musculoskeletal and connective tissue disorders
Fibromyalgia
Treatment of Fibromyalgia
Stretching and aerobic exercise, local heat, and massage Stress management Tricyclic antidepressants orcyclobenzaprineto improve sleep Nonopioid analgesics Stretching exercises, aerobic exercises, sufficient sound sleep, local applications of heat, and gentle massage may provide relief. Overall stress management (eg, deep breathing exercises, meditation, psychologic support, counseling if necessary) is important. Exercises to gently stretch the affected muscles should be done daily; stretches should be held for about 30 seconds and repeated about 5 times. Aerobic exercise (eg, fast walking, swimming, exercise bicycling) can lessen symptoms. Improving sleep is critical. Sedating drugs can be taken but only at night and only to improve sleep. Low-dose oral tricyclic antidepressants at bedtime (eg,amitriptyline10 to 50 mg,trazodone50 to 150 mg,doxepin10 to 25 mg) or the pharmacologically similarcyclobenzaprine10 to 30 mg may promote deeper sleep and decrease muscle pain. The lowest effective dose should be used. Drowsiness, dry mouth, and other adverse effects may make some or all of these drugs intolerable, particularly for older patients. Nonopioid analgesics (eg,acetaminophen, nonsteroidal anti-inflammatory drugs [NSAIDs]) may help some patients. Opioids should be avoided.Pregabalin,duloxetine, andmilnacipranare available for treatment of fibromyalgia, but should be used as adjuncts to exercise, measures to improve sleep, and stress management; they may help modestly to reduce pain. Occasional injections of 0.5%bupivacaineor 1%lidocaine1 to 5 mL are used to treat incapacitating areas of focal tenderness, but such injections should not be relied on as primary treatment because evidence does not support their regular use. Drugs taken by the patient should be reviewed to identify those that may aggravate sleep problems. Such drugs should be avoided. Overview of Anxiety Disorders , , Biofeedback , 1.Macfarlane GJ, Kronisch C, Dean LE, et al: EULAR revised recommendations for the management of fibromyalgia.Ann Rheum Dis. 76(2):318-328, 2017. doi: 10.1136/annrheumdis-2016-209724. Epub 2016 Jul 4. PMID: 27377815. 