Once you have been given the diagnosis of fibromyalgia, you may be interested in what treatments are available. Because no one knows the exact cause of the disease, the treatments are completely empirical, based on what seems to help the symptoms and what makes sufferers feel better.
Many medications have been tried and are in use for the management of fibromyalgia symptoms, including sleeping medication, medications for pain, and antidepressant medications.
Some medications directly address the pain of fibromyalgia while others improve the mood-related symptoms or help you sleep. You may have to try several different medications with your doctor’s advice in order to find a single medication or combination of medications that help manage the symptoms.
Medications that have been tried and used successfully in some fibromyalgia patients include the following:
- These are among the first medications used to treat fibromyalgia. Antidepressants have been known to relieve symptoms of fatigue, improve pain symptoms, and improve one’s ability to sleep. There are two types of medications used to treat fibromyalgia. The first includes the newer agents, such as selective serotonin reuptake inhibitors or SSRIs and the second include tricyclic antidepressants, which have been in use for many decades for the treatment of depression and many other related conditions.
- Tricyclic Antidepressants. These include medications such as nortriptyline (Pamelor) and amitriptyline. These act on the levels of neurotransmitters in the brain, specifically serotonin and norepinephrine. It is well known that people with chronic pain syndromes like fibromyalgia by increasing these neurotransmitters in the brain. Tricyclic antidepressants have the ability to relax muscles that have become painful and elevate the effects of the body’s natural endorphins, which are the innate painkillers of the brain. Tricyclic antidepressants work very well for people with fibromyalgia but have a variety of side effects than can be intolerable, including constipation, dry mouth, dry eyes, drowsiness, and dizziness.
- SSRI Antidepressants. As mentioned, these are a newer class of antidepressants that have effects on the fatigue, sleep problems, and pain exhibited by those with fibromyalgia. Of the many SSRI antidepressants available for use in people with fibromyalgia, three SSRIs have been studied the most. These include milnacipran (Savella), venlafaxine (Effexor), and duloxetine (Cymbalta). Of the three, both Cymbalta and Savella have received FDA approval for the management of fibromyalgia. Effexor has less medical research to support its effectiveness. Other SSRIs that have been studied for use in patients with fibromyalgia include fluoxetine (Prozac), citalopram (Celexa) and paroxetine (Paxil).
Antidepressants have different actions on the body. What works well for one individual with fibromyalgia may be ineffective for another individual with the disease. You may have to try more than one antidepressant or try antidepressants of different classes in order to find one that best controls the sleep problems, fatigue, and pain you are experiencing. Some doctors use more than one type of antidepressant at the same time so don’t be alarmed if you are taking more than one.
- Over-the-counter pain relievers. Some people with fibromyalgia receive pain relief by taking acetaminophen. This has been known to increase the pain threshold so that pain is less significantly perceived. Other choices are nonsteroidal anti-inflammatory medication or NSAIDs, which include ibuprofen (marketed as Advil and Motrin) and naproxen (marketed as Naprosyn and Aleve). They act on pain and inflammation, reducing pain. The NSAIDs are not without side effects, which can include stomach upset, nausea, and stomach ulcers, especially with prolonged use. Things like bleeding in the stomach and heartburn can also be side effects of taking NSAID therapy, especially if you are over the age of 60 years. It is advisable to speak to your physician if you have to take NSAID therapy form more than ten days in a row. If you have a history of intestinal, stomach bleeding, or suffer from a bleeding disorder, make sure it is okay with your doctor to take these types of medications.
Acetaminophen has fewer side effects when compared to taking NSAID therapy but it cannot be taken safely by those who suffer from liver disease. In addition, if you take more than the recommended amount of acetaminophen, you run the risk of causing liver damage.
- Muscle relaxants. Some people with fibromyalgia have had relief of their muscle spasms by taking the drug cyclobenzaprine. This muscle relaxant has been found to lessen muscle tension and to help a person sleep better. Muscle relaxants act on the brain, which relaxes the muscles.
Muscle relaxants, unfortunately, can have their own set of side effects. Some side effects of muscle relaxants you may notice include dizziness, dry mouth, blurry vision, unsteadiness, drowsiness, and an alteration in the color of the urine. Muscle relaxants also decrease the seizure threshold so they must be taken with caution in those who suffer from a seizure disorder. If muscle relaxants are taken by the elderly, they can increase the incidence of hallucinations and confusion.
- Also known as, pregabalin, Lyrica is the only FDA-approved drug for the treatment of fibromyalgia. It was initially marketed as an anti-seizure drug but was found to help those with fibromyalgia sleep better, have decreased pain and an improvement in fatigue.
- Other anticonvulsant medications. Gabapentin, marketed as Neurontin, is an anti-seizure medication that has been used on people with fibromyalgia with some success in relieving their pain.
- Prescription pain-relievers have been used to manage the pain of fibromyalgia. One of them is Ultram (tramadol). It is a medication that is related to narcotics that acts on the brain to reduce the feelings of pain. It is sometimes used in the treatment of fibromyalgia because its addictive potential is less than that of narcotic pain relievers.
- Benzodiazepines are commonly used medications in the management of anxiety disorders. Some of them include clonazepam (Klonopin), alprazolam (Xanax), lorazepam (Ativan) and diazepam (Valium). Besides acting on anxiety and sleep, they seem to help relax the muscle spasms of those who have fibromyalgia. They also help relieve the symptoms of restless legs syndrome, which is commonly associated with fibromyalgia. The biggest problem with benzodiazepines is that they are very addictive and it is all too easy to become physically dependent on these mediations. Some people use these medications in doses above the recommended amounts, resulting in adverse side effects.
- Narcotic Pain Relievers. Some people with fibromyalgia are prescribed narcotic pain relievers for the relief of their chronic pain. Some of these include oxycodone (OxyContin), hydrocodone (Lortab) and a combination of oxycodone and acetaminophen, marketed as Percocet. Hydrocodone and acetaminophen are sometimes used together in a medication called Vicodin. Because these medications are highly addictive, they should be used as a last resort for the treatment of fibromyalgia after the other medications have been tried without relief of the fibromyalgia symptoms. Close medical supervision is required if you decide to take these medications for your fibromyalgia.