Fibromyalgia Non-Pharmacologic Management

Aka: Fibromyalgia Non-Pharmacologic Management

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II. Management: Reassurance and Education

  1. Fibromyalgia is a common, non-life threatening, real condition
  2. Extensive lab testing is unlikely to be helpful
  3. Establishing relationship with one medical provider is helpful
    1. Positive and empathic provider
  4. Review how the diagnosis was made with the patient
    1. Firm diagnosis is key to improvement
  5. Outline the therapeutic plan
    1. Emphasize that there are effective strategies (especially non-medication) that improve symptoms and quality of life
    2. Targets a reduction in pain, Fatigue, sleep problems and cognitive issues

III. Management: Increase Cardiovascular Exercise

  1. Simple, regular, achievable aerobic Exercise program
    1. Start with low intensity Exercise and advance to moderate frequent Exercise
  2. Aerobic Exercise has best evidence (with less evidence for Stretching, strengthening, Tai Chi and yoga)
    1. Jones (2009) Rheum Dis Clin North Am 35(2): 373-91 [PubMed]
    2. Brosseau (2008) Phys Ther 88(7): 857-71 [PubMed]
  3. Anticipate initial increase in myalgia and Fatigue
  4. Exercise conditioning ultimately improves function and sleep, and decreases Fatigue
  5. Choose low impact Exercise
    1. Water aerobics
    2. Swimming
    3. Bicycling
    4. Fast walking
  6. Exercise Program
    1. Start
      1. Five to 10 minutes per time at low intensity
      2. Gradually increase intensity as tolerated
    2. Goal
      1. Four times per week for 30 minutes per time
      2. Reach Maximal Heart Rate
  7. Monitor progress by graphing Exercise time and symptoms
  8. References
    1. Bidonde (2019) Cochrane Database Syst Rev (5): CD013340 [PubMed]
    2. Estevez-Lopez (2021) Arch Phys Med Rehabil 102(4): 752-61 [PubMed]
    3. Richards (2002) BMJ 325:185-7 [PubMed]

IV. Management: Keep patient employed

  1. Job modifications and improved ergonomics
  2. Work hour reductions may be needed
  3. Encourage walking and Stretching every 2-3 hours
  4. Education of work supervisors may be needed
  5. Consider "Return to Work" Centers
    1. Assess ergonomics and teach body mechanics
    2. Work hardening program

V. Management: Improve Sleep Quality

  1. See Sleep Hygiene
  2. Consider Medications to improve sleep (see Insomnia)
  3. Treat specific Sleep Disorders
    1. Restless Legs Syndrome
    2. Periodic Limb Movement Disorder
    3. Sleep Apnea

VI. Management: Physical Therapy (focus on active techniques)

  1. Stretching and range of motion Exercises
  2. Muscle Strengthening Exercises
  3. Teach proper Posture and body mechanics
  4. Heat Therapy
    1. Hot Packs
    2. Hydrotherapy
  5. Cold Packs
  6. Ultrasound
  7. Myotherapy
    1. Massage therapy
    2. Manipulation
  8. Transcutaneous Nerve Stimulation (TENS)
  9. Acupuncture
  10. Low Impact, Flexibility Activities
    1. Yoga
    2. Pilates
    3. Tai Chi
      1. Wilson (2020) Am Fam Physician 101(5) [PubMed]
        1. https://www.aafp.org/pubs/afp/issues/2020/0301/od1.html

VII. Management: Cognitive Behavior Therapy

  1. Individual or group therapy to assist behavior change
  2. Encourage a positive, active approach to condition
  3. Teaches realistic goal setting
  4. Decreases Chronic Pain and Fatigue, and improves sleep and overall function
  5. Consider symptom diary
  6. Relaxation Techniques
    1. Biofeedback
    2. Meditation
    3. Stress Reduction
  7. Coping skills
    1. Self talk
    2. Distraction
  8. Increase social interactions
  9. References
    1. Bernardy (2018) Eur J Pain 22(2): 242-60 [PubMed]
    2. Bernardy (2013) Cochrane Database Syst Rev (9): CD009796 [PubMed]

VIII. Management: Treat Comorbid Mood Disorders

  1. Mental Health counseling
  2. Antidepressants (e.g. Cymbalta)

IX. References

  1. Kodner (2015) Am Fam Physician 91(7): 472-8 [PubMed]
  2. Mascarenhas (2021) JAMA Intern Med 181(1): 104-12 [PubMed]
  3. Mist (2013) J Pain Res 6:247-60 [PubMed]
  4. Winslow (2023) Am Fam Physician 107(2): 137-44 [PubMed]

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