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Two years ago I found out I have fibromyalgia. I really wanted to avoid drugs, so I've been trying every other treatment under the sun. Nothing has helped, and I'm ready to throw in the towel. What should I take first?

Fibromyalgia (also known as fibromyalgia syndrome or FMS) is a chronic pain condition affecting many parts of the body. Muscle, joint, and bone pain is usually present along with a host of other signs and symptoms. Sleep disturbance causes a disruption of growth hormone (GH) that is normally released during sleep. A lack of sleep and decreased GH adds to the problem of pain and fatigue.

At the same time, there appears to be a dysregulation of the nervous system. People with FMS often register pain with stimuli that would not be painful in other individuals. This effect is called central sensitization.

Drug therapy is aimed at stopping the symptoms by regulating the nervous system. There are several groups of drugs available for the treatment of FMS. These include antidepressants and nonopioid analgesics (pain relievers). Stronger, opioid analgesics do not seem to be very helpful.

This year (2007), the FDA approved the use of one drug specifically for FMS: pregabalin. This is an agent normally used for patients with seizures. It appears to work by reducing the release of several neurotransmitters that send pain messages to the nervous system.

Most often, drugs are used in combination with one another. Each patient responds differently to various medications. Your physician will help you find the right drug or mix of medications that is best for you.

Experts advise using a management approach to this condition. Drug therapy should be part of an overeall plan that also includes diet, exercise, and counseling.

Behavioral therapy and psychologic support seem to be a key part of successful management for FMS. Many patients are also helped by alternative medicine such as chiropractic care, acupuncture, and reiki, shiatsu, or other massage techniques.

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