Got Fibro? Now What?

Ok, you have a diagnosis…now what’s going to happen?

ae78c7c2bc0e5642e361bf001c101af9Most likely, your doctor is going to give you medication. There are many different medications used to manage FM, including pain medicines, sleeping pills, and antidepressants.  Some help ease pain. Others boost mood and improve sleep. Working with your doctor will help you find the right medication to add to your multi-faceted comprehensive treatment regimen. That way, you can begin to manage your symptoms effectively…

The first medication doctors will often try is an anti-depressant (this does NOT mean you are necessarily suffering from depression!), which helps relieve pain, fatigue, and sleep problems. Nonetheless, depression is commonly seen in people with FM.

Older anti-depressants, called tricyclics (including Elavil (amitriptyline) and Pamelor (nortriptyline)), have been used for many years to treat FM. They work by raising the levels of chemicals (neurotransmitters) in the brain.

Tricyclic anti-depressants increase levels of serotonin and norepinephrine in the brain. People with chronic pain often have decreased levels of these calming neurotransmitters. Tricyclics can relax painful muscles and heighten the effects of endorphins – the body’s natural painkillers. While these medications are often very effective, the side effects can sometimes make them difficult to take as they may cause drowsiness, dizziness, dry mouth, dry eyes, and constipation.

There are numerous types of anti-depressants and several of them have been shown to help relieve the pain, fatigue, and sleep problems in people with FM.

pillsThe most well-studied anti-depressants for FM include Cymbalta (duloxetine), Savella (milnacipran), and Effexor (venlafaxine). Cymbalta and Savella are specifically FDA-approved to treat FM. There is less medical research to show that Effexor helps FM. Other anti-depressants that have also been studied for FM and may help include Prozac (fluoxetine), Paxil (paroxetine), and Celexa (citalopram).

That’s a lot of different choices to work through and yes, it’s all trial and error to see what works for you. What works for one person with FM may not work for someone else. Different anti-depressants work differently in the body. That’s why you may have to try more than one anti-depressant to find the one that best relieves the pain, fatigue, and sleep difficulties. Your doctor may even want you to try a combination of more than one anti-depressant at a time.

Then, there are different types of pain relievers, sometimes recommended to ease the deep muscle pain and trigger-point pain that comes with FM. The problem is these pain relievers don’t work the same for everyone, either.

article-new_ehow_images_a05_sc_bu_can-nexium_-800x800Non-steroidal anti-inflammatory drugs (NSAIDs), when taken alone, don’t typically work that well for FM. However, when combined with other medications, NSAIDs often do help. NSAIDs are available over the counter and include drugs such as aspirin, ibuprofen, and naproxen. Further, the over-the-counter pain reliever acetaminophen elevates the pain threshold so you perceive less pain. Acetaminophen is relatively free of side effects. But avoid this medication if you have liver disease.

You also need to be careful taking aspirin or other NSAIDs if you have stomach problems. These medications can lead to heartburn, nausea or vomiting, stomach ulcers, and stomach bleeding. Don’t ever take over-the-counter NSAIDs for more than 10 days without checking with your doctor. Taking them for a prolonged period increases the chance of serious side effects.

Sometimes, your doctor will prescribe the muscle relaxant cyclobenzaprine. has proved useful for the treatment of FM. It has proved to be helpful with easing muscle tension and improving sleep. Muscle relaxants work in the brain to relax muscles; but you may experience dry mouth, dizziness, drowsiness, blurred vision, clumsiness, unsteadiness, and change in the colour of your urine. These medications may increase the likelihood of seizures, confusion and hallucinations.

Most recently, Lyrica, originally used to treat seizures, is being used to treat FM. Lyrica affects chemicals in the brain that send pain signals across the nervous system. So it reduces pain and fatigue and improves sleep.

Neurontin (gabapentin) is another anti-seizure medication that has also been shown to improve FM symptoms.

SMFM-278Other medications include pain relievers such as Ultram (tramadol) which is a narcotic-like medication that acts in the brain to affect the sensation of pain. However, it is not as addictive as narcotics.

In addition, doctors may prescribe benzodiazepines such as Ativan (lorazepam), Klonopin (clonazepam), Valium (diazepam), and Xanax (alprazolam) to help relax painful muscles, improve sleep, and relieve symptoms of restless legs syndrome. Benzodiazepines are addictive and must be used with caution on a short-term basis. Taking more than recommended increases the risk of serious side effects, including death.

Powerful narcotic medications, such as Percocet and OxyContin (oxycodone) and Vicodin and Lortab (hydrocodone), should only be considered if all other drugs and alternative therapies have been exhausted and there is no relief.

All of this seems quite daunting which is why you need to surround yourself with a team you trust, which may include doctors, friends and/or family. The most consistent treatment advice that all the experts in FM try to promote is a multi-faceted approach. So, as well as all these medications, you will need to explore a whole range of complementary treatments.

FCKI don’t mean to scare you; in fact, I am trying to help by blogging about research and my experiences with different activities (please explore the site). There is also a directory of other FM bloggers that allows you to find people who are going through the same stuff as you.

There Ain’t No Magic Pill

“There’s no magic pill…to fix their fibromyalgia,” says Mark J. Pellegrino, MD, of Ohio Pain and Rehabilitation Specialists and author of 13 books on fibromyalgia. “A balanced approach is important.”

And many experts agree the best treatment for fibromyalgia is a multifaceted approach that combines medication with lifestyle changes and alternative treatments.

But what about if you’re new to all of this? Where do you even start?

A treatment plan gives structure to getting from here to there. Be realistic and (yes, you’re already probably sick of hearing this already) small steps! A treatment plan is different from devising goals because of its flexibility and internal exploration. In most clinical settings, a treatment plan review is done quarterly or even monthly. After each review, the plan is rewritten to meet current needs.

Start With a Diagnosis

There are no lab tests for fibromyalgia. Doctors diagnose it by considering criteria such as how long you’ve had pain and how widespread it is, and by ruling out other causes. This can be a long and complicated process because the symptoms associated with fibromyalgia can be caused by other conditions. So it’s best to see a doctor who is familiar with fibromyalgia – which can be easier said than done, sometimes!

Learn About Fibromyalgia Medications – You are YOUR Best Advocate!

Once you’ve been diagnosed with fibromyalgia, your doctor will talk to you about treatment options. Several types of medicines are used to help manage fibromyalgia symptoms such as pain and fatigue.

Three medications are FDA-approved to treat fibromyalgia:

  • Cymbalta (duloxetine): a type of antidepressant called a serotonin and norepinephrine reuptake inhibitor (SNRI). Researchers aren’t sure how Cymbalta works in fibromyalgia, but they think that increasing levels of serotonin and norepinephrine help control and reduce feelings of pain.
  • Lyrica (pregabalin): Lyrica is a nerve pain and epilepsy drug. In people with fibromyalgia, it may help calm down overly sensitive nerve cells that send pain signals throughout the body. It has been effective in treating fibro pain.
  • Savella (milnacipran): Savella is also an SNRI. While researchers aren’t exactly sure how it works, studies have shown that it helps relieve pain and reduce fatigue in people with fibromyalgia.

Antidepressants are also sometimes prescribed to help people manage fibromyalgia symptoms:

  • Tricyclic antidepressants. By helping increase levels of the brain chemicals serotonin and norepinephrine, these medications may help relax painful muscles and enhance the body’s natural painkillers.
  • Selective serotonin reuptake inhibitors (SSRIs). Your doctor may prescribe one of these types of antidepressants by itself or in combination with a tricyclic antidepressant. SSRIs prevent serotonin from being reabsorbed in the brain. This may help ease pain and fatigue.

These medications are also sometimes prescribed for fibromyalgia:

  • Local anesthetics. Injected into especially tender areas, anesthetics can provide some temporary relief, usually for no longer than three months.
  • Anticonvulsants or seizure medications such as Neurontin are effective for reducing pain and anxiety. It is unclear how these medications work to relieve the symptoms in fibromyalgia.
  • Muscle Relaxants are occasionally prescribed to help alleviate pain associate with muscle strain in those with fibromyalgia.

Stay Active

Exercise is an important part of managing fibromyalgia symptoms. Staying physically active can relieve pain, stress, and anxiety.

The key is to start slowly. Begin with stretching and low-impact activities, such as walking, swimming or other water exercises, or bicycling. Low-impact aerobic exercises such as yoga, tai chi, or Pilates can also be helpful. Prior to starting any exercise routine, or if you want to increase the intensity of your exercise, talk with your doctor.

Physical Therapy

Physical therapy can help you get control of your illness by focusing on what you can do to improve your situation, rather than on your chronic symptoms.

A physical therapist can show you how to get temporary relief from fibromyalgia pain and stiffness, get stronger, and improve your range of motion. And she can help you make little changes, such as practicing good posture, that help prevent painful flare-ups.

Alternative Therapies

A number of popular fibromyalgia treatments fall outside the realm of mainstream medicine. In general, there hasn’t been extensive research on complementary and alternative medicine (CAM), but anecdotal evidence suggests that some may work. Always talk with your doctor before starting any alternative treatment.

Popular alternative treatments include:

  • Acupuncture. This ancient healing practice aims to increase blood flow and production of natural painkillers with thin needles inserted into the skin at strategic points on the body. Some studies report that acupuncture may help ease pain, anxiety, and fatigue.
  • Massage therapy. This may help reduce muscle tension, ease pain in both muscles and soft tissue,improve range of motion, and boost production of natural painkillers.
  • Chiropractic treatment. Based on spinal adjustments to reduce pain, this popular therapy may help relieve fibromyalgia symptoms.
  • Supplements. A number of dietary and other supplements are touted as treatments aimed at relieving fibromyalgia symptoms. Some of the most popular for fibromyalgia include magnesium, melatonin, 5-HTP, and SAMe, which may affect serotonin levels. However, results of studies on these supplements are mixed. Be sure to talk with your doctor before taking any supplements. Some may have side effects and could react badly with medication you are taking.
  • Herbs. As with supplements, scientific evidence for the effectiveness of herbs is mixed. A few studies have shown that St. John’s wort can be as effective as certain prescription medication for treating mild depression.

This is just a start – and you will probably need to tweak your plan as you go along, throwing out activities and treatments that don’t work for you, while grasping the positives with both hands. Remember, it may take a while to get where you want to be – it is all about experimentation (and just because something works for me does not mean it will work for you).

If you’d like to see iHerb’s selection of supplements, click here. Use Coupon Code LHJ194 to get $10 off any first time order over $40 or $5 off any first time order under $40.

Lab Rats Wanted

Are you willing to put your body on the line? Or might you be at the end of your tether and willing to try anything?

As it is beyond me to list EVERY research study on FM, here are all the studies that are currently recruiting in the top 6 countries where my blog is being read:

*** If you live in another country, visit ClinicalTrials.gov, then enter your country and ‘fibromyalgia’ in the search box…you never know what you might find ***

Australia

NIL

Canada

A Phase 3b Multicenter Study of Pregabalin in Fibromyalgia Subjects Who Have Comorbid Depression

Conditions: Fibromyalgia

Interventions: Drug: Pregabalin; Drug: placebo

The Impact of Omega-3 Fatty Acid Supplements on Fibromyalgia Symptoms

Conditions: Fibromyalgia

Interventions: Dietary Supplement: Omega-3 (oil); Dietary Supplement: Fatty Acids (placebo)

Online Acceptance-based Behavioural Treatment for Fibromyalgia

Conditions: Fibromyalgia

Interventions: Behavioural: Acceptance-based behavioural therapy;   Other: Will vary per participant

India

Adolescent Fibromyalgia Study

Conditions: Fibromyalgia

Interventions: Drug: placebo; Drug: pregabalin (Lyrica)

A Study of Duloxetine in Adolescents With Juvenile Primary Fibromyalgia Syndrome

Conditions: Fibromyalgia

Interventions: Drug: Duloxetine; Drug: Placebo

Pregabalin In Adolescent Patients With Fibromyalgia

Conditions: Fibromyalgia

Interventions: Drug: pregabalin

Israel

Prevalence of Fibromyalgia in Israel

Conditions: Fibromyalgia

Interventions:

Effect of Milnacipran in Patients With Fibromyalgia

Conditions: Fibromyalgia

Interventions: Drug: Minalcipran; Drug: Placebo

Peripheral Arterial Tonometry (PAT) Evaluation of Sleep in Fibromyalgia

Conditions: Fibromyalgia

Interventions:

Study Assessing the Efficacy of Etoricoxib in Female Patients With Fibromyalgia

Conditions: Fibromyalgia

Interventions: Drug: etoricoxib

Cognitive Dysfunction in Fibromyalgia Patients

Conditions: Fibromyalgia

Interventions:

United Kingdom

NIL

United States of America

Observational Study of Control Participants for the MAPP Research Network

Conditions: Fibromyalgia; Irritable Bowel Syndrome; Chronic Fatigue Syndrome,

Interventions:

Pain and Stress Management for Fibromyalgia

Conditions: Fibromyalgia

Interventions: Behavioural: Stress and Emotions; Behavioural: Thoughts and Behaviours; Behavioural: Brain and Body

Adolescent Fibromyalgia Study

Conditions: Fibromyalgia

Interventions: Drug: placebo; Drug: pregabalin (Lyrica)

A Phase 3b Multicenter Study of Pregabalin in Fibromyalgia Subjects Who Have Comorbid Depression

Conditions: Fibromyalgia

Interventions: Drug: Pregabalin; Drug: placebo

A Study of Duloxetine in Adolescents With Juvenile Primary Fibromyalgia Syndrome

Conditions: Fibromyalgia

Interventions: Drug: Duloxetine; Drug: Placebo

Pregabalin In Adolescent Patients With Fibromyalgia

Conditions: Fibromyalgia

Interventions: Drug: Pregabalin

Combined Behavioural and Analgesic Trial for Fibromyalgia

Conditions: Fibromyalgia

Interventions: Drug: Tramadol; Drug: Placebo; Behavioural: Cognitive Behaviour Therapy for FM; Behavioural: Health Education

Quetiapine Compared With Placebo in the Management of Fibromyalgia

Conditions: Fibromyalgia

Interventions: Drug: quetiapine; Drug: Placebo

Cyclobenzaprine Extended Release (ER) for Fibromyalgia

Conditions: Fibromyalgia; Pain; Sleep; Fatigue

Interventions: Drug: cyclobenzaprine ER (AMRIX); Drug: placebo

Tai Chi and Aerobic Exercise for Fibromyalgia (FMEx)

Conditions: Fibromyalgia

Interventions: Behavioural: Lower frequency, shorter period of Tai Chi; Behavioural: Higher frequency, shorter period of Tai Chi; Behavioural: Shorter frequency, longer period of Tai Chi; Behavioural: Higher frequency, longer period of Tai Chi; Behavioural: Aerobic Exercise Training

Effects of Direct Transcranial Current Stimulation on Central Neural Pain Processing in Fibromyalgia

Conditions: Fibromyalgia

Interventions: Procedure: Transcranial Direct Current Stimulation (tDCS)

Lifestyle Physical Activity to Reduce Pain and Fatigue in Adults With Fibromyalgia

Conditions: Fibromyalgia

Interventions: Behavioural: Lifestyle physical activity (LPA); Behavioural: Fibromyalgia education

Neurotropin to Treat Fibromyalgia

Conditions: Fibromyalgia

Interventions: Neurotropin

Effect of Milnacipran on Pain in Fibromyalgia

Conditions: Fibromyalgia

Interventions: Drug: Neurotropin

Investigation of Avacen Thermal Exchange System for Fibromyalgia Pain

Conditions: Fibromyalgia

Interventions: Device: AVACEN Thermal Exchange System

Phase 2 Study of TD-9855 to Treat Fibromyalgia

Conditions: Fibromyalgia

Interventions: Drug: TD-9855 Group 1; Drug: TD-9855 Group 2; Drug: Placebo

Cymbalta for Fibromyalgia Pain

Conditions: Fibromyalgia

Interventions: Drug: Duloxetine

Effects of Milnacipran on Widespread Mechanical and Thermal Hyperalgesia of Fibromyalgia Patients

Conditions: Fibromyalgia

Interventions: Drug: Milnacipran

Qigong Exercise May Benefit Patients With Fibromyalgia

Conditions: Fibromyalgia

Interventions: Behavioural: Intervention Group; Behavioural: Placebo Comparator: Control Group

Effect of Temperature on Pain and Brown Adipose Activity in Fibromyalgia

Conditions: Fibromyalgia, Pain

Interventions:

Effect of Milnacipran in Patients With Fibromyalgia

Conditions: Fibromyalgia

Interventions: Drug: Minalcipran; Drug: Placebo

The Pathogenesis of Idiopathic Dry Eyes

Conditions: Dry Eye, Fibromyalgia

Interventions:

Evaluation and Diagnosis of People With Pain and Fatigue Syndromes

Conditions: Fatigue; Fibromyalgia; Pain; Complex Regional Pain Syndrome; Reflex Sympathetic Dystrophy

Interventions:

The Functional Neuroanatomy of Catastrophizing: an fMRI Study

Conditions: Fibromyalgia

Interventions: Behavioural: Cognitive Behavioural Therapy; Behavioural: Education

A Placebo-Controlled Trial of Pregabalin (Lyrica) for Irritable Bowel Syndrome

Conditions: Irritable Bowel Syndrome

Interventions: Drug: Pregabalin (Lyrica); Drug: Placebo

 

 

Got Morning Stiffness?

When asked, most of us would say that the most debilitating symptoms of FM are pain, fatigue, and sleep disturbances. For me, the next one is stiffness – and who wouldn’t complain about waking up each morning to a body that feels like the final stages of rigor mortis?

But most doctors generally regard it as a minor symptom or a sign of inflammation unrelated to the fibromyalgia.

121. rise and shineWhen doctors think of stiffness, they conjure up rheumatoid arthritis and other inflammation-related joint diseases that make it harder for these patients to get going in the morning. Yet studies in FM patients also show stiffness is usually worse in the morning and “morning stiffness has been rated as more severe in fibromyalgia than rheumatoid arthritis,” says Robert Bennett, M.D. of Oregon Health and Science University in Portland. He says people with both conditions have worse stiffness than those with FM alone. But why would FM patients be troubled by stiffness?

As people age, they get arthritis, become less active, and expect a little morning stiffness. However, this does not explain why a 25 or 45-year-old FM sufferer would show signs of joint stiffness on a test involving the ankle. Needless to say, FM patients showed twice as much stiffness as age-matched healthy controls.

Stiffness sometimes correlates with pain, which means that the drugs used to treat our pain should help with the stiffness – but, in a study supported by Eli Lilly, the use of Cymbalta only improved the symptom by a tiny 10%. This compares closely to the 13% benefit found in the trials of Lyrica.

If the pain of FM was solely related to the stiffness, the drugs should be able to produce significant improvement in this symptom. Yet they don’t.

Fibromyalgia is a messy multi-system condition. There is the central nervous system component involved in processing pain, an area all the drugs are supposed to work on (Cymbalta, Lyrica and Savella). There are trigger points and tender points, which cause serious pain and restrictive movement. In addition, you have to remember the circulatory system, and FM patients have increased arterial stiffness (but that’s a whole other post).

Your arteries should be flexible, but studies show a reduction of the elastic-like qualities in us compared to age-matched controls. An overly active sympathetic nervous system is thought to be partly to blame.

Therapies to relax your sympathetic nerves, such as a hot shower and many other approaches, often ease morning stiffness. One of the three FDA-approved drugs may even help, but just don’t expect too much from them.

Untitled

LOST

 

Day 4 – Lost another 30mg of Cymbalta today. Lost my rehab session to my dodgy tummy. Lost 3 hours to an afternoon nap. Lost the rest of the day…not sure where that went.

NOTE: To all those sending me such lovely wishes (especially in the last couple of days), I have been reading them and I thank you all; I am just not able to even think about replying to you in my current state.

 

DANGER!

 

The powers-that-be (my GP, my rehab doc, Mommy and I) have decided that the experiment to wean off Sertraline (anti-depressant) and start Cymbalta (both anti-depressant and used for FM pain), in the hopes that I could lose the Lyrica from my daily intake, has failed; so we are reversing all our (my) hard work to go back to the way it was. It wasn’t perfect (far from it) but it was better than what I have now.

So, all good, right? Not quite. I want to be back on the sertraline (and away from icky side-effects) in two weeks – for when I go to Bali (that would be the very festive, hot pink area). So, we are fast-forwarding it all:

 

Basically, I’m warning you guys that my posts and comments could be…um…interesting (not sure if that would be the right word).

Now, you might be wondering what that last column labelled Codeine is about: after my holiday (vacation for you US  citizens), my rehab doc has decided I need to give up codeine (hence the very red part) before we try any other type of pain killer – cold turkey: no panadeine forte, no panadeine extra, no ibuprofen plus, etc! And no anti-inflammatories! I’m doing it at home but he has said that some people have to go to hospital – I hope not me. I am very attached to writing to you guys from my couch each day.

 

A Plan Goes Awry

It has finally dawned on me…remember that my GP, Mommy and I are using me as a lab rat for my treatment plan. This could be the reason that I’m feeling worse (inside, not necessarily pain-wise) than I ever have before (except perhaps after an operation where a knife-wielding surgeon has carved up parts of my body)!

The plan is/was to replace Sertraline AND Lyrica with just Cymbalta:

1. maintain Lyrica dosage – 150 mg am & pm (til step 6);

No problem with this part of the plan.

2. stop taking the Prednisolone;

No problem here, either

3. Wean off Sertraline over the week;

Slowly becoming more irritable (or so I have been told!)

4. no anti-depressant for one week;

Really irritable, some collapsing on the floor in tears, really tired – this would be when I posted the SQUISH picture, and started the Things I Have Lost series

5. 4 weeks of 30mg Cymbalta;

No real help on this minimal dosage, still really tired, not quite as much crying, can’t be bothered with much, lots of pain EVERYWHERE! – and that would be The Mess That Blubbered

6. 4 weeks on 60mg Cymbalta – NOW:

Not impressed with Cymbalta as an anti-depressant (not even up to the FM dosage yet), feeling nothing but exhausted ALL the time, really noticing temperature changes within my own body

So now, I’m supposed to increase the Cymbalta again while reducing my Lyrica but I really can’t see how the Cymbalta is going to help me with pain management when it can’t even cope with the depression in my body, and it appears to be making a lot of symptoms worse

And I’m just not sure where to go from here…

Men Get Fibro, Too!

Fibromyalgia can take years to diagnose—three to five years on average—but, if you’re a man, it can take even longer! It is common knowledge (at least, with us) that FM is diagnosed in 2% to 4% of the population but is about nine times more common in women than men.

The lower numbers mean that doctors are less likely to consider the diagnosis in the first place, and, what’s more, fibromyalgia may look slightly different in men than women. The condition may be milder in men, who may also have fewer symptoms. Some research has suggested that men tend to have less frequent flare-ups of their symptoms, which also are likely to last for shorter periods of time.

However, one Israeli study in 2000 found that men with fibromyalgia actually had more severe symptoms, decreased physical function, and lower quality of life than women the same age with fibromyalgia.

Part of the reason men are less likely to be diagnosed may be due to deeply ingrained social norms that teach men to hide their feelings, making them less likely to seek help for something that could be viewed as a weakness, like body pain. Doctors need to question their male patients about pain to get their patients to talk, because men are sometimes reluctant to talk about it.

Unfortunately, as we know, FM also still has a serious credibility problem. Even if men are willing to talk, not all doctors believe what they are hearing. In a 2007 survey, more than 25% of the 2,000 fibromyalgia patients questioned reported that their doctors did not view fibromyalgia as a ‘very legitimate’ disorder.

Fortunately, at least for patients in the US, the Food and Drug Administration’s approval of three drugs—Cymbalta, Lyrica, and Savella (Lyrica has not been approved by the PBS in Australia – I have no idea about other countries) —for FM has helped to bring the condition out of the closet, says Patrick Wood, MD, a member of the medical advisory board of the National Fibromyalgia Association. “With the release of recent medications, there’s been a greater orientation to the reality of this disorder and emphasis to make it something that’s treated as a legitimate condition.”

But in addition to disbelief and social norms, there are also some physical variations that make fibromyalgia different in men. The current guidelines for diagnosing fibromyalgia include feeling pain at 11 or more of 18 common tender points. But because the average woman is more sensitive to pain than the average man, women score higher on this diagnostic test and, therefore, meet the criteria for fibromyalgia more frequently than men, explains Daniel Clauw, MD, the director of the Chronic Pain and Fatigue Research Center at the University of Michigan, in Ann Arbor.

Dr Clauw supports the burgeoning movement to eliminate the tender points test from fibromyalgia diagnoses because of this bias toward women. “Using [tender points] criteria, fibromyalgia is about 95% female,” he says. “That will probably go down to about 65% because chronic, widespread pain is only about 1.5 times greater in women than in men.”

Another deviation may be chemical imbalances in the brain. Dr Wood suggests hormones may play a role. “With the dopamine system, in particular, there are gender differences as to how the brain responds to situations,” he says, pointing particularly to stress. “Estrogen is very excitatory to the central nervous system, [while] progesterone is very calming.” Greater attention to hormonal imbalances may lead to gender-specific treatment in the future, he adds.

However Dr Clauw is not convinced that estrogen is the culprit. “Pregnancy and menopause [cause great changes in estrogen] and neither of those are associated with changes in pain in women,” he says. “We simply don’t know why women have more pain than men.” Until the condition is more deeply understood, managing the pain is any patient’s best plan of attack.

Despite the gender imbalance, advice for thriving with fibromyalgia is gender neutral. Both men and women can benefit from the same advice.

Both men and women deserve to have their pain treated.

Treat Your Pain

Many experts believe the best treatment for fibromyalgia is a multifaceted approach that combines medication with lifestyle changes and alternative treatments. And, it looks like Mommy and I have been left alone to learn how to manage/treat/cope/handle/survive (choose the most appropriate verb) my fibromyalgia. Having read lots of your stories and received plenty of advice, I am working on my own treatment plan – do I have a choice?

But what about if you’re new to all of this? Where do you even start?

A treatment plan gives structure to getting from here to there. Be realistic and (yes, you’re already probably sick of hearing this already) small steps! A treatment plan is different from devising goals because of its flexibility and internal exploration. In most clinical settings, a treatment plan review is done quarterly or even monthly. After each review, the plan is rewritten to meet current needs.

Start With a Diagnosis

There are no lab tests for fibromyalgia. Doctors diagnose it by considering criteria such as how long you’ve had pain and how widespread it is, and by ruling out other causes. This can be a long and complicated process because the symptoms associated with fibromyalgia can be caused by other conditions. So it’s best to see a doctor who is familiar with fibromyalgia – which can be easier said than done, sometimes!

Learn About Fibromyalgia Medications – You are YOUR Best Advocate!

Once you’ve been diagnosed with fibromyalgia, your doctor will talk to you about treatment options. Several types of medicines are used to help manage fibromyalgia symptoms such as pain and fatigue.

Three medications are FDA-approved to treat fibromyalgia:

  • Cymbalta (duloxetine): a type of antidepressant called a serotonin and norepinephrine reuptake inhibitor (SNRI). Researchers aren’t sure how Cymbalta works in fibromyalgia, but they think that increasing levels of serotonin and norepinephrine help control and reduce feelings of pain.
  • Lyrica (pregabalin): Lyrica is a nerve pain and epilepsy drug. In people with fibromyalgia, it may help calm down overly sensitive nerve cells that send pain signals throughout the body. It has been effective in treating fibro pain.
  • Savella (milnacipran): Savella is also an SNRI. While researchers aren’t exactly sure how it works, studies have shown that it helps relieve pain and reduce fatigue in people with fibromyalgia.

Antidepressants are also sometimes prescribed to help people manage fibromyalgia symptoms:

  • Tricyclic antidepressants. By helping increase levels of the brain chemicals serotonin and norepinephrine, these medications may help relax painful muscles and enhance the body’s natural painkillers.
  • Selective serotonin reuptake inhibitors (SSRIs). Your doctor may prescribe one of these types of antidepressants by itself or in combination with a tricyclic antidepressant. SSRIs prevent serotonin from being reabsorbed in the brain. This may help ease pain and fatigue.

These medications are also sometimes prescribed for fibromyalgia:

  • Local anesthetics. Injected into especially tender areas, anesthetics can provide some temporary relief, usually for no longer than three months.
  • Anticonvulsants or seizure medications such as Neurontin are effective for reducing pain and anxiety. It is unclear how these medications work to relieve the symptoms in fibromyalgia.
  • Muscle Relaxants are occasionally prescribed to help alleviate pain associate with muscle strain in those with fibromyalgia.

Stay Active

Exercise is an important part of managing fibromyalgia symptoms. Staying physically active can relieve pain, stress, and anxiety.

The key is to start slowly. Begin with stretching and low-impact activities, such as walking, swimming or other water exercises, or bicycling. Low-impact aerobic exercises such as yoga, tai chi, or Pilates can also be helpful. Prior to starting any exercise routine, or if you want to increase the intensity of your exercise, talk with your doctor.

Physical Therapy

Physical therapy can help you get control of your illness by focusing on what you can do to improve your situation, rather than on your chronic symptoms.

A physical therapist can show you how to get temporary relief from fibromyalgia pain and stiffness, get stronger, and improve your range of motion. And she can help you make little changes, such as practicing good posture, that help prevent painful flare-ups.

Alternative Therapies

A number of popular fibromyalgia treatments fall outside the realm of mainstream medicine. In general, there hasn’t been extensive research on complementary and alternative medicine (CAM), but anecdotal evidence suggests that some may work. Always talk with your doctor before starting any alternative treatment.

Popular alternative treatments include:

  • Acupuncture. This ancient healing practice aims to increase blood flow and production of natural painkillers with thin needles inserted into the skin at strategic points on the body. Some studies report that acupuncture may help ease pain, anxiety, and fatigue.
  • Massage therapy. This may help reduce muscle tension, ease pain in both muscles and soft tissue,improve range of motion, and boost production of natural painkillers.
  • Chiropractic treatment. Based on spinal adjustments to reduce pain, this popular therapy may help relieve fibromyalgia symptoms.
  • Supplements. A number of dietary and other supplements are touted as treatments aimed at relieving fibromyalgia symptoms. Some of the most popular for fibromyalgia include magnesium, melatonin, 5-HTP, and SAMe, which may affect serotonin levels. However, results of studies on these supplements are mixed. Be sure to talk with your doctor before taking any supplements. Some may have side effects and could react badly with medication you are taking.
  • Herbs. As with supplements, scientific evidence for the effectiveness of herbs is mixed. A few studies have shown that St. John’s wort can be as effective as certain prescription medication for treating mild depression.

This is just a start – and you will probably need to tweak your plan as you go along, throwing out activities and treatments that don’t work for you, while grasping the positives with both hands. Remember, it may take a while to get where you want to be – it is all about experimentation (and just because something works for me does not mean it will work for you). Lastly, try not to get discouraged (Ha!) but we’re all here to support you.