What Are the Newest Treatments for Fibromyalgia?

Pregabalin

Pregabalin is an anticonvulsant that is used to treat epilepsy, anxiety, and neuropathic pain and may be helpful in treating fibromyalgia. Pregabalin reduces fibromyalgia symptoms by lowering pain by up to 25% and improves sleep and tiredness. It is unclear how pregabalin acts to alleviate fibromyalgia symptoms, but some believe it attaches to a protein in the nerve cells that is responsible for increased pain sensitivity.

Long-term pregabalin use can cause various side effects such as:

• Dizziness
• Drowsiness
• Dry mouth
• Constipation
• Increased hunger
• Weight gain
• Edema
• Swelling of the hands and feet
• Excessive happiness
• Difficulty concentrating
• Balance disorder 
• Blurred vision

Duloxetine

Duloxetine is a selective SNRI that stabilizes mood, reduces pain, and improves sleep. It is a type of antidepressant and is usually used to treat chronic pain. The exact role of duloxetine in treating fibromyalgia is unclear. It is believed that symptoms of fibromyalgia, especially pain, may be suppressed with increased activity of serotonin and norepinephrine in the brain.

Side effects of duloxetine include:

• Nausea and vomiting
• Constipation
• Dry mouth
• Increased sweating
• Decreased appetite
• Drowsiness
• Agitation

Transcranial magnetic stimulation (TMS)

So far, TMS therapy has only been approved by the FDA for the treatment of major depression. However, multiple studies have shown that it can be very effective for fibromyalgia as well.

Pain associated with fibromyalgia is caused by muscles locally and by the brain’s perception of pain signals. TMS uses magnetic pulses to directly stimulate the brain cells and alter their perception of pain. Although similar to fibromyalgia drugs in effectiveness, TMS does not carry any negative side effects.

• Cognitive behavioral therapy (CBT): CBT is often used to treat fibromyalgia by helping patients learn how to cope with their condition and manage pain.
• Stress management: Stress reduction through deep breathing exercises or meditation may improve fibromyalgia symptoms. 
• Exercise: Although exercise may initially aggravate pain, doing it gradually and regularly can reduce symptoms. Low-impact exercises such as stretching, walking, swimming, and water aerobics are all appropriate exercises.
• Acupuncture: Acupuncture involves inserting very small needles into the skin at various depths, which is believed to cause changes in blood flow and neurotransmitter levels in the brain and spinal cord. 
• Tai chi and yoga: Tai chi and yoga both involve meditation, slow movements, deep breathing, and relaxation, all of which can be effective in treating fibromyalgia symptoms.
• Dietary modifications: Eating healthy and nutritious foods, quitting tobacco and alcohol, and limiting caffeine intake can improve energy levels and promote overall health.

Although the cause of fibromyalgia is unknown, it is speculated that it may be caused by a nerve cell misfiring in the central nervous system, which causes abnormalities in processing pain sensations. Factors that may contribute to the development of the condition include:

• Genetics
• Physical and emotional stress
• Childbirth
• Injury
• Infection
• Surgery

Fibromyalgia presents with similar symptoms as arthritis, such as pain and fatigue, but it does not cause permanent joint damage or deformity.

The most common symptom of fibromyalgia is widespread pain, which can occur in one or more areas of the body. Pain may migrate over the body and change in intensity on a daily or even hourly basis. 

Other symptoms of fibromyalgia include:

• Excessive fatigue
• Increased sensitivity to pain
• Muscle stiffness
• Sleeping difficulty
• Irritability
• Headache
• Gastrointestinal problems such as:
  • Constipation
  • Diarrhea
  • Irritable bowel syndrome
  • Stomach pain
  • Bloating
• Bladder dysfunction
• Increased sensitivity to light, sounds, and smell
• Heightened sensitivity to touch and pressure
• Disturbances in memory and concentration
• Problems with cognition (mental processes) known as “fibro-fog”
• Mood disorder
• Depression

Risk factors for fibromyalgia include:

• Age: Fibromyalgia is mostly seen among people ages 20-50, although children and teens may also develop the condition.
• Sex: About 80%-90% of people with fibromyalgia are women.
• Family history: Fibromyalgia may run in the family. If your immediate relative has fibromyalgia, you are at higher risk.
• Rheumatic diseases: If you have a history of other rheumatic diseases such as ankylosing spondylitis, rheumatoid arthritis or lupus, the risk of fibromyalgia increases.
• Stressful events: Fibromyalgia is sometimes linked to stressful or traumatic incidents, such as a car accident or family member's death.

Fibromyalgia cannot be diagnosed through physical exams, blood tests, urine tests, or imaging tests, although the data can be used to rule out other illnesses.

A diagnosis can be confirmed based on a medical history of three months of widespread pain with causative underlying diseases and one or more other chronic symptoms such as:

• Chronic sleep problems
• Exhaustion
• Cognitive or memory challenges

Although fibromyalgia is not a life-threatening disease, it can cause severe disability and reduced function. Timely medical attention and appropriate treatment can help reduce symptoms and improve quality of life.