Fibromyalgia Treatment - Cure, Treatment Therapy for fibromyalgia
FibromyalgiaTreatment and cure
There is no generally accepted clinical care pathway for the treatment of patients with fibromyalgia. However, there is agreement that successful treatment plans should begin with patient education and reassurance that the disorder is neither life threatening nor imaginary, or associated with development of joint deformities.
We have found that patients in our clinic frequently have been told that their symptoms are psychiatric in origin or feigned. Thus, our patients usually are relieved to learn that many patients who come to our clinic have psychiatric or psychological problems but that these problems are not the cause of their pain, fatigue, or other symptoms associated with fibromyalgia.
There also is general agreement that, although pharmacologic therapies do not eliminate pain, they may help patients better manage their pain. We tend to emphasize the use of medications such as amitriptyline, cyclobenzaprine or fluoxetine. Alternatively, we may use anxiolytic medications such as alprazolam in patients who are highly anxious. Overall, we tend to limit the use of antiinflammatory agents, narcotic analgesics, and muscle relaxants.
It should be noted that patients often exhibit symptoms of both anxiety and depression. These patients frequently are difficult to treat and we tend to obtain consultations for them with colleagues who are highly experienced in managing persons with complex psychiatric disorders and somatic symptoms. Finally, on rare occasions, we have resorted in a totally empiric fashion to short courses (<1 week) of small doses of corticosteroids (prednisone 1–5 mg/day on an as-needed basis), in those patients with joint hypermobility in whom pain flare-ups appear to be clearly related to physical trauma and who cannot take either the classical (COX-1 inhibitor) or the newer (COX-2 inhibitor) NSAIDs. Nevertheless, we are aware that studies of the effectiveness of prednisone in patients with fibromyalgia have produced negative results.
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Another key element in the treatment of fibromyalgia is physical exercise. Consistent with the approach of McCain and associates and of other investigators, we encourage our patients to engage in graduated aerobic exercise regimens led by physical therapists who are skilled in using learning principles to reward patients for meeting daily exercise quotas. It is essential that therapists make realistic assessments of the patients' exercise tolerance levels at baseline and devise exercise programs (e.g., water aerobics) that will meet patients' specific needs. Careful baseline assessment and tailoring of treatments to individual needs are essential to prevent patients from experiencing failure early in treatment and, thus, losing motivation to change their exercise behavior.
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