Fibromyalgia Treatments: Use & Benefits

Wondering what other fibromyalgia patients use to treat their symptoms and how they rate these therapies? Emma K. Guymer, M.D. looked at key symptom ratings, frequency of other associated conditions, and use of various treatments in 150 fibro patients in Australia.*

The evaluated patients were referred by Melbourne physicians to a local rheumatology clinic between March 2008 and September 2010. No one was pre-selected based on symptoms or treatments because the study goal was to look at factors in a community sample of people with fibromyalgia.

Out of 150 patients, 63% met the strict tender point criteria (i.e., they had at least 11 of the 18 specified tender points), while the remaining study participants were diagnosed with fibro based on symptoms. The latter method is common practice by many physicians who recognize the widespread pain of fibromyalgia and its associated symptoms. Both approaches are described in our website section on diagnosis.

As expected, patients meeting the tender point criteria had higher ratings for pain, fatigue and trouble sleeping, as well as a greater number of associated conditions. Among all 150 patients the average number of associated conditions was five. The two most common were chronic headaches and irritable bowel syndrome, as shown below.

“A higher number of associated conditions in this group of patients was correlated with a longer duration of symptoms, worse pain, and a higher illness impact,” states Guymer. Why more associated conditions were found in patients with a longer illness duration was not addressed.

Study participants’ average age was 47 and duration of fibro was 10 years. Guymer found that the younger a patient’s age, the more serious they rated their fatigue. She suggests that may be because “younger people expect to have higher than usual energy levels in keeping with their peers.” This implies older patients are more apt to attribute fatigue to aging, which could be a false assumption.

What about the use of various treatments and their rated benefits? At the time of the study, low-dose tricyclic antidepressants (such as amitriptyline), Cymbalta, and Lyrica were available in Australia, although not specifically approved for treating fibromyalgia. Guymer’s research report emphasizes that these three medications have “evidence of significant benefit in the management of fibromyalgia.” But as it turned out, these meds did not live up to expectations.

Only 35% of the patients were taking the medications Guymer described as “evidence-based.” Perhaps the low usage of these meds was due to their poor performance. The only benefit obtained from them was a slight improvement in physical function, but they did not reduce the key symptoms of pain, fatigue, or disrupted sleep.

Psychological approaches to pain management had been tried by 30% of the 150 fibro patients, but did not produce improvements. “Complementary or alternative therapies were being used regularly at least once a month for the past three months by almost half of the patients,” says Guymer. Examples included naturopathy, osteopathy, physical therapy, massage, acupuncture, chiropractic treatment, and movement therapies such as tai chi. These treatments provided a significant decrease in anxiety.

Patients engaged in regular aerobic exercise at least 20 minutes twice per week (44%) had reduced illness impact scores, better physical function, and less fatigue, anxiety and depression. Whereas patients who were less likely to exercise had a greater number of other associated conditions and higher scores for pain, fatigue, and sleep disruption. It’s difficult to know whether those who exercised were just more able to do so.

Staying fit is an important goal for maintaining overall health and function for anyone, with fibro or not. Surprisingly, milder movement therapies, such as tai chi and yoga, were not considered forms of exercise in this study despite reports showing they help fibromyalgia patients maintain function.

Exercise and certain medications (tricyclic antidepressants, Cymbalta and Lyrica) are all touted to improve the pain of fibromyalgia, yet this study failed to substantiate these claims. Guymer and her colleagues did not point this out in the article, but the data was clear about lack of pain relief. One could only guess this omission is somehow related to the consultation fees received by the authors from the makers of Cymbalta and Lyrica (Eli Lilly and Pfizer).

* Guymer EK, et al. Clinical characteristics of 150 consecutive fibromyalgia patients attending an Australian public hospital clinic. Int J Rheumatic Dis 15:348-57, 2012.