Fibromyalgia Research and Treatment Advances

Fibromyalgia is a chronic condition marked by widespread pain, fatigue, depression, sleep problems, and brain fog. If you have it, you know there are limited treatment options and even fewer explanations for your symptoms. But take heart: Doctors are working on several new treatments and have made a number of breakthroughs that may improve your symptoms and quality of life.

With fibromyalgia, it’s hard to get the deep sleep you need to feel restored and refreshed. In fact, 9 out of 10 people with fibromyalgia wrestle with getting quality sleep. That makes other symptoms like pain and fatigue even worse. Recently, the FDA approved a new form of the drug cyclobenzaprine (Tonmya) for people with fibromyalgia. It’s a muscle relaxant that you place under your tongue each night at bedtime to get restorative sleep. It's absorbed more quickly than the swallowed form of cyclobenzaprine (Flexeril). Your doctor may prescribe it along with other treatments, such as regular exercise and sleep.

Chronic pain may speed up gray matter loss (atrophy) in the brain. In one study, doctors found that fibromyalgia patients lost nearly four times the gray matter as patients their age who didn’t have the condition. Cognitive behavioral therapy for insomnia (CBT-I) may help. It reframes thoughts and behaviors that keep you from sleeping well. For example, if you can’t fall asleep within 20 minutes, get up, and then go back to bed when you’re sleepy. A study of patients who received eight weeks of CBT-I found they had reduced insomnia and increased thickness in their brain’s gray matter.

These painless, noninvasive techniques treat fibromyalgia pain by stimulating certain parts of your brain. Transcranial direct-current stimulation (tDCS) delivers electronic currents to your brain through a soft band that a doctor places around your head. Doctors believe tDCS may change how the brain processes pain or increase blood flow to certain parts of the brain. Repetitive transcranial magnetic stimulation (rTMS) uses electromagnetic pulses to reduce activity in parts of the brain that process pain. Studies show it may also increase neuroplasticity, the brain’s ability to change how it responds to certain patterns, such as chronic pain.

The FDA has authorized a therapy you can wear – and control with your smartphone. The Quell-FM TENS device attaches to your body with a band wrapped around your arm or upper calf. It sends electrical pulses to stimulate the nerves in the affected part of your body. You can increase or decrease the intensity of the electrical pulses through a phone app. Doctors believe it activates your body’s natural neurological response to reduce pain. It can be worn during sleep. Fibromyalgia patients who tried this treatment at home during a three-month study reported reduced pain and few side effects.

Most fibromyalgia treatments focus on managing symptoms such as pain and poor sleep. But a broader approach – one that blends physical activity, psychological therapy, and health education – may be equally helpful. In one study, fibromyalgia patients took part in a 12-week group-based program that focused on health education, physical exercise, and cognitive behavioral therapy. The goal was to teach them to manage their symptoms, reduce emotional distress, and improve their physical health. At the end of the program, patients reported an improved quality of life, a reduced need for medications, and a greater awareness of their health needs and self-care.

For most types of pain, including fibromyalgia pain, a one-size-fits-all approach to pain management doesn’t work. That’s because each person experiences and responds to pain differently. Our pain response is determined by things such as our environment, race, ethnicity, and gender. Doctors are working to solve this problem by studying how our individual DNA (genome) responds to drug treatment. If they can tailor pain management to each patient based on their genetic makeup, it could lead to improved patient outcomes.

Although fibromyalgia affects millions of people around the globe, doctors don’t fully understand what causes it. Fibromyalgia symptoms often overlap with those of other conditions, leading to late diagnoses and misdiagnoses. Doctors are working to better understand the changes within the body that allow fibromyalgia to happen (pathophysiology). One of the things they’re looking at are biomarkers (signs), like inflammation or oxidative stress, that may help them detect cell changes. That could help with diagnosing fibromyalgia.

Doctors are making strides in finding new treatments for fibromyalgia. Still, challenges persist. Fibromyalgia symptoms differ from person to person and often overlap with symptoms of other conditions. So it’s often under-diagnosed, misdiagnosed, or diagnosed late. And, there is no standard tool to diagnose fibromyalgia. Also, many doctors are still trying to fully understand its causes, and there’s limited scientific evidence about proven therapies.