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Fibromyalgia
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==Treatment== Main treatment approaches for fibromyalgia include patient education, exercise including stretching, message, [[Fibromyalgia drugs|medication]], alternative treatments for [[pain management]], and stress management or mental health treatments for any related depression or anxiety.{{citation needed | date = 2021}}<ref name="FibroBasics" /><ref name="ScienceOfFibro" /> {{See also|Fibromyalgia drugs}} ===United States=== Rheumatology and primary care providers: Diagnosing and treatment: *2012, [https://www.mayoclinicproceedings.org/article/S0025-6196(12)00299-6/abstract A Framework for Fibromyalgia Management for Primary Care Providers]<ref>{{Cite journal | last = Arnold | first = Lesley M. | last2 = Clauw | first2 = Daniel J. | last3 = Dunegan | first3 = L. Jean | last4 = Turk | first4 = Dennis C.| date = 2012 | title = A Framework for Fibromyalgia Management for Primary Care Providers |url =https://www.mayoclinicproceedings.org/article/S0025-6196(12)00299-6/abstract|journal=Mayo Clinic Proceedings|language=English|volume=87|issue=5 | pages = 488–496|doi=10.1016/j.mayocp.2012.02.010|issn=0025-6196|via=}}</ref> Rheumatologists stopped treating fibromyalgia patients and primary care providers began treatment managment although rheumatologists are most often the specialist to diagnose. {{See also|Fibromyalgia disability process}} ===Drugs=== {{Main article| page_name = Fibromyalgia drugs}} === Therapies === ==== Exercise ==== ''Please Note'': The research supporting these treatments are for fibromyalgia patients '''without''' [[ME/CFS]] sufferers due to it's hallmark symptom of [[post-exertional malaise]]. [[File:Warm water exercise.JPG|200px|thumb|left|Warm water exercise can be helpful for fibromyalgia. Start slow and don't push through the pain.<ref name="Ronenn" /><ref>{{Cite journal | last = Bidonde | first = Julia | last2 = Busch | first2 = Angela J. | last3 = Webber | first3 = Sandra C. | last4 = Schachter | first4 = Candice L. | last5 = Danyliw | first5 = Adrienne | last6 = Overend | first6 = Tom J. | last7 = Richards | first7 = Rachel S. | last8 = Rader | first8 = Tamara | date = 2014-10-28 | title = Aquatic exercise training for fibromyalgia| url = https://www.ncbi.nlm.nih.gov/pubmed/25350761|journal=The Cochrane Database of Systematic Reviews|issue=10 | pages = CD011336|doi=10.1002/14651858.CD011336|issn=1469-493X|pmid=25350761}}</ref> Image source: [https://commons.wikimedia.org/wiki/File:Water_aerobics_in_a_swimmingpool_Gambia.jpg Wikimedia Commons]. Author: Peter van der Sluijs, cropped, license: CC-BY-SA-2.5.]] <blockquote>Several studies have found that warm-water pool exercise is a beneficial treatment for fibromyalgia. A very large survey of patients found that 26% have used pool therapy, rating it as very effective.<ref name="Bennett2007">{{Cite journal | last = Bennett | first = Robert M. | author-link = | last2 = Jones | first2 = Jessie | authorlink2 = | last3 = Turk | first3 = Dennis C. | authorlink3 = | last4 = Russell | first4 = I. Jon | authorlink4 = | last5 = Matallana | first5 = Lynne | authorlink5 = | date = Mar 9, 2007 | title = An internet survey of 2,596 people with fibromyalgia| url = https://doi.org/10.1186/1471-2474-8-27|journal=BMC Musculoskeletal Disorders|volume=8|issue=1 | pages = 27|doi=10.1186/1471-2474-8-27|issn=1471-2474|pmc=1829161|pmid=17349056|quote=|via=}}</ref> The same survey found 74% of patients found heat helpful - either warm water or heat packs.<ref name="Bennett2007" /> Warm water especially important in FMS because the vasodilatory effect of the heating may improve blood flow to muscles, helping to reduce pain, and many people with FM are also intolerant of cold. A warm-water pool is one that's kept around 89.6 to 93 degrees Fahrenheit (32 to 34 Celsius), which is several degrees warmer than most heated pools.<ref name="Munguia2007">{{Cite journal | last = Munguía-Izquierdo | first = D. | last2 = Legaz-Arrese | first2 = A. | date = 2007 | title=Exercise in warm water decreases pain and improves cognitive function in middle-aged women with fibromyalgia| url = https://www.ncbi.nlm.nih.gov/pubmed/18173915|journal=Clinical and Experimental Rheumatology|volume=25|issue=6 | pages = 823–830|issn=0392-856X|pmid=18173915|via=}}</ref></blockquote> Dr Roubenoff Ronenn recommends moderate aerobic exercise and weights with six to eight reps, and then a day or two of rest in between. He cautions people not to start a program if they are in a flare.<ref name="Ronenn">{{Cite web | url = http://www.arthritis.org/living-with-arthritis/tools-resources/expert-q-a/fibromyalgia-questions/fibromyalgia-exercise.php | title = Fibromyalgia Exercise {{!}} Exercising with Fibromyalgia | last = Ronenn | first = Roubenoff | date = | website = arthritis.org|archive-url=|archive-date=|access-date=2018-08-09}}</ref> {{See also|Exercise}} ==== Massage ==== *2014, [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930706/ Massage Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials]<ref name="Yan2014">{{Cite journal | last = Li | first = Yan-hui | last2 = Wang | first2 = Feng-yun | last3 = Feng | first3 = Chun-qing | last4 = Yang | first4 = Xia-feng | last5 = Sun | first5 = Yi-hua | date = 2014-02-20 | title = Massage Therapy for Fibromyalgia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930706/|journal=PLoS ONE|volume=9|issue=2|doi=10.1371/journal.pone.0089304|issn=1932-6203|pmc=|pmid=24586677 | pages = |via=}}</ref> ==== Acupuncture ==== Manual acupuncture (skin penetration without stimulation) is the most common form of acupuncture but gives no clinically significant pain relief to fibromyalgia patients, but a [[Cochrane]] review found '''electro-acupuncture''', which involves an electrical current, significantly reduced [[pain]], stiffness, and [[fatigue]] and improve sleep quality and global well-being in people with fibromyalgia for a one-month period, but not long term.<ref name="NBK279092" /><ref name="Cochrane-acupuncture">{{Cite journal | last = Deare | first = JC | last2 = Zheng | first2 = Z | last3 = Xue | first3 = CCL | first4 = Jian Ping | last4 = Liu | first5 = Jingsheng | last5 = Shang | first6 = Sean W | last6 = Scott | first7 = Geoff | last7 = Littlejohn | url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4105202 | title = Acupuncture for treating fibromyalgia]|journal=Cochrane Database Syst Rev. | date = May 31, 2013|issue=5 | pages = CD007070 |volume=2013|doi=10.1002/14651858.CD007070.pub2|pmc=PMC4105202|pmid= 23728665}}</ref> 2016 reviewed acupuncture (AC), electroacupuncture (EAC) and moxibustion, but found none improved quality of life in women with fibromyalgia.<ref name="CAM">{{Cite journal| first = Paulo Araujo | last = Diasa | first2 =André Brito Bastos | last2 = Guimarães | first3 = Andrea | last3 = de Oliveir Albuquerque | first4 = Karoline Lucas | last4 = de Oliveir | first5 = Maria Luzete Costa | last5 = Cavalcante | first6 = Sergio Botelho | last6 = Guimarães | date = 2016-01-01 | title = Short-term complementary and alternative medicine on quality of life in women with fibromyalgia| url = https://www.sciencedirect.com/science/article/pii/S2095496416602352|journal=Journal of Integrative Medicine|language=en|volume=14|issue=1 | pages = 29–35|doi=10.1016/S2095-4964(16)60235-2|issn=2095-4964}}</ref> "There was no significant improvement in pain or reduction of tender points in any of the groups studied, at the end of the 8th session."<ref name="CAM" /> In 2004, [[U.S. Department of Health and Human Services]] (HHS) and Centers for Medicare and Medicaid Services (CMS) ruled a noncoverage determination for acupuncture.<ref>{{Cite web | url = https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R11NCD.pdf | title=CMS Manual System Pub. 100-03 Medicare National Coverage Determinations | last = | first = | date = Apr 16, 2004 | website = CMS.gov|format = PDF | archive-url=|archive-date=|access-date=}}</ref>
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