Recent treatment recommendations for Fibromyalgia

Recent talks at the American College of Rheumatology Annual Meeting looked at overall treatment protocols we should see.

The two presentations:

Daniel J. Clauw, MD, a rheumatologist and professor of anesthesiology and medicine and director of the Chronic Pain and Fatigue Research Center at the University of Michigan, focused on the nature of pain experienced by patients with fibromyalgia and how clinicians can treat it. Carmen E Gota, MD, of the Cleveland Clinic, stressed the importance of exercise and tailored patient care.

Clauw looked at three areas of pain, centralized pain, peripheral pain and peripheral neuropathic pain. He states opiates are limited. “’The body’s natural opioid production system may be impacted in fibromyalgia, so giving them opioids could be fueling the fire,’”

I have written articles about how opiates tend not to be our best choice, two being Fibromyalgia and Opiates for pain: Helpful or hindering?, Opiates and fibromyalgia- a treatment for severe pain but the brain works against us so there is some suggestion that opiates and FM might not get along.

Instead he recommends tricyclic compounds, serotonin and norepinephrine reuptake inhibitors, and gabapentinoids for the centralized pain.

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Gota’s talk, on the other-hand, looked at non-medication treatments such as exercise.

“In 2010, about 80% of patients were taking analgesic drugs and 52% were taking central acting drugs,” she said. “Over time, we have seen an increasing use of [central nervous system] CNS drugs. However, despite the increasing use of centrally acting drugs, we do not see a decrease in use of analgesics.”

Her recommendations are a strong emphasis on exercise but also CBT; Physical therapy, acupuncture or hydrotherapy for example; and meditation. With exercise having the most consistent impact.

This is one study I posted of Fibromyalgia and exercise

Both Clauw and Gota stress patient management over and above trying to categorize the patient into a diseased state.

“It is important to know your patient, because that will determine how you are going to treat your patient,” she added. “Establish a network of collaborators who will help treat your patient, including primary care providers, physical therapists, psychologists or psychiatrists, and sleep medicine experts.”

And this is… nothing new at all. They have been saying this for years now. Exercise. No opiates. Same old same old, but they seem to be suggestive comprehensive treatment options to replace the lack of opiates. Medication, psychologist, sleep experts, physio and so forth. A comprehensive method is indeed needed. And they are right that symptoms need to be attacks and modified where modifications can be done.