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PM & R Treatment of Fibromyalgia

*Reprinted from Health Points, Vol 5, No. 1, Jan-Feb-Mar 2000 issue

By Mark J. Pellegrino, M.D.

Numerous medical professionals and specialists treat fibromyalgia, and one specialty in particular, Physical Medicine and Rehabilitation, is especially skilled at diagnosing and treating chronic conditions such as fibromyalgia. A physician specializing in Physical Medicine and Rehabilitation is called a physiatrist (pronounced fiz e AH trist). I am a Board Certified Physiatrist who has fibromyalgia, so I deal with fibromyalgia every day on both a professional and personal level.


Over the past eleven years I have seen and treated more than 10,000 people with fibromyalgia. I wish I could see I have found a cure, but I haven’t. However, I try to help people heal and improve even if they still have fibromyalgia, at least until a cure is found.


My specialty focuses on improving function and improving one’s quality of life. In fact, the word "habile" from which rehabilitation is derived, is Latin for "to make able again". I feel this word is an embodiment of our unique treatment philosophies. This approach naturally applies in the diagnosis and treatment of fibromyalgia. The Physical Medicine and Rehabilitation strategy is to empower the fibromyalgia person with abilities to improve the quality of life, even if the condition is still present.


Often we tend to talk about people with fibromyalgia as a homogenous group of people. That is, we all have the same thing. Whereas we all have the same condition, we certainly do not behave in the same manner, nor do we all respond the same to treatment. What works for one person may not work at all for another person. There is no universal recipe for treating fibromyalgia because each of us with fibromyalgia is a unique individual. We each need to be handled with special unique care and each of us needs to identify our own specific fibromyalgia treatment goals. Remember, we are special people indeed!


Specific fibromyalgia treatment goals that I identify for each individual include:


  1. Decreasing pain, as much as possible. It would be great if everyone could go into remission and be pain free, but this rarely happens. What usually happens, however, is that the pain can decrease and sometimes decrease considerably from a higher level to a much lower and more stable level. Some people achieve remissions where they hardly feel any pain.

  2. Improving function. Even if a person is unable to do activities done prior to developing fibromyalgia, one can still improve and learn to focus on the abilities. That is why I like the word "habile", because it focuses on making able again, or abilities, focusing on the positive. Too often, we tend to focus on the negative, or inabilities, or things that we used to do. Remember habile!

  3. Teaching a successful program to self-manage fibromyalgia. We live with this condition every day so we should try to find out what works and learn to do it ourselves. We can’t sling our doctors and therapists over our backs, carry them with us throughout the day, and pull them out when needed for increased pain. (Ouch! That would really hurt, wouldn’t it?) We must manage our pain as best we can by ourselves on a daily basis.


I use a combination treatment approach that is individualized for each person. The following is a summary of treatment strategies:

  1. Education. This is half the battle. People with fibromyalgia must understand that this condition is not life threatening, deforming or paralyzing, and it is a valid medical condition. The more one learns about fibromyalgia, the more it is understood and the less frightening it becomes.

  2. Medicines. There is no magical medicine to eliminate all the symptoms of fibromyalgia, but many medicines can be helpful in controlling various symptoms. I use sleep modifiers (i.e. Ambien, Restoril), antidepressant medicines (i.e. tricyclics and serotonin reuptake inhibitors), pain medicines and various other prescribed medicines. Often different medicines need to be tried to find the best combination, and even when a good combination is found, the medicines can "stop working" after a while. Rotating different medicines over time can help.

  3. Nutritional supplements. A variety of nutritional supplements can be used to help the symptoms of fibromyalgia. Magnesium with malic acid, 5-HTP, Colostrum and others can be beneficial. Many people who are too sensitive to prescribed medicines can better tolerate nutritional supplements.

  4. Pain management. I like to prescribe a program that may include moist heat, bioelectric therapy, trigger point injections, ultrasound and more with the goal of decreasing pain to a lower level. Once the pain has decreased, one can try to progress an exercise program.

  5. Exercises. It is important to increase the flexibility and tone of the muscles. This can be done by instructing a person on a combination of postural stretches, light aerobic conditioning and strengthening and toning exercises. Elastic bands such as Therabands can be used.

  6. Manual therapy. This includes therapeutic massage, myofascial release, soft tissue mobilization and adjustments.

  7. Relaxation. Sometimes one of the best treatments to prescribe is relaxation! Deep breathing exercises, guided imagery, biofeedback, yoga, tai chi, and prayer are a few examples of relaxation techniques.

  8. Home program. Each individual needs to find whatever works best and follow through with a home program on a regular basis.


One does not have to be a physiatrist to want to help diagnose and treat people with fibromyalgia. Many doctors and specialists want to help and would be open-minded and try to use the best of all available treatment options to enable each individual to achieve the best quality of life with the least amount of pain. The doctor’s job, whatever his or her qualifications are, is to try to point you in the right direction. You have two important qualifications: you must have fibromyalgia, and you must want to do better!

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