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Ali Weekley

Professor Hellmers

English 1201

15 July 2021

What is the best treatment to manage fibromyalgia?

Fibromyalgia is a chronic widespread pain disorder that causes physical and

psychological symptoms. This disease has no cure or traditional method for treatment. This

disease is known to drastically influence a person’s quality of life. How do you treat a disease

that currently has no cure? What is the best way to manage the symptoms of this disease?

Roughly 2-8% of the population worldwide is affected by fibromyalgia and one-third of

that population is disabled from the disease (Sarzi-Puttini). To diagnosis fibromyalgia a person

must experience chronic widespread pain for over 3 months, have tenderness in their trigger

points, eliminate other possible diagnoses, and consist of other symptoms like fatigue, insomnia,

stiffness, irritable bowel syndrome, anxiety, or emotional distress (Lawson and Wallace 29). The

main reason this disease is hard to treat is from the lack of understanding the epidemiology and

large variety of symptoms that are present with the disease (Carter). It is evident that a

multidisciplinary approach is necessary to address all aspects of the disease and to improve a

person’s quality of life.

The first approach is to use pharmaceuticals to treat the physical aspects of the disease.

Today, there are few medications that are solely designed for the treatment of fibromyalgia. Dr.

Erin Lawson and Dr. Mark S. Wallace, who are both apart of the Department of Anesthesiology

and Center for Pain Medicine at University of California San Diego, wrote the book

Fibromyalgia: Clinical Guidelines and Treatments to provide the most updated information of
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the disease as of 2015. The major classes of medication for fibromyalgia consist of

antidepressants, serotonin norepinephrine reuptake inhibitors, antiepileptic medication, muscle

relaxants, and nonsteroidal anti-inflammatory drugs. Current FDA approved medications for

fibromyalgia alone are pregabalin, duloxetine, and milnacipran (Lawson and Wallace 103). Dr.

Piercarlo Sarzi-Puttini also indicated the same pharmaceutical options in her academic journal

called “Diagnostic and therapeutic care pathway for fibromyalgia”. However, her research has

concluded that many patients’ withdrawal from the use of their medications due to the side

effects. Dr. Piercarlo Sarzi-Puttini states, “results obtained with pharmacological treatment alone

are often unsatisfactory, and drug treatment should be part of a multidisciplinary therapeutic

approach, which also includes nonpharmacological strategies.” Both sources believe that

pharmaceuticals are an important aspect for treatment, but it is evident that nonpharmacological

approaches are necessary to address all symptoms.

A common nonpharmacological approach is exercise. There are numerous forms of

exercise like stretching, physical therapy, and aerobic exercise. The academic journal “Preferred

Exercise and Mental Health of the Patients with Fibromyalgia Syndrome” found that resistance

training, walking, or stretching improved the mood of the patients, decreased depression, and

improve the overall quality of life of the patients (Andrade). Dr. Alexandro Andrade also

mentions that “aerobic exercise with that of a muscle-strengthening… significantly reduced the

impact of FMS on the quality of life and depression.” Exercise can help both mentally and

physically. Dr. Erin Lawson and Dr. Mark S. Wallace make similar conclusions by stating,

”Low-intensity, low-impact aerobic exercise programs with the ability to tailor the exercise

prescription to the needs of the individual show the strongest evidence for clinical improvement

in symptoms” (72). However, both sources found that many people struggle with maintaining
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their exercise as it can be repetitive or make them sorer after. Dr. Alexandro Andrade believes

that by allowing the patients to choose their own exercises they will be more dedicated to

following the protocol. Incorporating exercise into the treatment plan is highly encouraged.

Another approach is to eliminate stress in the patient’s life. Dr. Teemu Zetterman works

in the Department of Anesthesiology, Intensive Care and Pain Medicine and has found that “FM

patients often report an inability to relax” and “ repeated cognitive stress increases pain intensity

in FM patients.” From his research, he believes that targeting stress and anxiety could help

alleviate pain. Dr. Erin Lawson and Dr. Mark S. Wallace also recognized this claim and stated in

their book that “In populations suffering from fibromyalgia, several studies have shown high

levels of emotional stress and increased prevalence of psychological and psychiatric disorders”

(87). Therefore, finding treatments that approach the psychological symptoms can help improve

the patient’s quality of life.

There are numerous ways to approach the psychological symptoms of fibromyalgia.

“Integrating Counseling and Brain-Based Treatments for Fibromyalgia” is an article that brings

attention to the importance of helping the psychological effects of the disease. Carter, the author,

states, “the rate of patients suffering from fibromyalgia and reporting one or more mood

disorders is approximately 74%. This renders traditional pharmacological interventions

inadequate as a singular approach to the treatment of fibromyalgia.” The psychological methods

that have produced desirable results are cognitive behavioral therapy, meditation, guided

imagery, counseling, and methods of cognitive distraction (Carter). These methods are also

supported in the other academic journals previously mentioned.

A technique that could be used to limit stress is guided imagery. University of Michigan

Medicine describes, on their webpage, that guided imagery consists of the patient tensing a group
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of muscles as they breathe in and then untensing their muscles as they breathe out. This allows

for the patient’s muscles to relax and cause for them to no longer feel anxious or stressed. Carter

agrees with this technique of guided imagery and believes that it works due to utilizing cognitive

distraction. Controlling the patients mind influences the pain that the patient is feeling. Guided

imagery and muscle relaxation can relieve fibromyalgia pain.

Another psychological technique it cognitive behavioral therapy (CBT). Dr. Bennett in

his academic journal “Cognitive Behavioral Therapy for Fibromyalgia”, he explores the effect of

CBT use in fibromyalgia patients. CBT “focuses on strategies for self-management of pain and

stress, relaxation training, and recognition of maladaptive thought patterns with appropriate

substitutions and problem solving” (Bennett). CBT has been proven to improve the

psychological and physical symptoms of fibromyalgia when used with other techniques. The use

of CBT is also supported by Dr. Lawson and Dr. Wallace and Carter.

One last technique that can be used is acupuncture. Dr. Lawson and Dr. Wallace have

found that “acupuncture can lead to neuroplasticity and long- term depression of pain pathways”

(114). This indicates that acupuncture can be a very useful technique. Dr. Karatay, who works in

the Department of Physiotherapy and Rehabilitation, has discovered that acupuncture balances

the neurotransmitters and pain receptors in the body which results in the alleviation of pain.

Acupuncture is a technique that can hep patients have a better quality of life.

Numerous techniques can be explored and analyzed in this paper. It is evident that there

is not a single best option and that every patient will have a different regimen of techniques that

work best for them. Nikki Marshall spoke out about her own fibromyalgia struggles in her

periodical “Fibromyalgia flattens me. Here’s what helps me cope with constant pain”. This is a

great pathos source that can be used as an example in this paper.

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The best method of treatment appears to be a multimodal approach that has proven to

produce the best quality of life for patients with fibromyalgia (Sarzi-Puttini)(Lawson and

Wallace)(Carter). The best method to improve the quality of life for people with fibromyalgia is

to take a psychological, physical, and pharmacological approach. This consists of a daily

regimen of activities to decrease the symptoms that the person is experiencing.

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Works Cited

Andrade, Alexandro, et al. “Preferred Exercise and Mental Health of the Patients with

Fibromyalgia Syndrome.” Complementary Therapies in Clinical Practice, vol. 40, no.

April 2019, Elsevier Ltd, 2020, p. 101195, doi:10.1016/j.ctcp.2020.101195. Accessed 18

July 2021.

Bennett, Robert, and David Nelson. “Cognitive Behavioral Therapy for Fibromyalgia.” Nature

Clinical Practice Rheumatology, vol. 2, no. 8, 2006, pp. 416–24,

doi:10.1038/ncprheum0245. Accessed 27 July 2021.

Carter, Hannah, et al. “Integrating Counseling and Brain-Based Treatments for

Fibromyalgia.” Counseling Today, vol. 63, no. 11, May 2021, pp. 12–14. EBSCOhost,

search.ebscohost.com/login.aspx?direct=true&db=vsh&AN=150243718&site=eds-live.

Accessed 18 July 2021.

Karatay, Saliha, et al. “Effects of Acupuncture Treatment on Fibromyalgia Symptoms,

Serotonin, and Substance P Levels: A Randomized Sham and Placebo-Controlled

Clinical Trial.” Pain Medicine (United States), vol. 19, no. 3, 2018, pp. 615–28,

doi:10.1093/pm/pnx263. Accessed 27 July 2021.

Lawson, Erin, and Mark S. Wallace. Fibromyalgia: Clinical Guidelines and Treatments.

Springer International Publishing Switzerland, 2015.

Leyasw. “Symptoms and signs fibromyalgia tender points vector image.” VectorStock, www.vect

orstock.com/royalty-free-vector/symptoms-and-signs-fibromyalgia-tender-points-vector-

31164736. Accessed 27 July 2021.

Marshall, Nikki. “Fibromyalgia flattens me. Here’s what helps me cope with constant pain.” The

Guardian, 30 June 2021, www.theguardian.com/australia-news/commentisfree/2021/jun/

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30/fibromyalgia-flattens-me-heres-what-helps-me-cope-with-constant-pain. Accessed 18

July 2021.

Sarzi-Puttini, Piercarlo, et al. “Diagnostic and Therapeutic Care Pathway for

Fibromyalgia.” Clinical and Experimental Rheumatology, vol. 39 Suppl 130, no. 3, May

2021, pp. 120–127, www.clinexprheumatol.org/article.asp?a=17132.pdf. Accessed 18

July 2021.

Stress Management: Doing Progressive Muscle Relaxation.” University of Health Michigan

Medicine, University of Michigan, 31 Aug. 2021, www.uofmhealth.org/health-

library/uz2225. Accessed 27 July 2021.

Zetterman, Teemu, et al. “Muscle Activity and Acute Stress in Fibromyalgia.” BMC

Musculoskeletal Disorders, vol. 22, no. 1, Feb. 2021, p. 183. EBSCOhost,

doi:10.1186/s12891-021-04013-1. Accessed 18 July 2021.