Your Fibromyalgia

1 de 3

http://www.webmd.com/fibromyalgia/fibromyalgia-health-check/default.htm

This content is selected and controlled by WebMD's editorial staff.

HEALTH
You report that a doctor has diagnosed you with fibromyalgia and that you are taking prescription medication for the condition.
If your pain has been reduced or eliminated, you should continue with the treatment recommended by your doctor. If your pain is not
well-controlled, your doctor may keep adjusting your treatment regimen to find a combination of medication and nonmedication therapies
that work for you. Responses to treatment vary by person, and finding the right mix may take a few months.

Fibromyalgia Medications
Although all of the prescription medications mentioned below have been studied in people with fibromyalgia, only three have been approved
by the U.S. Food and Drug Administration (FDA) specifically for use in those who have fibromyalgia: Cymbalta (duloxetine), Lyrica
(pregabalin), and Savella (milnacipran).
Analgesics. Although pain is a key symptom of fibromyalgia, certain types of analgesics, or pain relievers, have not been found effective,
including some opioids, such as OxyContin (oxycodone) or Percocet (acetaminophen and oxycodone). The mild opioid Ultram (tramadol),
with or without acetaminophen, has been shown to be effective for those with fibromyalgia. However, due to side effects and dependency
issues, opioids should be used only when other medications and therapies have proven ineffective.
Over-the-counter medications, such as acetaminophen and NSAIDs, may also benefit those with fibromyalgia. However, NSAIDs have been
shown to be ineffective when used alone for fibromyalgia pain, which may be because fibromyalgia pain is not related to inflammation.
Antidepressants. Many people with fibromyalgia also suffer from depression. The relationship between the two is unclear. Depression may
be due to fibromyalgia symptoms, such as chronic pain and fatigue. It may also be related to imbalances of the brain chemicals serotonin
and norepinephrine, which are seen in both conditions.
For many, taking an antidepressant often helps decrease the sense of pain. While Cymbalta (duloxetine) is the only antidepressant
FDA-approved to treat fibromyalgia, others prescribed for people with chronic pain or depressed mood associated with fibromyalgia include
Elavil (amitriptyline), Paxil (paroxetine), and Prozac (fluoxetine). While not an antidepressant, Savella (milnacipran) is approved for
fibromyalgia and works much like an antidepressant by altering chemical imbalances in the brain.
Antiseizure medications. Recent fibromyalgia research has found that altered function of the central nervous system (brain and spinal
cord) may play a role in fibromyalgia symptoms. Antiseizure medications that act on the central nervous system have been proven to sustain
pain reduction and improve sleep quality in people with fibromyalgia. Lyrica (pregabalin) is the only antiseizure medication approved for
fibromyalgia, although Neurontin (gabapentin) is also used.
Muscle relaxants. These help relieve painful muscle spasms. Muscle relaxants commonly used in people with fibromyalgia include
Cycloflex (cyclobenzaprine), Flexeril (cyclobenzaprine), Norflex (orphenadrine citrate), and Soma (carisoprodol), and Zanaflex (tizanidine).
Sleep medications. When pain prevents you from getting an uninterrupted night's sleep, you will feel the effects, which may include
memory loss, difficulty concentrating, a weakened immune system, weight gain, irritability, and an increased sense of pain. If you are waking
unrefreshed due to poor sleep caused by fibromyalgia symptoms, your doctor may recommend over-the-counter or prescription medications
to help with sleep such as Ambien (zolpidem), Lunesta (eszopiclone), or Sonata (zaleplon).
Medications are just part of the treatment plan for people with fibromyalgia, however. Studies have also shown that exercise, patient
education programs, and cognitive behavioral therapy can treat fibromyalgia.

Cognitive Behavioral Therapy (CBT)

Studies show that CBT, which adjusts maladaptive patterns of thinking, can be as beneficial for treatment of pain and depressed mood.
Working with a therapist, you can learn how to overcome negative thoughts and to learn to focus on activities and thoughts that bring you
pleasure instead.

Patient Education Classes

There is strong evidence showing that such classes, especially when combined with CBT and exercise, greatly help reduce some of the
symptoms of fibromyalgia for three months to one year. In a patient education class, lectures, written materials, and demonstrations are
used to teach people with fibromyalgia how to reduce their symptoms and maintain control of their condition.

WELL-BEING
Sounds like you are having a tough time. Your responses to several questions indicate that fibromyalgia significantly affects your life and
health. That's understandable, but it's time for you to start feeling better more often by considering whether you are doing everything you
can to help manage your fibromyalgia. Focusing on living a healthy lifestyle certainly can make a big difference in how you feel.

Eat Right and Light

Everybody, regardless of health condition, should strive to eat a balanced diet in the right portion sizes. Optimal nutrition contributes to
optimal health. The body simply works best when it gets the nutrients it needs through a wide variety of foods taken in moderation.

Exercise a Little Every Day

Aerobic exercise and muscle strengthening have been found to improve the ability to function, boost mood, and decrease fatigue. If you are
experiencing any of these symptoms, you should consider beginning an exercise program. However, do not start any exercise program until
you have gotten your doctor's approval.
You may experience mild-to-moderate muscle pain at first as the body adjusts, but the long-term benefits of sticking with exercise far
outweigh any short-term discomfort you may experience. Some exercise may be less painful than others, such as walking or doing aerobics
in a heated pool, although doctors suggest experimenting to find a program that you feel most comfortable doing. Eventually, you can
gradually increase how often and how intense you exercise, so your body can benefit even more.

Keep Stress in Check

The standard pace of life these days seems fast and furious, so slowing down to relax may feel like a waste of time. But it's not. In fact,
finding time every day to slow down and take it easy is an extremely valuable part of a healthy lifestyle. Reducing stress reduces the

1/12/2013 13:43

Your Fibromyalgia

2 de 3

http://www.webmd.com/fibromyalgia/fibromyalgia-health-check/default.htm

intensity of pain. Simply sitting comfortably in a quiet room and breathing deeply can help. If you have trouble simply letting stress go,
therapists can help you learn simple mind-over-matter techniques, such as guided imagery to visualize a calm place, progressive muscle
relaxation to eliminate tension in the body, meditation, biofeedback, and even hypnosis.

Be a Social Animal
It's true: People do need people. If you have a strong, supportive social network, tapping into it to visit friends or asking for help when you
need it may help with some of your symptoms. Being connected to others has been shown to reduce pain and anxiety. One-on-one
counseling, group counseling, and support groups also provide a place to vent about your frustrations, while receiving encouragement and
coping techniques from others who may share similar symptoms.
If you are doing everything you are supposed to be doing and still suffering, then you should set up an appointment with your doctor to have
your treatment plan re-evaluated. Perhaps it is time for a change in medication or medication dosage.

KNOWLEDGE
How much do you really know about fibromyalgia? See how your answers stacked up. You answered 4 of 5 questions correctly or 80
percent.

Fibromyalgia does not shorten life span: TRUE

Fibromyalgia doesn't directly decrease the quantity of years lived, but it can greatly impact the quality of them. Pain and severe fatigue can
make keeping up with responsibilities at work and at home quite difficult, leading some people with the condition to file for disability.
Fibromyalgia can make physical movements painful, so many people with the syndrome tend to limit exercise; some even develop a fear of
physical movement. Ultimately, avoiding movement reduces fitness level and leads to a sedentary state, which can increase the risk for
other health problems, such as obesity, heart disease, diabetes, or stroke. Although there is no cure for fibromyalgia, proper treatment can
help improve the quality of life and help prevent further health problems that could shorten life span.
All doctors know how to diagnose and treat fibromyalgia: FALSE
Diagnosing fibromyalgia can be tricky, and not all doctors are experienced in doing so. For many people with fibromyalgia, the doctor initially
may suspect that symptoms, such as widespread pain, fatigue, waking unrefreshed, and headaches, are caused by another condition with
overlapping symptoms. If you have been diagnosed with a condition that has the same or similar symptoms and your symptoms are not
improving with treatment, talk to your doctor about the possibility of a fibromyalgia diagnosis.
People with fibromyalgia feel pain when they start to exercise, but they should continue to exercise anyway: TRUE
Scientific studies show that when people living with fibromyalgia participate in a daily exercise routine, they have less pain and experience
improved function. Talk to your doctor about your exercise regimen. Depending on your health and physical condition, some exercises may
not be recommended.
When beginning an exercise program, you may experience mild-to-moderate muscle pain as the body adjusts, but the long-term benefits
exceed the short-term pain experienced. The key is to overcome exercise-related pain, along with any fear of pain exercise might cause, by
preparing the body for exercise and finding an exercise program that you feel comfortable doing. And some exercises may be less painful
than others, such as walking or doing aerobics in a heated pool instead of walking or doing aerobics on land. You should speak with your
doctor for help finding the right exercise routine for you.
Strong narcotics, such as Lortab (hydrocodone) or Percocet (oxycodone) are recommended for the pain of fibromyalgia:
FALSE
Narcotic opioid pain relievers, such as Lortab (acetaminophen and hydrocodone), OxyContin (oxycodone), or Percocet (acetaminophen and
oxycodone), are not recommended for treating fibromyalgia pain simply because they don't work for many people who have the condition. A
study from the University of Michigan helps explain why. Researchers there found that the opioid receptors in the brains of people with
fibromyalgia have a decreased ability to bind and therefore less of a chance for medications targeting those receptors to ease fibromyalgia
pain. The study also found that people with fibromyalgia and depression had the least available opioid receptors, making pain relief even
more challenging.
Because researchers have learned more about how fibromyalgia affects the central nervous system (brain and spinal cord), they have
found that anticonvulsants (antiseizure medications) are helpful. These medications include Lyrica (pregabalin), which has been
FDA-approved for fibromyalgia, and Neurontin (gabapentin). Both work directly on the brain and spinal cord to reduce the production of pain
signals. These medications not only ease pain but also decrease fatigue and help patients get more refreshing sleep, which also helps
improve symptoms.
There are no blood tests that help to diagnose fibromyalgia: FALSE
There is a blood test, called FM/a, that looks for levels of certain proteins in the immune system that are lower in people who have
fibromyalgia. It can help doctors identify the condition more quickly compared to the years of testing some people have gone through.
However, because this is a relatively new test, health insurers may not yet cover the cost.
1. Wolfe, F, Smythe, HA, Yunus, MB, et al. American College of Rheumatology (ACR) 1990 Criteria for the Classification of Fibromyalgia. Arth & Rheum 1990;
33(2):160-172.
2. Goldenberg, DL, Burckhardt, C, Crofford, L. Management of fibromyalgia syndrome. JAMA 2004; 292(19):2388-2395.
3. Carville, SF, Arendt-Nielsen, S, Bliddal, H, et al. EULAR evidence based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis
2007; online.
4. Burckhardt, CS, Clark, SR, Bennett, RM. The Fibromyalgia Impact Questionnaire: Development and validation. J Rheum 1991; 18(5):728-733.
5. Crofford, L. Pain management in fibromyalgia. Curr Opin Rheumatol 2008; 20(3):246-250.
6. Harris, R, Clauw, D, Scott, D, et al. Decreased central mu-opioid receptor availability in fibromyalgia. J Neurosci 2007; 27(37):1000-1006.
7. Zautra, A. Strengthening resilience capacity might light the way to a brighter future for patients with fibromyalgia. Nat Clin Pract Rheumatol 2008; published
online.
8. Gowans, S, deHueck, A. Effectiveness of exercise in management of fibromyalgia. Curr Opin Rheumatol 2004; 16(2):138-142.
9. Rooks, D, Gautam, S, Romeling, M, et al. Group exercise, education, and combination self-management in women with fibromyalgia: a randomized trial. Arch
Intern Med 2007; 167(20):2192-2200.
10. Jones, K, Clark, S, Bennett, R. Prescribing exercise for people with fibromyalgia. AACN Clin Issues 2002; 13(2):277-293.
11. Chakrabarty, S, Zoorob, R. Fibromyalgia. Am Fam Physician 2007; 76(2):247-254.
12. Goldenberg, D. Multidisciplinary modalities in the treatment of fibromyalgia. J Clin Psychiatry 2008; 69(Suppl 2):30-34.
13. Zozulya, A, Gabaeva, M, Sokolov, O, et al. Personality, coping style, and constitutional neuroimmunology. J Immunotoxicol 2008; 5(2):221-225.
14. Karp, J, Shega, J, morone, N, Weiner, D. Advances in understanding the mechanisms and management of persistent pain in older adults. Br J Anaesth 2008;
101(1):111-120
15. American College of Rheumatology:Fibromyalgia.
16. Nickerson , B PharmD, BCPS; Recent Advances in the Treatment of Pain Associated With Fibromyalgia; US Pharm. 2009;34(9):49-55.
17. Russell IJ, Kamin M, Bennett RM, et al. Efficacy of tramadol in treatment of pain in fibromyalgia. J Clin Rheumatol. 2000;6:250-257.
18. Bennett RM, Kamin M, Karim R, et al. Tramadol and acetaminophen combination tablets in the treatment of fibromyalgia pain: a double-blind, randomized,
placebo-controlled study. Am J Med. 2003;114:537-545.
19. Bennett RM, Schein J, Kosinski MR, et al. Impact of fibromyalgia pain on health-related quality of life before and after treatment with tramadol/acetaminophen.
Arthritis Rheum. 2005;53:519-527.
20. Buckhardt CS, Goldenberg D, Crofford L, et al. Guideline for the management of fibromyalgia syndrome pain in adults and children. Glenview, IL: American
Pain Society; 2005.
21. Fibromyalgia Symptoms.Org: Muscle Relaxants
22. Tofferi, J. Jackson, J. OMalley, P. Treatment of Fibromyalgia With Cyclobenzaprine: A Meta-Analysis; Arthritis & Rheumatism; 2004; 51: 913.

1/12/2013 13:43

Your Fibromyalgia

3 de 3

http://www.webmd.com/fibromyalgia/fibromyalgia-health-check/default.htm

23. Bernardy K, Fuber N, Kollner V, Hauser W.; Efficacy of cognitive-behavioral therapies in fibromyalgia syndrome - a systematic review and metaanalysis of
randomized controlled trials; J Rheumatol. 2010 Oct;37(10):1991-2005.
24. Fors EA, Sexton H, Gotestam KG. The effect of guided imagery and amitriptyline on daily fibromyalgia pain. J Psychiatr Res. 2002;36:179

THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a
substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking
treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency,
immediately call your doctor or dial 911.

My Notes:

1/12/2013 13:43