Which pain-reduction strategies are used in fibromyalgia rehabilitation?

Answer

Numerous modalities, including electrotherapy, cryotherapy, and therapeutic heat, can reduce pain.^[3]Teach patients how and when to use therapeutic modalities as part of their maintenance program. One investigator has recommended muscle energy treatments, positional release methods, and massage as part of the rehabilitation program to decrease stiffness and pain.

It has been shown that inhibition of the pain pathway can be achieved by systemic administration of local anesthetics such as intravenous lidocaine in neuropathic pain states. On this basis, intravenous lidocaine has been used for the management of fibromyalgia pain. This treatment option is not a traditional pain management option, and it may be associated with cardiac and neurologic side effects.

A small study evaluating the effect of intravenous lidocaine combined with amitriptyline on pain relief and plasma serotonin, norepinephrine, and dopamine levels revealed no benefit in reducing pain or in changing plasma serotonin and norepinephrine levels.^[12]Thirty patients were treated with amitriptyline 25 mg plus either intravenous saline or lidocaine in saline. Each patient had plasma serotonin, norepinephrine, and dopamine levels drawn at the beginning of the study and at 4 weeks. Patients rated their pain intensity on a numeral scale initially and weekly for 4 weeks. Since this study failed to show benefit in fibromyalgia pain and significant side effects are associated with intravenous lidocaine, caution is recommended if considering intravenous lidocaine with or without amitriptyline.

Ekici et al compared the efficacy of manual lymph drainage therapy (MLDT) with connective tissue massage (CTM) in the treatment of fibromyalgia.^[13]In a randomized, controlled trial utilizing 50 women with primary fibromyalgia, 25 patients were treated with MLDT, with the rest receiving CTM therapy. Both techniques appeared to be useful in reducing pain and improving patients' health status and health-related quality of life. However, patient responses on the Fibromyalgia Impact Questionnaire indicated that MLDT was better than CTM at reducing morning tiredness and anxiety.

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