Fibromyalgia syndrome (FMS) is
by generalized pain,
tenderness at various points on the body.
cause of FMS is poorly understood,
makes the condition difficult to treat.
However, recent research is leading to some
potentially effective new treatments.
The mainstay of treatment for FMS is light
aerobic exercise. This seems to reduce pain
and fatigue, perhaps by increasing the brain's
production of pain-relieving neurochemicals.
Some patients do best with a treadmill or
light jogging program; others benefit most
from aquatic exercise in a warm therapy
pool. Intensive exercise such as weightlifting,
high-impact aerobics or heavy isometrics is
not recommended for FMS and often makes
the pain worse.
Many FMS patients have underlying postural
problems that contribute to their pain. A
physical therapy program that's aimed at
stretching the tight muscles and improving
posture is often very useful.
A number of medications have been used for
FMS with varying benefit. Certain
antidepressants may help restore sleep,
reduce depressive symptoms and ease pain.
Examples are tricyclic drugs (amitriptyline,
nortriptyline and related agents), a class of
drugs known as selective serotonin reuptake
inhibitors, or SSRIs (paroxetine, sertraline
and others), and newer agents such as
venlafaxine. Nonsteroidal drugs such as
ibuprofen are often used, but they usually just
"take the edge off" the pain. The use of
morphine and other narcotics for FMS is
Newer treatments have evolved as we have
come to understand more about FMS. Some
patients have difficulty maintaining adequate
blood pressure when standing or changing
positions. That condition, called neurally
mediated hypotension, is diagnosed using a
tilt-table test to evaluate blood pressure
control. FMS patients with positive test
results may benefit from increased fluid and
salt intake, the use of elastic supportive
garments such as stockings and abdominal
binders, and drugs that boost blood pressure.
A small subgroup of FMS patients has
structural problems in the head or neck that
compress the brainstem or spinal cord. Such
problems can be detected during a careful
physical examination and confirmed with
magnetic resonance imaging (MRI), if
Many FMS patients suffer from severe
anxiety or depression related to their chronic
pain. For those individuals, psychological
counseling, often coupled with behavioral
techniques such as relaxation training and
biofeedback, can be very helpful.
Although no perfect treatment for FMS
exists, many options are available. Talk to
your physician to see what tests and
treatments are right for you. Physicians who
routinely manage FMS include
rheumatologists (arthritis specialists) and
physiatrists (rehabilitation specialists).