fibromyalgia.
  • Pregabalin (Lyrica) is the first medicine that is FDA-approved to treat fibromyalgia.
  • Modafinil may help with fatigue.
  • Sodium oxybate may help with excessive sleepiness.

Symptom-Specific Drugs

Other symptom-specific drugs include:

  • various headache remedies
  • sleep aids such as:
    • zolpidem
    • eszopiclone
    • ramelteon
    • zaleplon
  • muscle relaxants
    • carisoprodol
    • metaxalone
    • methocarbamol

Source: NIH Publication NO. 04-5326

Continue Reading