|
Fibro Treatments
Medication by itself is of little value in treating fibromyalgia.
Successful treatment demands the patient's active involvement in treatment
as well as lifestyle changes. Each of the six parts of treatment (Medication to improve deep sleep, regular sleep hours and an adequate amount of sleep, daily gentle aerobic exercise and stretching, avoidance of over exertion and stress, treatment of any coexisting sleep disorders and patient education) is
important. If any one is omitted, the chance of significant improvement is
considerably reduced.
Medications
A number of medications have been used to improve sleep in
fibromyalgia. The oldest of these is amitriptyline (Elavil), a medication
first used to treat depression. Amitriptyline and related medications
probably work by improving the quality and depth of deep sleep rather than
by any effect on mood. Although it probably works as well as any of the
other medications, amitriptyline causes frequent bothersome side effects
such as weight gain, dry mouth, daytime tiredness, and trouble
concentrating more often than other medications with durations of action
more appropriate for sleep so I usually try these other medications first.
They include trazodone (Desyrel), diphenhydramine (Benadryl),
cyclobenzaprine (Flexeril), alprazolam (Xanax), and carisoprodol (Soma).
Medication is started at a low dose and gradually increased until you
sleep well at night and feel good during the day, encounter unacceptable
side effects, or reach the prescribed maximum dose. Starting low and slow
helps minimize initial side effects such as dizziness, nausea, and morning
grogginess. By two to four weeks, most patients find that their fibromyalgia symptoms are starting to improve.
It often takes a lot of adjusting of the dose to get it right.
It may be necessary to try several medications in succession or sometimes
in combination.
Regular sleep
Patients with fibromyalgia must try to get to bed by the same time
every night and get an adequate amount of sleep (anywhere from 1 to 12
hours depending on the individual). Staying up just one hour late may
cause an exacerbation that lasts for several days. Many patients with
fibromyalgia are worse with the change to or from Daylight Savings time.
To avoid this problem, try to make the switch in fifteen minute increments
every few days instead of by one hour over one night. I have had little
success getting patients truly feeling well who work shifts that prevent
them from having a consistent bedtime or require that they sleep during
the day.
Exercise
Both daily gentle aerobic exercise and stretching exercises are
important. While patients who try to do too much exercise too soon or of
the wrong type will make themselves temporarily worse, most patients who
don't begin a daily aerobic exercise regimen will never notice much
improvement. Aerobic exercise is defined as exercise that gets your heart
rate up to a target heart rate for the duration of the exercise period. It
is very important to count your pulse and not just guess. If your pulse is
too low or too high, you may be just wasting your time or even causing
harm.
Avoid physical and emotional stress
Too much physical activity of the wrong kind will make you feel worse.
Rather than doing housecleaning, yard work, or other physical activity all
on one day, break up the task so that you do a half hour or an hour every
day until it is done. While it is difficult to learn to do this, it is
essential that you be able to sense when you have reached your limit and
stop. By pacing yourself, you will be more productive overall.
Stress also worsens fibromyalgia symptoms. If you have ongoing problems
with depression or anxiety, consider seeking help for them from your
family doctor or a psychiatrist. Anxiety and depression may arise as
symptoms of fibromyalgia and in turn cause insomnia, leading to worsening
of the underlying problem. Relaxation techniques or a chronic pain program
can also help lower your stress level and are of proven benefit in
treating fibromyalgia.
Treat other sleep disorders
Several other sleep disorders besides insomnia may aggravate
fibromyalgia. Almost half of men with fibromyalgia and some women have
obstructive sleep apnea. In this condition the patient snores loudly and
has periodic pauses in breathing after which he starts breathing again
with a snort. Periodic limb movements of sleep is a condition in which
patients jerk or kick every 30 to 90 seconds for long periods during the
night and is also frequent in FMS.
Support and education
Patients who make the effort to learn as much as possible about this
disorder usually do better than those who don't. There are local support groups
in most areas now. Two large national support organizations produce good
newsletters and can help you find a local support group or physician:
Fibromyalgia Alliance of America, Inc.
PO Box 21990
Columbus, OH 43221-0990
Phone (614) 457-4222
Fax (614) 457-2729
|
Fibromyalgia Network
PO Box 31750
Tucson, Az. 85751-1750
Phone: (520) 290-5508
Fax: (520) 290-5550 |
|
