Treatment for fibromyalgia syndrome (FMS) from the NIDR

Treatments for FMS are in many instances palliative and often include patient education, physical therapy and counseling.

At this time there is no special diet for patients with FMS, but several reports indicate that fish oil, magnesium/malic acid combinations or vitamins (particularly B12) may be effective.

Stress reduction and developing improved coping mechanisms are suggested, often through counseling, hypnosis, electromyograms and biofeedback, fitness training, self-help group discussions and cognitive or behavioral therapy.

Gradual exercise programs including swimming and walking, which is low impact, are suggested. Physical therapy in the form of gentle massage, strengthening exercises, electronic acupuncture and relaxation techniques is also being used and may prove to be helpful.

The antidepressants amitriptyline or cyclbenzaprine hydrochloride, in low doses, have been shown to be beneficial in decreasing depression, relaxing craniofacial and skeletal muscles, improving sleep and releasing endorphins. These drugs act by blocking norepi-nephrine and serotonin re-uptake inhibition. Of course, benefits are also accompanied by risks. Common side effects of these drugs include weight gain, palpitation and urinary retention.

Benzodiazepines such as clonazepam also promote better sleep, relax craniofacial as well as skeletal muscles and help restless leg syndrome. These drugs can be used with the anti-depressants or with serotonin re-uptake inhibitors but they can also become addictive. Analgesic agents have only limited usefulness in FMS and it is best to avoid narcotics.

Non-steroidal anti-inflammatory drugs, although often used in FMS, have not proven to be beneficial in clinical trials. Steroids do not appear to be helpful. Injecting tender points with steroids or local anesthetics such as lidocaine is considered controversial and could lead to a dependence on this method for the relief of symptoms.

Other therapeutic approaches being studied include s-adenosyl-methionine or SAM-e (an antidepressant with anti-inflammatory actions), capsaicin creams (which delete substance P but can be irritating), alprazolam (drugs like Xanax) to decrease panic reactions and sleep preparations such as zolpidem.

Meanwhile, in the absence of a well-defined, science-based diagnosis and therapy for FMS, patients use complementary or alternative medicine measures such as over-the-counter dietary, vitamin or herbal products, spiritual practices, homeopathy, reflexology, chiropractic strategies and massage.

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