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Fibromyalgia, Non-Pharmacological Treatment

We see quite a few patients with fibromyalgia in our clinic. Frequently, they come to us at a later stages of their quest for treatment but sometimes we get to see them earlier, when non-pharmacological options can still be sufficient. Drug free interventions are generally recommended as first-line treatment of fibromyalgia. Those include psychological treatments such as cognitive behavioural therapy and mindfulness, hypnosis, acceptance and commitment therapy, and attachment-based compassion therapy. There are also different forms of exercise, balneotherapy, education, electrotherapy, complementary and alternative medicine and massage. We have been using cold laser, MLS laser in clinic which appears to be helpful to a lot of patients as well.

However, which interventions are effective for the different symptoms is not well understood. It seems however, exercise overall improves all outcomes but the benefits vary between types of exercise for each specific outcome, for example, although all types of exercise could be effective for pain apart from flexibility exercise, only aerobic and strengthening exercises tend to be effective for sleep. Exercise is also superior to usual care for fatigue, and depression. Mindfulness, hypnosis, acceptance, and commitment therapy are more effective than usual care for pain, sleep, and depression but not fatigue. Other interventions such as acupuncture and massage therapy affect both central and peripheral pain mechanisms and improve most symptoms. The important feature of most of these therapies is that patients completing a nonpharmacological treatment program for fibromyalgia should be reviewed approximately 3 monthly and the treatments reinforced as required as the effects may not last. 

To conclude, it may be better and more effective to start treatment earlier when non-pharmacological options can be utilized and prior to needing to resort to other, more advanced options. 

Vladimir Fiks, MD Medical Director Advanced Pain Management Center and Cedar Hills Surgery Center

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