Heated pool therapy, certain medications among new treatments

New recommendations for fibromyalgia relief: heated pool therapy, certain medications among new treatments

Often misunderstood and/or incorrectly diagnosed, fibromyalgia is an arthritis-related condition marked by generalized muscular pain and fatigue. Its symptoms are common and laboratory tests are generally normal, so people with fibromyalgia may be told that the condition is “all in their head.” But according to the Arthritis Foundation in Atlanta, GA, about two percent of the U.S. population, or about 6 million people, may have this mysterious condition. Researchers speculate that many factors may play a role in this condition, including infection, physical trauma, emotional trauma or hormonal changes, but there is no definitive answer.

SIGNS & SYMPTOMS. Doctors generally diagnose fibromyalgia if a person has a history of widespread pain on both sides of the body and above and below the waist that has lasted for at least three months. People with fibromyalgia often have pain in at least 11 of 18 tender points–specific spots on the body which are unusually sensitive to touch. There are no specific laboratory tests available for diagnosing fibromyalgia, so doctors must rely on patient histories, self-reported symptoms, a physical examination and a manual tender point examination. As a result, it takes an average of five years for a fibromyalgia patient to get an accurate diagnosis.

NEW TREATMENTS MAY OFFER RELIEF. Once diagnosed, treatment, too, is a work-in progress. Treatment options include pain-relieving medications and medications to improve sleep, exercise programs that stretch muscles, relaxation techniques to ease muscle tension and anxiety, and educational programs.

Recently, a new assessment of fibromyalgia treatments presented at the European league Against Rheumatism (EULAR) meeting in Amsterdam added heated pool therapy combined with exercise, as well as some specific analgesics and antidepressants to the mix. In fact, substantial evidence suggests that an individually tailored exercise program in combination with heated pool therapy is especially effective and helpful for people with this painful condition, reported Ernest H. Choy, MD, FRCP, a consultant senior lecturer in rheumatology at Kings College in London, UK.

DRUG THERAPY ALSO OFFERS RELIEF. The mild narcotic tramadol (Ultram) is also helpful, he said, but he pointed out that questions regarding its long-term use remain. A number of antidepressants have also been shown to be effective in reducing pain symptoms in randomized controlled trials including amitriptyline, fluoxetine (Prozac), duloxetine (Cymbalta, Xeristar, Yentreve), and ixel (Milnacipran). Many people with fibromyalgia also have problems sleeping, and antidepressants help relieve pain and improve sleep. They are usually prescribed in lower doses than for depression. Cognitive behavioral therapy, relaxation, physiotherapy, and psychological support may also help, according to the recommendations which will be submitted for publication in the Annals of the Rheumatic Diseases.

NEEDLING AWAY AT FIBROMYALGIA? Acupuncture may also reduce symptoms, according to a study by researchers from the Mayo Clinic in Rochester, MN that appears in a recent issue of the Mayo Clinic Proceedings. In the new study of 50 people with fibromyalgia, those who received acupuncture showed significant improvements–particularly in anxiety and fatigue–compared with the control group which did not get acupuncture. The benefit produced by acupuncture was actually similar to that reported with drugs, including antidepressants, the researchers report. All participants received treatment every two to four days over a period of three weeks for a total of six sessions.

True acupuncture reduced scores on a standard measure assessing fibromyalgia-related pain by seven points, with the largest difference in scores occurring at one month. People who received acupuncture did not, however, report an increased level of activity or physical functioning, but study authors point out that this was not a predesigned endpoint; nor did they encourage participants to change behaviors.


To relieve symptoms of fibromyalgia, consider:

* An individually tailored exercise program combined with heated pool therapy

* Taking the mild narcotic tramadol, or antidepressants

* Cognitive behavioral therapy

* Relaxation techniques

* Physiotherapy

* Psychological support


* Fibromyalgia is an arthritis-related condition marked by generalized muscular pain and fatigue.

* About two percent of the U.S. population, or about 6 million people, may have this mysterious condition.

* Researchers speculate that many factors play a role in causing fibromyalgia, including infection, physical trauma, emotional trauma or hormonal changes.


Daniel J. Clauw, Chronic Pain and Fatigue Research Center, Professor, Internal Medicine-Rheumatology, University of Michigan, Ann Arbor, MI

“Treatments for fibromyalgia are available and they do work for most people. If the average practicing physician used the therapies shown to be effective in fibromyalgia, the majority of patients would have their pain reasonably well-managed. Unfortunately, many physicians don’t differentiate between the pain of fibromyalgia and that of arthritis and other conditions. We know that different types of pain need different types of treatment. The new EULAR recommendations may help doctors better address pain in fibromyalgia. In the new recommendations, warm water therapy just happened to have shown impressive and significant effects, but this doesn’t mean that warm water therapy is what all fibromyalgia patients need. It is one way of exercising. The message is that however patients with fibromyalgia can increase their activity and/or exercise, it will improve their condition. At the end of the day, if their pain is not getting better it might be time to try other treatments.”

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