Fibromyalgia: Medications Are Not the Answer

In case you missed it:  there is an excellent article on fibromyalgia in the April 16, 2014 issue of JAMA.¹ The author’s summary points are remarkable:  “If clinicians treat fibromyalgia or other chronic pain conditions with drugs alone, they will fail…In fact, all oral analgesics (e.g. NSAIDs and opiods) are only modestly effective for treating chronic pain (and work well in only 1/3 of patients).” 

Fibromyalgia is a poorly understood condition characterized by hypersensitivity to pain stimuli. When activated, peripheral pain signals get amplified by the brain.  Patients complain of diffuse muscle aches, fatigue, and insomnia that interfere with their daily function. They may also experience headaches, depression, and other regional pain syndromes. The patient in the JAMA article describes fibromyalgia in this way:

“Most people do not understand fibromyalgia.  They don’t really get it; they see you, and you look fine.  So they do not understand.  The fibromyalgia pain feels like a deep muscle strain or pain.”

Treating chronic pain syndromes requires a multi- pronged approach: education, exercise, cognitive behavioral therapy, stress reduction, and sleep hygiene.  There is a role for medications like duloxetine and cyclobenzaprine, but it is a supplemental one. Sounds like good advice, but most physicians know how difficult it is to modify patient behaviors without the assistance of an intensive team of multidisciplinary professionals- professionals who can offer appropriate physical, cognitive, emotional, and medical strategies to help these patients.    

Finally, physicians need to exercise their empathic muscle with these patients. They need “to really get it”, to understand better what it’s like to live with fibromyalgia.   

–Dean Gianakos, MD, FACP

Dean Gianakos, MD, FACP, practices and teaches general internal medicine in the Lynchburg Family Medicine Residency and Geriatrics Fellowship, Lynchburg, VA.  He frequently writes and lectures on the patient-physician relationship, end-of-life care, and the medical humanities.

Clauw, DJ. Fibromyalgia:  A Clinical Review.  JAMA. 2014; 311(15):1547-1555.