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The remedies for the treatment of fibromyalgia are usually antidepressants, such as amitriptyline or duloxetine, muscle relaxants, such as cyclobenzaprine, and neuromodulators, such as gabapentin, for example, prescribed by the doctor. In addition, alternative therapies, such as aromatherapy, psychotherapy or acupuncture, can assist in treatment and help control symptoms. Physiotherapy through exercise and massage is also important to help relieve pain and prevent further attacks.
Fibromyalgia treatment is individualized and based exclusively on symptoms, so it is important to consult a rheumatologist, neurologist or psychiatrist to assess, diagnose and indicate the best treatment. Discover 4 physiotherapy treatments for fibromyalgia.
1. Antidepressants
Antidepressants are indicated for the treatment of fibromyalgia because they act directly on the brain, regulating substances that are important for its functioning, such as serotonin, norepinephrine and dopamine, thus improving pain, fatigue and sleep and increasing mood. The most prescribed antidepressants by the doctor are:
Amitriptyline (Tryptanol or Amytril): the recommended starting dose is 10 mg daily and should be taken at night, 2 to 3 hours before going to bed;
Nortriptyline (Pamelor or generic): like amitriptyline, the recommended starting dose is 10 mg per day and can be increased gradually by the doctor, if necessary. The capsule should be taken at night before bedtime;
Duloxetine (Cymbalta or Velija): generally, the starting dose is 30 mg and can be increased to a maximum of 60 mg per day according to medical evaluation;
Fluoxetine (Prozac or Daforin): for best effect, fluoxetine should be used in high doses, above 40 mg per day, however only the doctor can evaluate the dosage to be indicated;
Moclobemide (Aurorix or generic): the recommended starting dose is 300 mg daily, usually divided into two doses and should be taken after meals. If necessary, the dose can be increased by up to a maximum of 600 mg per day.
The dose of all antidepressants is individualized and treatment must continue for at least 4 to 6 weeks to achieve the drug's effectiveness.
2. Muscle relaxant
The muscle relaxant is used in fibromyalgia to decrease the stiffness of muscles that become stiff causing pain throughout the body, in addition to improving sleep. In this case, cyclobenzaprine is the muscle relaxant indicated by the doctor and the recommended doses are 1 to 4 mg at night and the duration of treatment should be 2 to 3 weeks.
3. Antiparkinsonian
Antiparkinsonians, which are drugs for the treatment of Parkinson's, such as pramipexole (Stabil or Quera), are also indicated to reduce the pain of fibromyalgia and improve sleep. The recommended starting dose is 0.375 mg per day, and the dose can be gradually increased up to a maximum of 1.50 mg per day.
4. Painkillers
Simple painkillers like paracetamol (Tylenol or generic) and opioids like tramadol (Tramal or Novotram) are recommended to improve the pain of fibromyalgia. These painkillers can be taken alone or can be combined for better pain relief, as they act on different stages involved in pain. The doses of these drugs must be guided by the doctor and tramadol is only sold with a prescription.
5. Neuromodulators
Neuromodulators act directly on the nervous system, regulating the pathways responsible for pain and, thus, effectively reduce the pain caused by fibromyalgia. These medications include:
Gabapentin (Neurontin or Gabaneurin): should be taken orally, in the initial dose of 300 mg per day, which can be increased to a maximum of 900 mg to 3600 mg per day;
Pregabalin (Lyrica or Insit): the initial dose of 75 mg orally, twice a day, that is, 150 mg per day. The dose of pregabalin can be increased gradually, according to the doctor's assessment, to a maximum of 450 mg per day, divided into 2 doses.
Both gabapentin and pregabalin can be taken before or after meals and are sold only with a prescription. It is recommended that the first dose is taken at night, at bedtime.
6. Sleep inducers
Sleep disorders are common in fibromyalgia, both insomnia and not having restful sleep. Sleep inducers are generally recommended to relieve this type of disorder and include:
Zopiclone (Imovane): the recommended dose is a maximum of 1 tablet of 7.5 mg orally at night and the treatment should not exceed 4 weeks to avoid causing dependence;
Zolpidem (Stilnox or Zylinox): a maximum of 1 10 mg tablet should be taken orally immediately before bedtime, as it has an action 30 minutes after taking the dose, and the duration of treatment should be as short as possible, not exceeding 4 weeks.
Sleep inducers help to reduce muscle tension caused by not sleeping well and are often indicated to complement the treatment of fibromyalgia pain.
7. Anxiolytics
Anxiolytics are drugs that act by decreasing anxiety, cause muscle relaxation and induce sleep, improving the symptoms of fibromyalgia. Anxiolytics should be used for a short period because of their ability to cause addiction and include:
Lorazepam (Lorax or Ansirax): has an intermediate effect time of 10 to 20 hours and a single daily dose of 1 to 2 mg should be taken, usually at bedtime;
Diazepam (Valium or Uni-Diazepax): the duration of the diazepam effect is longer, for 44 to 48 hours, and the recommended dose is 1 tablet of 5 to 10 mg orally, at night, which can be adjusted from according to medical evaluation.
Treatment with anxiolytics should always start with the lowest possible dose and last for a maximum of 2 to 3 months.
In addition to medicines purchased at the pharmacy, some home remedies options such as teas and juices help to relieve the pain of fibromyalgia and reduce some symptoms such as tiredness and sleep disorders. Learn more about home remedies for the treatment of fibromyalgia.