How to best treat fibromyalgia

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Patients with fibromyalgia experience chronic, diffuse pain across the body, due to exquisitely sensitivity of the brain & spinal cord (“central sensitization”). The keys to relief are prompt diagnosis, interdisciplinary pain care, & not overlooking co-existing pain conditions.

Total body pain

The best way to describe the experience of fibromyalgia is total body pain including a variety of unpleasant sensations: aching, throbbing, tingling, burning, and numbness.

This pain disrupts daily life, including mood, sleep, memory, concentration, & energy level.

Due to central sensitization, light sensation that should register as “touch” is experienced as “pain” instead.

Keys to relief

  • Prompt diagnosis: Some patients with fibromyalgia have a treatable underlying cause. Early diagnosis & treatment can reduce the risk of developing central sensitization.
  • Interdisciplinary care: Fibromyalgia involves the entire chronic pain cycle and requires team biomedical, biomechanical, & psychological treatments.
  • Not overlooking co-existing pain conditions: Other focal chronic pain condition may co-exist with fibromyalgia. Targeted treatment may provide substantial relief. This should be pursued deliberately, to avoid compromising treatment of fibromyalgia itself.

Prompt diagnosis

It may be helpful to seek consultation with specialist physicians. Diagnosis of fibromyalgia is “by exclusion” where a series of other conditions are ruled out by tests.

  • Vitamin D deficiency (most common) & other vitamin or micronutrient deficiencies
  • Small-fiber neuropathy or other peripheral neuropathy
  • Chronic rheumatologic & inflammatory diseases (sometimes pain is the first symptom)
  • Chronic infection (including infected tooth)
  • Ensure routine cancer screening is up-to-date
  • And many others

Interdisciplinary pain care

  • Graded exercises focusing on aerobic exercises
  • Cognitive & behavioral therapy (CBT)
  • Non-opioid medications to “activate the brainstem to treat pain” with duloxetine & tricyclic antidepressants
  • Glial cell modulators in particular low-dose naltrexone
  • Non-invasive neuromodulation: transcranial magnetic stimulation (TMS) & vagal nerve stimulation (VNS)

Co-existing pain should be treated

Many co-existing pain conditions respond well to targeted treatments: chronic migraine, TMJ dysfunction (i.e. jaw), dystonia, peripheral nerve entrapments (e.g. carpal tunnel syndrome), joint issues.