Jones and her colleagues discovered that most people with fibromyalgia do not secrete sufficient growth hormone during vigorous exercise. Growth hormone helps build muscle tissue, so not having enough of it may contribute to exercise-induced muscle pain in people with fibromyalgia. Pyridostigmine blocks a hormone called somatostatin, which inhibits the production of growth hormone. The drug is FDA-approved to treat myasthenia gravis, an autoimmune disorder in which control of muscles is gradually lost. Jones’ study suggests the drug can normalize growth hormone levels in fibromyalgia patients during exercise so that they can better tolerate physical activity. However, the drug has been used only experimentally in this way.

Jones also says a product called Spray and Stretch, a spray-on skin refrigerant that numbs pain, can be helpful when people with fibro­my­algia start an exercise program. “Us­ing a skin refrigerant before stretching can help make the workout session less painful, reducing the chance that the patient will stop trying to exercise and allowing them to get the benefits of being physically active,” says Jones.

Biofeedback

People who use biofeedback feel they have more control over their condition. Biofeedback teaches people how to relax clenched or tight muscles or change other physiological functions, like slowing a racing heartbeat. “Biofeedback equipment gives a patient information about specific physiological functions so they can work to control those functions,” says Mark D. Litt, PhD, a professor of behavioral sciences at the University of Connecticut Health Center in Farm­ing­ton, and researcher of biofeedback in people who clench their jaw muscles and have temporomandibular joint (TMJ) pain, which is common in those with fibromyalgia.

“My patients are given information about the state of chewing muscles along their jaw joint, the ones that make your mouth clench,” Litt says. Through electrodes attached to the body, a machine lets people know when their muscles clench. People then try ways to lower the muscle tension. “Most people find they can do it if they can find a way to relax,” Litt says. “For example, some people go into mini trances; some people count in their heads.”

McKiernan says biofeedback ther­apy taught her basic relaxation techniques, including visualization. With eyes closed, she relaxes and pictures a radio-like box, custom­ized with dozens of dials labeled with fibromyalgia symptoms, such as Pain, Worry, Anxi­ety, Stress and so on. If she’s having trouble falling asleep, she visualizes turning the “Awakeness” dial down and cranking the “Sleepy” dial up. Sometimes, she admits, she needs to adjust the dials again and again, but the biofeedback exercise helps. “It’s been useful to me to feel like I have a certain amount of control,” she says.

Fibromyalgia patients have been benefiting from other types of biofeedback, too. Neurofeedback is a type of biofeedback that monitors and records brain waves using an electroencephalograph (EEG) or similar instrument, explains David V. Nelson, PhD, of the Comprehensive Pain Center, Department of Anesthesiology and Psychiatry, at Oregon Health & Science University in Portland. In a recent British study, neurofeedback, which helps improve mental concentration, was shown to improve memory.

How does it work? Brain waves normally range from slow to fast, indicating the level of activity in the brain, he explains. Some people with fibromyalgia have shown brain wave abnormalities. For instance, they might have more active brain wave activity at night, which robs them of deep, restorative sleep, and have less active brain wave activity during the day, which contributes to fatigue and “fibro fog.”

Nelson is currently conducting a study in which tiny pulses of electromagnetic stimulation boost the slower daytime brain waves of people with fibromyalgia. He hopes to show that this type of brain wave therapy can help normalize brain activity so that fibromyalgia patients feel less fatigued and can then better tolerate other treatments, such as exercise.