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.
Cons: Although studies suggest that exercise can improve pain, the pain may get worse before it gets better. It's hard to getand staymotivated to exercise when you're in pain.
Cognitive behavioral therapy
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.
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.
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.
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.
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.
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.
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.
Cons: These drugswhich include amitriptyline, cyclobenzaprine, and nortriptylineare 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.
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.