Amanda Wray Although there is no known cure for fibromyalgia, a multidisciplinary team effort using combined treatment approaches, including patient education, aerobic exercise, cognitive behavioral therapy and pharmacologic therapies have been shown to improve symptoms and function in patients with fibromyalgia. Helping patients to identify which combination of these therapies makes the most impact on their quality of life can be part of a successful symptom self-management system. Education is paramount to the success of this kind of protocol, both for healthcare professionals as well as the patient. A team approach is the key to the overall success of this type of program, but it takes time and effort for a busy physician to create the team and then to monitor its success. At a minimum the number of team members must include: a physician to oversee the overall treatment regimen including prescribing and monitoring medications; an a complimentary medicine professional to guide the patient in discerning what type of alternative therapy protocols might be beneficial, such as an aerobic exercise program and who monitors the program’s success, makes appropriate activity changes and motivates the patient; and a mental health expert adept at cognitive behavior therapy who can also counsel patients in learning how to make adjustments in their life to accommodate changes that naturally occur when living with a chronic illness. Identifying and treating painful comorbid or overlapping conditions is also an important part of any treatment regimen. If a patient’s symptoms include irritable bowel and migraine headaches, then the treating physician should concentrate on remedies for those disorders. Once their symptomology is under better control, the fibromyalgia specific symptoms might be more distinct and easier to treat. The difficulty with this approach is that most FM patients have so many different symptoms, the physician might be overwhelmed and not know where to begin in a successful treatment regimen. This problem accentuates the need for more physician education which gives the tools necessary to identify overlapping conditions and what to do about them in the treatment of FM. Along with appropriate medical care it is important for the person with fibromyalgia to recognize the need for lifestyle adaptation. Most people are resistant to change because it implies adjustment, discomfort and effort. However, in the case of FM, change can bring about recognizable improvement in function and quality of life. Becoming educated about FM gives the person more potential for improvement. The good news is that since 2007 when the first of three FDA approved FM medications became available, continuing medical education programs focused on primary care physicians and other healthcare professionals have helped to broaden medical awareness about how to make an FM diagnosis and how to initiate effective treatment protocols. Pain Management A number of pharmacological treatments for fibromyalgia are available for prescription. The first to be approved by the U.S. Food and Drug Administration to treat fibromyalgia was pregabalin (Lyrica®); the second was duloxetine (Cymbalta®); and the third was milnacipran (Savella®). Other FM medications are currently in development, and may soon receive FDA approval to treat fibromyalgia. Additionally, healthcare providers may treat patients' FM symptoms with non-narcotic pain relievers (e.g. tramadol) or low doses of antidepressants (e.g. tricyclic antidepressants, serotonin reuptake inhibitors) or benzodiazepines. Patients must remember that antidepressants are "serotonin builders" and can be prescribed at low levels to help improve sleep and relieve pain. If the patient is experiencing depression, higher levels of these or other medications may need to be prescribed. Lidocaine injections into the patient's tender points also work well on localized areas of pain. An important aspect of pain management is a regular program of gentle exercise and stretching, which helps maintain muscle tone and reduces pain and stiffness.Sleep Evaluation and Implementation Improved sleep can be obtained by implementing a healthy sleep regimen. This includes going to bed and getting up at the same time every day; making sure that the sleeping environment is conducive to sleep (i.e. quiet, free from distractions, a comfortable room temperature, a supportive bed); avoiding caffeine, sugar, and alcohol before bed; doing some type of light exercise during the day; avoiding eating immediately before bedtime; and practicing relaxation exercises as you fall to sleep. When necessary, there are new sleep medications that can be prescribed, some of which can be especially helpful if the patient's sleep is disturbed by restless legs or periodic limb movement disorder. Scientific studies are now showing that many people with fibromyalgia also have neurally mediated sleep apnea. It is a good idea to get a sleep lab study done to discover exactly what kind of sleep problem the patient is dealing with. If the person does have sleep apnea, a CPAP machine or a special oral appliance created to move the jaw forward during sleep have been shown to be effective.Mental Health Support Learning to live with a chronic illness often challenges an individual emotionally. The FM patient needs to develop a program that provides emotional support and increases communication with family and friends. Many communities throughout the United States and abroad have organized fibromyalgia support groups. These groups often provide important information and have guest speakers who discuss subjects of particular interest to the FM patient. Counseling sessions with a trained professional may help improve communication and understanding about the illness and help to build healthier relationships within the patient's family.Other Treatments Complementary therapies can be very beneficial. These include: physical therapy, therapeutic massage, myofascial release therapy, water therapy, light aerobics, acupressure, application of heat or cold, acupuncture, yoga, relaxation exercises, breathing techniques, aromatherapy, cognitive therapy, biofeedback, herbs, nutritional supplements, and osteopathic or chiropractic manipulation. One of the most important factors in improving the symptoms of FM is for the patient to recognize the need for lifestyle adaptation. Most people are resistant to change because it implies adjustment, discomfort and effort. However, in the case of FM, change can bring about recognizable improvement in function and quality of life. Becoming educated about FM gives the patient more potential for improvement. An empathetic physician who is knowledgeable about the diagnosis and treatment of FM and who will listen to and work with the patient is an important component of treatment. It may be a family practitioner, an internist, or a specialist (rheumatologist or neurologist, for example). Conventional medical intervention may be only part of a potential treatment program. Alternative treatments, nutrition, relaxation techniques, and exercise play an important role in FM treatment as well. Each patient should, with the input of a healthcare practitioner, establish a multifaceted and individualized approach that works for them.