The 4 Rs of Fibromyalgia Treatment

BY WENDY HENDERSON & DR. GINEVRA LIPTAN
The first step is “rest,” important for anyone who suffers from a chronic illness but something that many fibromyalgia patients struggle to get enough of. The second is “repair,” through digestion and nutrition. The third step is “rebalance,” reducing the inflammation and addressing hormone imbalance. The final step in Dr. Liptan’s treatment program is “reduce,” using targeted medicine to reduce fatigue and other symptoms.

Fibromyalgia is a common chronic pain disorder characterized by complex symptomatology and few consistently effective treatments. The purpose of this review is to highlight the recent literature from April 2005 through September 2006 involving treatment options.

Recent Findings: Prior evidence suggests that medication and self-management approaches to care can improve symptoms, function and well-being in this patient population. Recent studies examining the efficacy of two serotonin and norepinephrine-reuptake inhibitors – duloxetine and milnacipran – and the anticonvulsant pregabalin are encouraging. Studies evaluating different forms of exercise continue to support the belief that increased physical activity is an essential component of any treatment plan for the patient with fibromyalgia. Three studies added to the understanding of treatment adherence. Finally, three studies evaluating the efficacy of acupuncture in the treatment of fibromyalgia showed conflicting results, but added to the knowledge needed for clinicians to have substantive conversations with patients.
Summary: Recent studies support the recommendation of a multimodal approach to treatment involving individualized, evidence-based pharmacotherapy and self-management. Treatment goals should include the improvement of symptoms, primarily pain and sleep, and the promotion of positive health behaviors with the aim of improving physical function and emotional well-being.

In this video from the Frida Center for Fibromyalgia, Dr. Ginevra Liptan talks about the symptoms of the fibromyalgia and her four Rs approach to treatment for the condition.

The first step is “rest,” important for anyone who suffers from a chronic illness but something that many fibromyalgia patients struggle to get enough of. The second is “repair,” through digestion and nutrition. The third step is “rebalance,” reducing the inflammation and addressing hormone imbalance. The final step in Dr. Liptan’s treatment program is “reduce,” using targeted medicine to reduce fatigue and other symptoms.

Fibromyalgia is a common, multidimensional disorder with complex symptomatology and relatively poor treatment outcomes.[1,2**] Fibromyalgia is characterized by widespread pain for longer than 3 months and bilateral sites of amplified tenderness.[3] In most patients, fibromyalgia is associated with fatigue, sleep dysfunction, stiffness, depression, anxiety, cognitive disturbance, or exercise intolerance,[2**,3,4] and is reported to be more common in women and individuals with other rheumatic conditions.[5] The prevalence of fibromyalgia is estimated to be 2% in the USA[6,7*] and Canada.[8] The etiology and pathophysiology of fibromyalgia remain unclear. Current hypotheses center on atypical sensory processing in the central nervous system and dysfunction of skeletal muscle nociception and the hypothalamic-pituitary-adrenal axis.[9,10,11,12**]

Current treatments for fibromyalgia include medical, self-management and alternative interventions. The number of published studies, particularly randomized controlled trials, has risen steadily over the past decade. Treatment remains inadequate to reliably resolve persistent symptoms and improve functional limitations and quality of life in most patients. One reason for unsatisfactory outcomes may be the absence of an evidence-based standard of care.

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