Diagnosis and Treatments

Diagnosis

In the past, doctors would check 18 specific points on a person’s body to see how many of them were painful when pressed firmly. Newer guidelines don’t require a tender point exam. Instead, a fibromyalgia diagnosis can be made if a person has had widespread pain for more than three months — with no underlying medical condition that could cause the pain.

To meet the criteria, you must have pain in at least four of these five areas:

  • Left upper region, including shoulder, arm or jaw
  • Right upper region, including shoulder, arm or jaw
  • Left lower region, including hip, buttock or leg
  • Right lower region, including hip, buttock or leg
  • Axial region, which includes neck, back, chest or abdomen

Blood tests

While there is no lab test to confirm a diagnosis of fibromyalgia, your doctor may want to rule out other conditions that may have similar symptoms. Blood tests may include:

  • Complete blood count
  • Erythrocyte sedimentation rate
  • Cyclic citrullinated peptide test
  • Rheumatoid factor
  • Thyroid function tests
  • Anti-nuclear antibody
  • Celiac serology
  • Vitamin D

If there’s a chance that you may be suffering from sleep apnea, your doctor may recommend an overnight sleep study.

Treatment

In general, treatments for fibromyalgia include both medication and self-care strategies. The emphasis is on minimizing symptoms and improving general health. No one treatment works for all symptoms, but trying a variety of treatment strategies can have a cumulative effect.

Medications

Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include:

  • Pain relievers
    Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may be helpful. Your doctor might suggest a prescription pain reliever such as tramadol (Ultram). Narcotics are not advised, because they can lead to dependence and may even worsen the pain over time.
  • Antidepressants
    Duloxetine (Cymbalta) and milnacipran (Savella – *not available in Canada) may help ease the pain and fatigue associated with fibromyalgia. Your doctor may prescribe amitriptyline or the muscle relaxant cyclobenzaprine to help promote sleep.
  • Anti-seizure drugs.
    Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin) is sometimes helpful in reducing fibromyalgia symptoms, while pregabalin (Lyrica) was the first drug approved by the Food and Drug Administration to treat fibromyalgia.

Therapies

A variety of different therapies can help reduce the effect that fibromyalgia has on your body and your life. Examples include:

  • Physical therapy.
    A physical therapist can teach you exercises that will improve your strength, flexibility and stamina. Water-based exercises might be particularly helpful.
  • Occupational therapy.
    An occupational therapist can help you make adjustments to your work area or the way you perform certain tasks that will cause less stress on your body.
  • Counseling.
    Talking with a counselor can help strengthen your belief in your abilities and teach you strategies for dealing with stressful situations.

Lifestyle and home remedies

Self-care is critical in the management of fibromyalgia.

  • Stress management
    Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. But try not to change your routine completely. People who quit work or drop all activity tend to do worse than do those who remain active. Try stress management techniques, such as deep-breathing exercises or meditation.
  • Sleep hygiene
    Because fatigue is one of the main characteristics of fibromyalgia, getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping.
  • Exercise regularly
    At first, exercise may increase your pain. But doing it gradually and regularly often decreases symptoms. Appropriate exercises may include walking, swimming, biking and water aerobics. A physical therapist can help you develop a home exercise program. Stretching, good posture and relaxation exercises also are helpful.
  • Pace yourself
    Keep your activity on an even level. If you do too much on your good days, you may have more bad days. Moderation means not overdoing it on your good days, but likewise it means not self-limiting or doing too little on the days when symptoms flare.
  • Maintain a healthy lifestyle
    Eat healthy foods. Limit your caffeine intake. Do something that you find enjoyable and fulfilling every day.

Alternative medicine

Complementary and alternative therapies for pain and stress management aren’t new. Some, such as meditation and yoga, have been practiced for thousands of years. But their use has become more popular in recent years, especially with people who have chronic illnesses, such as fibromyalgia.

Several of these treatments do appear to safely relieve stress and reduce pain, and some are gaining acceptance in mainstream medicine. But many practices remain unproved because they haven’t been adequately studied.

  • Acupuncture
    Acupuncture is a Chinese medical system based on restoring normal balance of life forces by inserting very fine needles through the skin to various depths. According to Western theories of acupuncture, the needles cause changes in blood flow and levels of neurotransmitters in the brain and spinal cord. Some studies indicate that acupuncture helps relieve fibromyalgia symptoms, while others show no benefit.
  • Massage therapy
    This is one of the oldest methods of health care still in practice. It involves use of different manipulative techniques to move your body’s muscles and soft tissues. Massage can reduce your heart rate, relax your muscles, improve range of motion in your joints and increase production of your body’s natural painkillers. It often helps relieve stress and anxiety.
  • Yoga and tai chi
    These practices combine meditation, slow movements, deep breathing and relaxation. Both have been found to be helpful in controlling fibromyalgia symptoms.

Source: mayoclinic.org