As knowledge about fibromyalgia has progressed, so has our understanding of treatments. Today, many fibromyalgia specialists will recommend a multimodal treatment protocol, or a treatment that includes several different therapies, rather than a single approach to treating fibromyalgia pain.
In this article, we’ll look at several different types of fibromyalgia treatments that might be included in a multimodal treatment plan—pharmacological, behavioral, and physical—and why specialists often counsel patients that the best fibromyalgia treatment includes a combination of all three.
Pharmacological Treatment for Fibromyalgia
There are three medications that have been approved by the Food and Drug Administration (FDA) for fibromyalgia:
- Pregabalin (Common brands: Lyrica)
- Duloxetine (Common brands: Irenka, Cymbalta)
- Milnacipran (Common brands: Savella)
These medications are relatively new fibromyalgia treatments, all of them having received FDA approval after 2000. A generic version of the extended-release formulation of pregabalin was made available in the United States as of April 2021, making it one of the latest fibromyalgia treatment options in this category.
Although these drugs are the only ones that have been FDA-approved for fibromyalgia, many different medications are commonly used off-label for fibromyalgia to treat the symptoms and pain, including a variety of other types of antidepressants or novel agents.
Medication therapy is not mandatory for the treatment of fibromyalgia pain, because of the limited efficacy of any one individual drug when it comes to pain reduction. That’s why experts often advise that the most effective treatment for fibromyalgia will include non-drug treatments as well, either with or instead of medication options depending on the patient.
Non-Drug Treatment for Fibromyalgia
Medications alone don’t tend to improve pain and quality of life to a significant degree for fibromyalgia patients, and they can have adverse side effects. That’s why a variety of non-medication treatments are often recommended by fibromyalgia treatment specialists, to use in parallel with medication therapy and to provide improvement in pain and other fibromyalgia-related symptoms like sleeplessness or anxiety.
Some patients prefer these non-drug treatments or “natural” remedies because they can have fewer side effects compared to medications.
Behavioral treatments include things like cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT). These therapies focus on empowering the patient through techniques that improve patients’ coping mechanisms with regards to their pain, so that they’re able to live their best lives and live the values that they deem important.
Cognitive behavioral therapy (CBT) and Acceptance and Commitment Therapy (ACT) have been shown in multiple well-designed studies to be helpful for managing fibromyalgia-related and chronic pain. Some outcomes in clinical trials include:
- 74% of patients reported better sleep quality (vs. Control)
- 76% of patients no longer affected by clinical depression
- 60% of patients no longer affected by clinical anxiety
Physical modalities—activity, exercise, movement—can often be used interchangeably as fibromyalgia therapies. The focus is on moving in a way that feels good to the fibromyalgia patient, so that they’re able to keep their muscles strong, and boost endorphins that come from movement.
Often, these physical modalities can be used in tandem with behavioral therapies like CBT and ACT. Mindfulness strategies and acceptance strategies can help people with fibromyalgia not only navigate their daily activities, but also increase their ability to do other types of things that are important to them, whether it be attending social events, being able to go to a sporting event that they enjoy, or more physical activity.
Increasing Access to Fibromyalgia Treatments
Because there is a lack of providers and clinicians who are specialized in delivering comprehensive long-term management to treat chronic pain in fibromyalgia patients, access to care can be challenging. In addition, when people are experiencing pain, it can be hard for them to get to a provider and make it to their appointments to receive care.
Behavioral and physical treatments, in particular, can require regular visits to a healthcare provider. The amount of time it takes for patients to undergo this type of therapy may not be consistent with the lives they lead.
With the advent of telemedicine and digital therapeutics for fibromyalgia, more people have the ability to access specialty care in the comfort of their own home, without having the added burden and stress of driving, taking time off of work, or the travel expense to visit a provider.