Pros and Cons of 10 Fibromyalgia Treatments

• Fibromyalgia symptoms include tender points along the body, extreme fatigue, and sleeplessness. For years, people with this chronic pain condition were told their symptoms were not real—but times have changed.
• There are now three drugs approved by the Food and Drug Administration (FDA) to treat fibromyalgia, as well as researched behavior and lifestyle changes that can relieve pain, improve sleep, and hopefully lead to a better quality of life.
• Here are the pros and cons of some of the commonly recommended treatments for fibro.

Pros:

"Aerobic exercise can improve overall function and quality of life for people with fibromyalgia," says Lesley Arnold MD, a psychiatrist at the University of Cincinnati, in Ohio. "Start slowly and build up to 30 to 60 minutes a day of low-to-moderate intensity aerobic exercise," she says. Activities such as water aerobics, walking, and biking are best.

Cons: Although studies suggest that exercise can improve pain, the pain may get worse before it gets better. It's hard to get—and stay—motivated to exercise when you're in pain.

Cognitive behavioral therapy (CBT) is a type of counseling that focuses on changing the way people react to life circumstances, and, in the case of fibro, how they respond to pain or other triggers.

Pros: "It can help improve sleep, overall function, and coping skills for people with fibromyalgia," Dr. Arnold says. In addition, studies have shown that CBT can reduce depression.

Cons: It can take as many as 20 sessions to see results. Insurance coverage can vary. And some communities might not have therapists who have experience treating fibro patients, Dr. Arnold says, adding that pain centers are a good place to start looking.

In biofeedback, sensors help you monitor and learn how to control body processes such as blood pressure or heart rate.

Pros: "Biofeedback can help you control some fibromyalgia symptoms such as tension headaches and help you relax," Dr. Arnold says. It may also ease pain and morning stiffness.

Cons: It is usually done in conjunction with CBT, and there is not as much evidence for its effectiveness on its own, Dr. Arnold says. It can also be costly, and insurers won't always foot the bill. It can take as many as 10 sessions before you start to see results.

Approved by the FDA for fibromyalgia, duloxetine (Cymbalta) is an antidepressant that increases the activity of serotonin and norepinephrine, which halt pain signals from reaching the brain.

Pros: Half of people who try it will have a reduction in their pain of at least 30% to 40%. It also relieves coexisting depression and fatigue.

Cons: It doesn't appear to help much in the other half of people, and a pain reduction of 30% to 40% may still not cut it for some. All drugs can have side effects, and Cymbalta's may include nausea, constipation, diarrhea, fatigue, headache, and insomnia.

The most recent drug to be approved by the FDA for fibromyalgia, milnacipran (Savella) is an antidepressant.

Pros: It works in a similar manner to Cymbalta and is about as effective. "It can also help with pain and depression," Dr. Arnold says.

Cons: Milnacipran is not effective in everyone, and pain reductions, while meaningful, are not complete. Side effects may include nausea, constipation, stomach pain, headache, and insomnia.

Pros:

Physical therapy can improve strength and range of motion, and teach you ways to relieve muscle pain. You'll also learn how to pace activities to avoid making pain and fatigue worse.

Cons: It's highly therapist dependent. "If the physical therapist isn't familiar with fibromyalgia, it could make pain worse, especially early on," Dr. Arnold says.

Pros:

FDA approved for fibromyalgia, pregabalin (Lyrica) is a seizure drug that reduces the release of pain signals from nerves, and may have spillover benefits on sleep quality.

Cons: It's not effective in everyone, and even if it does work, it often reduces pain by only 30% to 40% , says Jianguo Cheng, MD, professor and director of the Cleveland Clinic Pain Medicine Fellowship Program, in Ohio. "You have to treat at least three people with fibromyalgia with pregabalin to make one person 30% better," he says. Side effects may include dizziness, sleepiness, headache, dry mouth, difficulty concentrating, nausea, and vomiting.

Pros:

Tai chi, a form of martial arts marked by slow, gentle movements and deep breathing, was recently reported to reduce fibromyalgia pain, depression, and anxiety, and improve sleep quality.

Cons: There are no known side effects of tai chi, but not everyone is motivated to try this ancient Chinese form of exercise, and finding an experienced teacher can be a challenge. It also isn't helpful for everyone who tries it. A small 2010 study found that tai chi improved fibromyalgia symptoms in about 80% of patients, compared with 50% of patients who did only stretching exercises.

Pros:

This class of drugs is usually given for sleep problems, and they may also help with pain and depression.

Cons: These drugs—which include amitriptyline, cyclobenzaprine, and nortriptyline—are not FDA approved for fibromyalgia. They are not as selective as drugs like Cymbalta and Savella, meaning they can affect a number of neurotransmitters, Dr. Arnold says. They are also associated with different side effects, including drowsiness, dry mouth, dizziness, fast heart rate, constipation, and weight gain. They can lose effectiveness after just one month.

Pros:

Downward Dog, Child's Pose, and other gentle yoga positions may help people with fibromyalgia. A two-hour weekly class—which included meditation and group therapy and was specifically geared for fibromyalgia patients— cut symptoms like pain, fatigue, and stiffness by 30% in about half of people who tried it for a year, a 2010 study found.

Cons: Yoga has few, if any, side effects, but it can be difficult to stay motivated if you're in pain, or you may fear that yoga postures will worsen pain. It can be tricky to find an instructor who has experience working with pain patients.