Now that you have been diagnosed with Fibromyalgia Syndrome (FMS), what next? While it may seem like your life is over, stop and take a deep breath; FMS symptoms CAN be controlled or at least reduced for the majority of people. It is important you learn as much as you can about FMS so you can actively be involved in your treatment plan. The more educated you are, the better able you will be to participate in your treatment plan.
After being diagnosed with FMS, you and your doctor will come up with a treatment plan to address your symptoms. This will be an individualized plan and will likely include some or all of the following:
Relaxation and stress management
Sleep and fatigue management
It is vitally important you are actively involved in your treatment plan and have a good relationship with your doctor. You should be able to ask your doctor questions and have input into your treatment plan. Both you and your doctor should be open to discussing things to help with symptom relief. It is important to know that with FMS, there isn’t a “one size fits all” solution. What works for one FMS patient might not work for the next. Most FMS treatment plans will involve a trial period to see which things work best for you. While there currently is no cure for FMS, there are things you can do to reduce FMS symptoms.
Medications – Some of the most commonly prescribed medications for FMS symptom control are Lyrica (pregabalin), Cymbalta (duloxetine), Savella (milnacipran hydrochloride), and Neurontin (gabapentin). In addition, you and your doctor may decide on a muscle relaxer such as Flexeril (cyclobenzaprine hydrochloride), and/or a sleep aid such as Elavil (amitriptyline hydrochloride – this is an anti-depressant but is commonly used as a sleep aid), Desyrel (trazadone hydrochloride - this is an anti-depressant but is commonly used as a sleep aid) or Ambien (zolpidem tartrate). Other medications sometimes prescribed include pain relievers such as Ultram (tramadol hydrochloride) or Norco (hydrocodone bitartrate/acetaminophen). Based on your situation, you and your doctor might explore medications for management of depression or anxiety. Reducing depression and anxiety can help with FMS symptom control.
Some important information about medications:
Follow your doctor’s instructions regarding usage. If you are unsure of something, contact your doctor for clarification.
All medications have a list of side effects. It is important to read the information provided by your doctor or pharmacist in order to familiarize yourself with potential side effects. Some people don’t experience any side effects or only mild side effects while others might experience a lot of side effects. Most side effects usually subside in 3-6 weeks; however, be sure to keep in touch with your doctor regarding side effects you are experiencing.
When stopping or starting medications or changing doses, it is important to try to adjust only one medication at a time. This way, if you experience a change (increased symptoms, side effects, or improved symptom control) you will know which medication caused the change.
Be sure to inform your doctor of ALL medications you take, even over the counter medications. You should also inform them of any vitamins you are taking so they can take that information into account when prescribing a medication as part of your FMS treatment plan.
It is important to have a system in place to help you remember to take your medications each day. Some people uses apps to assist with this, others may use a weekly or daily pill storage box. Taking medications at the same time each day helps maximum the benefit of the medication.
Refer to the Prescription Drug Savings section for information on potentially saving money on medications.
Lifestyle Changes – You most likely will need to make some lifestyle changes. This includes the following:
Learn to pace yourself. Overdoing it can cause an increase in FMS symptoms (flare). It is important to strive to find balance in completing tasks without overdoing it. Prioritize what needs to be done, it is helpful to write a to-do list. Break down larger tasks into smaller steps with time for rest in between.
Plan ahead. It is helpful if you can plan ahead whenever possible in order to give yourself plenty of time. For example, if you have children to get out the door in the morning (or yourself), plan the night before what they (or you) are going to wear in order to save time in the morning. By planning ahead you can save some valuable energy.
Learn to delegate. This is one of the hardest things to do, delegating tasks to other (asking for help). However, it is really important to become attuned to your body and its limits and to ask for help when needed.
Learn to say no. This is also a really hard thing to do. However, as previously mentioned, it is important to prioritize things and sometimes it will be necessary to say no to taking on new tasks.
Pamper yourself. Take time EVERY DAY to take care of YOU. A lot of FMS patients find pain relief in soaking in a warm / hot bath or spa. Add a little Epsom salt to your bath to help with muscle relaxation. Surround yourself with a favorite scent and put on relaxing music or sounds. Read a good book, work on a favorite project or activity, whatever you find rewarding.
Physical Therapy – Physical therapy can be an important part of your treatment plan. Before starting a physical therapy (PT) program, it is important to find a physical therapist who is knowledgeable about FMS. Benefits of PT in FMS include building muscle strength in core muscles which can lead to proper posture. Proper posture allows for more efficient muscle function which decreases fatigue and pain. Physical therapists can also help with appropriate stretching exercises which can reduce pain and fatigue and improve your range of motion. Physical therapy may involve the use of a Tens Unit. A Tens Unit works by sending stimulating pulses across the skin and along nerve strands which may help prevent pain signals from reaching the brain. A physical therapist can help you decide if this is something that might help you and make recommendations for home use of a Tens Unit. Lastly, physical therapists may make recommendations or employ the use of warm water therapy. Warm water therapy involves gentle exercises in a warm water pool which may help relieve FMS symptoms. You can also look for warm water or aqua therapy exercises thru local gyms or community programs.
Exercise – Oh, that dreaded word, exercise. With the pain and fatigue many FMS patients experience, why would they consider exercising? Well, first of all, when we are talking exercise for FMS patients, we are talking about low impact or “easy” exercise. Common exercises would include walking or riding a stationary bike. This does not have to be done at a high speed or for hours at a time. Even five minutes on an exercise bike or taking a walk to the end of the block has been shown to be beneficial. As you probably have heard, many studies have shown that exercise increases endorphins (happy chemicals in your brain) which boost your mood and is a natural painkiller. Start very slowly. Write down a measurable and achievable exercise goal. This might be something like, “I will walk to the end of the block and back on Monday, Wednesday, and Friday for 2 weeks. If you forget or don’t do it one of the days you planned, no big deal, don’t beat yourself up or feel bad about it. Just try again the next day. After a while, most FMS patients realize they do feel better when engaging in some type of regular physical activity so this can be an important component of your FMS treatment plan.
Relaxation and Stress Management – Effectively controlling your stress is key to FMS symptom control. Stress is unavoidable but there are things you can do to lower it. Some things that might help relieve stress are: talk thru your worries with a friend or loved one; balance work and recreation; do something for others which can get your mind off your own problems and help you feel good about yourself; learn to accept what you can’t change and work to move forward; do one thing at a time and don’t over-schedule yourself; take a walk or do some other type of physical activity; watch a funny movie or comedy show. Relaxation is also an important part of FMS symptom control. Deep breathing exercises throughout the day can help minimize stress and help you relax and decrease FMS symptoms. There are many guided relaxation apps and materials available on the internet or at your local library. Try several out and see what works for you. Meditation, guided imagery, and progressive muscle relaxation can be quite beneficial in reducing FMS pain for a lot of people.
Sleep and Fatigue Management – Sleep is also a big key to controlling FMS symptoms. This can be quite challenging as one of the symptoms of FMS is poor quality sleep or sleep disturbances. Some basic tips to help maximize your chance for good quality sleep: try to go to bed and wake up the same time each day, this helps regulate your sleep cycle; avoid caffeine or other stimulants after noon; if you go to bed and you don’t fall asleep within 20 minutes, get up and do a quiet activity (such as reading) in another room until you feel sleepy again; avoid long naps during the day as that can disrupt nighttime sleeping (short naps of 30 minutes or less are usually ok). It is important to make sure your doctor is aware of any sleep difficulties you are having as they might want to do tests to make sure there isn’t an underlying cause (such as restless legs syndrome or sleep apnea) to the problems you are having. Fatigue is another FMS symptom that can be difficult to deal with. Many people find that drinking plenty of water to stay hydrated and eating a small protein snack (such as a handful of nuts or protein bar) mid-morning and in the afternoon can help relieve some fatigue. Moving around, stretching, and getting fresh air can help with this as well. Be sure to discuss with your doctor if you are experiencing great difficulty with fatigue as they might have other suggestions / medication that can sometimes help.
Emotional Support – It is important to have a good support system to help you with this journey. This can include family, friends, therapist, pets, etc. Whoever or whatever is going to give you emotional support. Living with a chronic condition can be challenging and it is important to have “back-up.” A chronic condition such as FMS can also be difficult for your support team / family to understand. There are several good articles available to help family members and friends understand what life with a chronic condition is like. “The Spoon Theory” by Christine Miserandino (you can google this) is really good and there is also a good article on Wikihow.com (wikihow.com/understand-someone-with-chronic-pain).
Complementary Therapies – Some FMS patients find benefit in complementary therapies as part of their treatment plan. This could include acupuncture, acupressure, therapeutic massage, or chiropractic visits. Many FMS patients find benefit in using heat (heating pad, warm moist towels, heating blanket, hot shower) or cold (ice packs) on sore areas.
Alternative Therapies – Some FMS patients might explore alternative therapies such as special diets or vitamins. Please make sure to involve your physician with this.
Remember, although FMS can seem overwhelming, it is possible to achieve good symptom control for the vast majority of people using a comprehensive approach to treatment and working with your medical team hand in hand.