Conventional Medicine Approach For Fibromyalgia

Fibromyalgia is an not an easy condition to treat. Not all physicians are knowledgeable about fibromyalgia and its treatment, therefore a joint approach is needed. This could include  primary doctors, chiropractors, physiotherapists, psychiatrists, occupational therapists, as well as active participation from the patient in order to receive the best results.

Fibro treatments are often categorized in two; the traditional western medicinal treatment and the alternative treatments like naturopathic treatment.

Traditional western medicinal treatment

The Following are some commonly used categories of drugs for fibromyalgia.
Anti-depressants

Many people with fibromyalgia also suffer from depression. In these cases, antidepressant medications are prescribed in order to lift mood. However, regular doses of antidepressants are required in order to improve depression.

These include:

Tricyclic Antidepressants (TCAs)
Tricyclic antidepressants are among the oldest antidepressants on the market. They work by acting on serotonin and nor epinephrine, which are chemicals in the brain that help to transmit messages about pain and emotion. Low levels of these chemicals are associated with depression, fatigue and pain. TCAs work by slowing the breakdown of these chemicals. In low doses, tricyclics are also effective at reducing pain and facilitating restful sleep, both of which are helpful to fibromyalgia patients.

Studies show that TCAs are the best antidepressant drugs for people with fibromyalgia. About 32% of fibromyalgia sufferers experience relief with tricyclics. The most commonly prescribed TCA is amitriptyline; other tricyclics include doxepin, nortriptyline, and cyclobenzaprine. Though TCAs are highly effective, they are also associated with more severe side effects than other new antidepressant medications. These side effects include: dry mouth, constipation, blurred vision, fatigue, and low blood pressure. People with glaucoma, heart conditions, or seizure disorders should refrain from taking TCAs.

Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are one of the newer classes of antidepressants. They are widely prescribed for depression as well as a variety of other ailments. SSRIs work by stopping the breakdown of serotonin in the brain. Serotonin is a neurotransmitter, which helps the brain to communicate pain signals and emotions. SSRIs are highly effective at reducing feelings of depression and anxiety.

SSRIs are used in fibromyalgia in order to improve sleep patterns. SSRIs also help to bolster mood in fibromyalgia patients. Commonly prescribed SSRIs include: fluoxetine, paroxetine, and citalopram. SSRIs are not effective for pain relief and therefore are not used as often as TCAs. Recent studies show that SSRIs are most effective when used in combination with a TCA (for instance, fluoxetine and amitriptyline). Side effects of SSRIs are mild. This antidepressant’s drug side effects include nausea, weight gain, anxiety, loss of sex drive, and headaches.

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
SNRIs are very similar to TCAs, as they work on both serotonin and norepinephrine in the brain. However, SNRIs are better able to balance levels of both of these neurotransmitters, leading to fewer side effects. SNRIs are commonly prescribed to alleviate depression and boost energy.

SNRIs are used in fibromyalgia to relieve pain and disability. They are also beneficial for treating symptoms of depression. The most commonly prescribed SNRIs are duloxetine and venlafaxine. Effects of this antidepressant medication include: indigestion, nausea, sexual dysfunction, and loss of balance. SNRIs are not recommended for people with heart conditions.

Milnacipran is the third new medicine for fibromyalgia that has won approval from the FDA though it is the first drug being introduced into the US that specially treats fibromyalgia.
The good news for people that plan on trying out this new medicine for fibromyalgia is that Milnacipran is safe as well as effective as revealed by a study of its use on more than two thousand patients of fibromyalgia.
Mixed reuptake inhibitors

Some newer antidepressants raise levels of both serotonin and norepinephrine and are therefore called mixed reuptake inhibitors. Examples of these medications include venlafaxine (Effexor), duloxetine (Cymbalta), and (Savella). In general, these drugs work better for pain than SSRIs, probably because they also raise norepinephrine, which may play an even greater role in pain transmission than serotonin.
Benzodiazepines

Benzodiazepines can sometimes help 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. Doctors usually prescribe benzodiazepines only for people who have not responded to other therapies because of the potential for addiction. Benzodiazepines include clonazepam (Klonopin) and diazepam (Valium).

Analgesics
Analgesics are painkillers. They range from over-the-counter acetaminophen (Tylenol) to prescription medicines, such as tramadol (Ultram), and even stronger narcotic preparations. For a subset of people with fibromyalgia, narcotic medications are prescribed for severe muscle pain. However, there is no firm evidence that shows that narcotics actually work for patients 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 physically or psychologically dependent on them.

Non-steroidal Anti-Inflammatory Drugs (NSAIDs)
Non-steroidal anti-inflammatory drugs, including aspirin, ibuprofen (Advil, Motrin), and naproxen sodium (Anaprox, Aleve), are used to treat inflammation. Although inflammation is not a symptom of fibromyalgia, NSAIDs also relieve pain. The drugs work by inhibiting substances in the body called prostaglandins, which play a role in pain and inflammation. These medications, some of which are available without a prescription, may help ease the muscle aches of fibromyalgia. They may also relieve menstrual cramps and the headaches often associated with fibromyalgia.

Cognitive Behavior Therapy
Cognitive behavior therapy is a form of psychotherapy that emphasizes the important role of thinking in the patient feels and what they do. Cognitive therapy works to modify or eliminate the effect that thought patterns have on the symptoms; behavioral therapy aims to help change behaviors that may contribute to the symptoms.
The symptoms of fibromyalgia are often exacerbated by feelings of stress and other negative emotions. Cognitive behavioral therapy can help to pinpoint these emotions and teach the patients how to deal with them in a way that won’t cause symptom flare- ups. This form of therapy can also teach them how to modify or change certain behaviors to help reduce the severity of the pain and fatigue.

Cognitive behavior therapy is thought to relieve symptoms of pain and fatigue in 25% of fibromyalgia patients. Cognitive-behavior therapy has been proven effective for reducing sleep disturbances perpetuated by underlying factors common among fibromyalgia sufferers including: conditioned bedtime arousal, erratic sleep/wake scheduling, and spending too much time in bed. Cognitive behavior therapy also works well to relieve muscle pain and stiffness.

Trigger Point Injection Therapy
Trigger point injection therapy is a treatment used to relieve the pain and stiffness caused by trigger points in the muscles. Trigger points are like knots in the muscles, and they prevent the body parts from relaxing properly. In order to relieve trigger point tenderness, special injections containing anesthetics or corticosteroids are put directly into each trigger point. These injections “shut down” the trigger points, providing quick or immediate relief from pain.

Trigger point injections, though designed to relieve myofascial pain syndrome, can provide great benefits to those with fibromyalgia.

Because so many fibromyalgia sufferers also have myofascial pain syndrome, Trigger point injections provide a variety of benefits to the patient:
• Trigger point injections provide quick, long-lasting relief from trigger point pain
• Injections reduce the amount of referred pain
• Injections help to minimize the effects of other symptoms, including fatigue, stiffness, and disability
• Injections can be done quickly and conveniently in your physician’s office or at a pain clinic
• There is minimal recovery time involved in trigger point injection therapy