Aerobic Exercise !
A recent article in www.medscape.com by Alice Goodman summarised an overview of research on fibromyalgia treatment that was presented at the Paris 2014 European League Against Rheumatism Congress.
Winfried Häuser MD, from Technische Universität Munchen is an expert in the field of fibromyalgia. He believes that treatment for people with fibromyalgia should be individualised and include non pharmacalogical approaches, as these are often more effective than drugs. He explained that aerobic exercise is the most effective ‘weapon’ that we have and both healthy people and people with fibromyalgia benefit from continuous physical exercise.
He and his colleagues recently published a network meta-analysis which was an indirect comparison of all available therapies for fibromyalgia. They were unable to find any significant differences in effectiveness between drug and non-drug therapies. While the effects of drugs are lost once the patient stops taking them, the effects of aerobic exercise and multicomponent therapy are sustained but declining at 1 or 2 years.
Dr Häuser advocates a graduated approach to treating fibromyalgia.
Mild fibromyalgia: can be managed with reassurance from the doctor and encouragement to engage in regular physical and mental activities.
Moderate fibromyalgia: should be managed with aerobic exercise and the temporary limited use of drugs.
Severe fibromyalgia: can be managed with aerobic exercise, drugs and the psychological and/or psychopharmalogic treatment of mental comorbidities.
Dr Mary-Ann Fitzcharles, a rheumatologist at McGill University in Montreal who treats people with fibromyalgia, agreed with the patient-tailored approach outlined by Dr Häuser. She cautioned about overmedicating people, and keeping them on continued medications which have side effects. Non Pharmalocological therapies have no risks, she explained.
Dr Fitzcharles went on to say that non pharmacologic therapies are probably the most important ones for people with fibromyalgia. In her experience, every person with fibromyalgia should be managed with exercise, promotion of an internal locus of control and education.
Activity pacing is the key, in order to not overdo or avoid exercise.
Non Pharmacological therapies include:
- Aerobic exercise
Pharmacologic / drug therapies include:
- GABA analogues
- Serotonin-norepinephrine reuptake inhibitors (SNRIs)
- Tricyclic antidepressants
- Serotonin-specific reuptake inhibitors (SSRIs)
- Aerobic Exercise ‘Most effective weapon’ for Fibromyalgia. Medscape. June19, 2014. Annals of the Rheumatic Diseasesard.bmj.com
- Comparative efficacy of pharmacological and non-pharmacological interventions in fibromyalgia syndrome: network meta-analysis
Ann Rheum Dis 2013;72:955-962 doi:10.1136/annrheumdis-2011-201249
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