Treatment
Physicians prescribe a variety of medications in an attempt to alleviate the patients' symptoms, and there is no single most successful or 'best' treatment for Fibromyalgia. Current treatment options for pain associated with Fibromyalgia include physical therapy, nonsteroidal anti-inflammatories, muscle relaxers, opioid analgesics, anti-convulsants, tricyclic antidepressants, and more. In the 'Diagnosis' section you will learn about interpreting your pain and which types of medications will work for best alleviating each type of pain.
Fibromyalgia is one of the least understood disorders in medicine. In fact, The first 3 medications that have been approved for the treatment of Fibromyalgia are: Cymbalta, Savella (both Anti-Depressants), and Lyrica (anti-convulsant). Of course the fact there there are only three medications to this date that have been approved by the FDA for this painful condition, which is the 2nd most common ailment affecting the musculoskeletal system after osteoarthritis, is disheartening. Especially, since the disorder has been around since the 1800s (but only inducted into the ACR in the 1990's). Let your voice be heard and until there are more options, take a look at the information below.
There are several medications available from anticonvulsants (ie: Topomax, Lyrica) to antidepressants (Cymbalta, Savella), and tricyclic anti-depressants (such as Amitriptyline and Nortripyline) to painkillers (Vicoden, Percocet, OxyContin, Morphine, and even patch form pain control ie: Butrans), to muscle relaxers (ie: Flexeril) and nerve medications (Gabapentin, and slow-release Gabapentin-derivative Gralise.)
Medication alone doesn't often help Fibromyalgia pain in entirety. In speaking with many of the Fibro Fighters on the FibromyalgiandMe Facebook page and in my own experience, it often takes a blend of Western and Eastern medicine plus an honest effort of cutting out alcohol and sugar. Weaving in some Alternative Treatment such as Cognitive Therapy, Warm Pool Aquatics and light exercise ie: walking at low speed and perhaps yoga depending on severity of condition, has been shown in some studies to improve FMS pain.
Meds
Anti-Depressants
* One third of FMS patients are depressed, so the thought here is to prescribe something that will work on depression while interrupting pain cycles and to improve sleep. FMS is linked to low levels of serotonin, so while some have low levels of serotonin without depression and some have low levels along with depression, anti-depressants work on the serotonin centers in the brain and for some help reduce pain (and if-needed, with depression and anxiety.)
*There are three classes of antidepressants, tricyclics (TCAs), selective serotonin reuptake inhibitors (SSRIs) and seretonin norepinephrine reuptake inhibitors (SNRIs), each working on a different part of the brain. TCAs and SNRIs are the two classes which work for pain and depression, while SSRIs work for depression and anxiety and would need something added for pain relief.
*My own two cents on the topic is that I did try an SNRI that is specifically marketed for FMS and gained 60lbs in a matter of months and felt worse than ever - this is in no way to tell anyone not to try an anti-depressant, please know that I am not discouraging you! My point is clear and it is this: please be thorough with your physician (part of the purpose of this website, giving you the tools to decipher your pain signals, find your voice, and to open that conversation) so that your Fibro is accurately described and meds rx appropriately. The issue I had with gaining weight with the SNRI I took was that it made it so much harder for me to walk and get any light exercise, because there was more weight on my body and muscles and bones and I was more tired and sloppy...and when you have Fibro you notice! So be clear, be open minded, and BYOA.
TCAs: Studies show that TCAs are the best antidepressant drugs for people with FMS, with 32% of sufferers finding relief. TCAs work by acting on serotonin and norepinephrine, two chemicals (called neurotransmitters), that give messages from your brain to your body about pain and emotions. Examples of this are amitriptyline (and the newer version, nortiptyline), and cyclobenzaprine (which is also considered a muscle relaxer.)
SSRIs: SSRis are a newer class of anti-depressant and work on improving mood, depression, and anxiety in people with Fibromyalgia. Examples of SSRIs are fluoxetine (Prozac) and paroxetine (Paxil).
SNRIs: SNRIs are very similar to TCAs as they work on both serotonin and norepinephrine, but SNRIs are better able to balance the levels in these neurotransmitters which means less side effects. The most common SNRIs prescribed for Fibo is duloxetine (Cymbalta) and the very newly released and marketed for Fibro: Savella.
Anti-Convulsants
Lyrica: Most people equate Lyrica with being an anti-depressant because of the fact that it is grouped with two anti-depressants in the list of FDA Approved medications to treat FMS. But it actually is not - it is an anti-epileptic, prescription only medication, approved by the FDA for those with seizures, neuropathy, and of course with Fibromyalia. It is available in three different doses (300mg, 450mg, and 600mg).
Topomax: Called either Topomax or by its generic name of Topiramate, this prescription medicine was initially used to treat epilepsy. Topomax has been used "off-label" (meaning, the drug company does not market it for the use of this, however physicians have found a use for/success by using it for something other than it's intended use) Neurologists to treat Migraines and now Pain Specialists for Fibromyalgia. Topomax works by slowing down electrical signals and calming nerve cells in the brain.
Analgesics
Analgesic drugs act in various ways on the CNS (Central Nervous System) and include acetaminophens, NSAIDs (non-steroidal anti-inflammatory drugs), and opioids. A physician or specialist will determine which type of painkiller (analgesic) is appropriate and in which dosing regimen, for a Fibromyalgia patient. FMS is a complex disorder and every patient's needs, pain levels and symptoms can vary.
Acetaminophen: Aspirin and Tylenol are popular and recognizable brands of Acetaminophen, to give you an idea. Because FMS is a chronic illness (no cure and lifelong...although the patient may have periods of remission) it isn't safe to consume whole quantities of Acetaminophen on a daily basis, longterm. Acetaminophen is commonly mixed in smaller amounts with other medications however, such as Ultram/Tramadol and opioid painkillers, in order to offer patients much-needed, dual-acting pain relief.
Ultram: Ultram/ Tramadol and Ultracet are medications that fit into a class all their own. Ultram (and it's similar counterparts) works on the CNS and is a synthetic opioid and is mixed with acetaminophen. The American Journal of Medicine reported in 2003 that Ultracet has been found to reduce pain for some with FMS. It is imperative with any medication to be aware of all of the side effects, have a close and honest relationship with your physician, ask questions and BYOA.
NSAIDS: One very common mis-conception is that the pain of Fibromyalgia can be easily soothed with simple measures such as Motrin or other NSAIDS. Fibro does not cause inflammation in muscles, tissues and joints - but it does cause exceeding stiffness in muscles, tissues and joints. What does this mean? When your body's tissues are knotted up head to toe injuries ensue with simple activities - tears, herniated discs, and so on - and for these instances anti-inflammatories can be very helpful. On it's own however, without injury, anti-inflammatories have very little effect on the pain management of Fibromyalgia. To prevent injury in the first place light exercise is key - stretching and breathing, light yoga, walking - and a
muscle relaxer afterwards. Example of a muscle relaxer? Flexeril.
Interesting Fact: Research shows that Fibromyalgia patients may have lower levels of the muscle-cell chemicals phosphocreatine and adenosine triphosphate (ATP). Such chemicals regulate the level of calcium in muscle cells. Calcium is an important component in the muscles' ability to contract and relax. If ATP levels are low, calcium is not "pushed back" into the cells, and the muscle remains contracted.
Opiates: Although controversial due to the mis-use and abuse among many without serious and disabling disorders, opioid-analgesics offer many with chronic head to toe, writhing pain, relief from their pain cycle. This is not a cure of course, and the use of opiates for the management of FMS is sometimes-controversial due to the aforementioned mis-use of those who do not use it for chronic pain or for other un-kosher reasons. In my opinion, and in the opinion of some of the top doctors that I have met and had the pleasure of speaking with in pain management, it is vital to remember that these are medications for patients in severe pain. All too often these medications are criminalized and they are only seen as drugs due to news items and celebrity mis-use and so on. In reality however, when all other avenues have been explored or when pain just can't not be managed in any other way, painkillers truly improve the quality of life for chronic pain patients. The criminalization of legal medications such as painkillers set a huge and upward battle of stigma for those already battling very large and painful issues in their lives. According to the book 'Healing Fibromyalgia' and the physicians at Whole Health Chicago however, opiates can offer the only bit of relief for some patients - a Godsend from the day-in and day-out pain we feel. This said, Opiates are a very serious medical road to go down as far as treatment, always discuss all options with your physician and by the same token never let anybody tell you that they won't work for FMS - BYOA and find what works for you.
Finding a physician to properly treat this puzzling condition can be absolutely exhausting and downright confusing - see my Good Doctor List for a list of healers throughout the US who are Fibro-specialized. Have a suggestion? Email me - I would love to hear it and post on the Good Doctor List.
Below are a few web resources that you may find helpful as well:
Arthritis Today on Fibromyalgia News and Treatment
Please See my Disclaimer. I am not a Physician and all information, medical or otherwise, should be read for 'Entertainment Value' only.
Fibromyalgia is one of the least understood disorders in medicine. In fact, The first 3 medications that have been approved for the treatment of Fibromyalgia are: Cymbalta, Savella (both Anti-Depressants), and Lyrica (anti-convulsant). Of course the fact there there are only three medications to this date that have been approved by the FDA for this painful condition, which is the 2nd most common ailment affecting the musculoskeletal system after osteoarthritis, is disheartening. Especially, since the disorder has been around since the 1800s (but only inducted into the ACR in the 1990's). Let your voice be heard and until there are more options, take a look at the information below.
There are several medications available from anticonvulsants (ie: Topomax, Lyrica) to antidepressants (Cymbalta, Savella), and tricyclic anti-depressants (such as Amitriptyline and Nortripyline) to painkillers (Vicoden, Percocet, OxyContin, Morphine, and even patch form pain control ie: Butrans), to muscle relaxers (ie: Flexeril) and nerve medications (Gabapentin, and slow-release Gabapentin-derivative Gralise.)
Medication alone doesn't often help Fibromyalgia pain in entirety. In speaking with many of the Fibro Fighters on the FibromyalgiandMe Facebook page and in my own experience, it often takes a blend of Western and Eastern medicine plus an honest effort of cutting out alcohol and sugar. Weaving in some Alternative Treatment such as Cognitive Therapy, Warm Pool Aquatics and light exercise ie: walking at low speed and perhaps yoga depending on severity of condition, has been shown in some studies to improve FMS pain.
Meds
Anti-Depressants
* One third of FMS patients are depressed, so the thought here is to prescribe something that will work on depression while interrupting pain cycles and to improve sleep. FMS is linked to low levels of serotonin, so while some have low levels of serotonin without depression and some have low levels along with depression, anti-depressants work on the serotonin centers in the brain and for some help reduce pain (and if-needed, with depression and anxiety.)
*There are three classes of antidepressants, tricyclics (TCAs), selective serotonin reuptake inhibitors (SSRIs) and seretonin norepinephrine reuptake inhibitors (SNRIs), each working on a different part of the brain. TCAs and SNRIs are the two classes which work for pain and depression, while SSRIs work for depression and anxiety and would need something added for pain relief.
*My own two cents on the topic is that I did try an SNRI that is specifically marketed for FMS and gained 60lbs in a matter of months and felt worse than ever - this is in no way to tell anyone not to try an anti-depressant, please know that I am not discouraging you! My point is clear and it is this: please be thorough with your physician (part of the purpose of this website, giving you the tools to decipher your pain signals, find your voice, and to open that conversation) so that your Fibro is accurately described and meds rx appropriately. The issue I had with gaining weight with the SNRI I took was that it made it so much harder for me to walk and get any light exercise, because there was more weight on my body and muscles and bones and I was more tired and sloppy...and when you have Fibro you notice! So be clear, be open minded, and BYOA.
TCAs: Studies show that TCAs are the best antidepressant drugs for people with FMS, with 32% of sufferers finding relief. TCAs work by acting on serotonin and norepinephrine, two chemicals (called neurotransmitters), that give messages from your brain to your body about pain and emotions. Examples of this are amitriptyline (and the newer version, nortiptyline), and cyclobenzaprine (which is also considered a muscle relaxer.)
SSRIs: SSRis are a newer class of anti-depressant and work on improving mood, depression, and anxiety in people with Fibromyalgia. Examples of SSRIs are fluoxetine (Prozac) and paroxetine (Paxil).
SNRIs: SNRIs are very similar to TCAs as they work on both serotonin and norepinephrine, but SNRIs are better able to balance the levels in these neurotransmitters which means less side effects. The most common SNRIs prescribed for Fibo is duloxetine (Cymbalta) and the very newly released and marketed for Fibro: Savella.
Anti-Convulsants
Lyrica: Most people equate Lyrica with being an anti-depressant because of the fact that it is grouped with two anti-depressants in the list of FDA Approved medications to treat FMS. But it actually is not - it is an anti-epileptic, prescription only medication, approved by the FDA for those with seizures, neuropathy, and of course with Fibromyalia. It is available in three different doses (300mg, 450mg, and 600mg).
Topomax: Called either Topomax or by its generic name of Topiramate, this prescription medicine was initially used to treat epilepsy. Topomax has been used "off-label" (meaning, the drug company does not market it for the use of this, however physicians have found a use for/success by using it for something other than it's intended use) Neurologists to treat Migraines and now Pain Specialists for Fibromyalgia. Topomax works by slowing down electrical signals and calming nerve cells in the brain.
Analgesics
Analgesic drugs act in various ways on the CNS (Central Nervous System) and include acetaminophens, NSAIDs (non-steroidal anti-inflammatory drugs), and opioids. A physician or specialist will determine which type of painkiller (analgesic) is appropriate and in which dosing regimen, for a Fibromyalgia patient. FMS is a complex disorder and every patient's needs, pain levels and symptoms can vary.
Acetaminophen: Aspirin and Tylenol are popular and recognizable brands of Acetaminophen, to give you an idea. Because FMS is a chronic illness (no cure and lifelong...although the patient may have periods of remission) it isn't safe to consume whole quantities of Acetaminophen on a daily basis, longterm. Acetaminophen is commonly mixed in smaller amounts with other medications however, such as Ultram/Tramadol and opioid painkillers, in order to offer patients much-needed, dual-acting pain relief.
Ultram: Ultram/ Tramadol and Ultracet are medications that fit into a class all their own. Ultram (and it's similar counterparts) works on the CNS and is a synthetic opioid and is mixed with acetaminophen. The American Journal of Medicine reported in 2003 that Ultracet has been found to reduce pain for some with FMS. It is imperative with any medication to be aware of all of the side effects, have a close and honest relationship with your physician, ask questions and BYOA.
NSAIDS: One very common mis-conception is that the pain of Fibromyalgia can be easily soothed with simple measures such as Motrin or other NSAIDS. Fibro does not cause inflammation in muscles, tissues and joints - but it does cause exceeding stiffness in muscles, tissues and joints. What does this mean? When your body's tissues are knotted up head to toe injuries ensue with simple activities - tears, herniated discs, and so on - and for these instances anti-inflammatories can be very helpful. On it's own however, without injury, anti-inflammatories have very little effect on the pain management of Fibromyalgia. To prevent injury in the first place light exercise is key - stretching and breathing, light yoga, walking - and a
muscle relaxer afterwards. Example of a muscle relaxer? Flexeril.
Interesting Fact: Research shows that Fibromyalgia patients may have lower levels of the muscle-cell chemicals phosphocreatine and adenosine triphosphate (ATP). Such chemicals regulate the level of calcium in muscle cells. Calcium is an important component in the muscles' ability to contract and relax. If ATP levels are low, calcium is not "pushed back" into the cells, and the muscle remains contracted.
Opiates: Although controversial due to the mis-use and abuse among many without serious and disabling disorders, opioid-analgesics offer many with chronic head to toe, writhing pain, relief from their pain cycle. This is not a cure of course, and the use of opiates for the management of FMS is sometimes-controversial due to the aforementioned mis-use of those who do not use it for chronic pain or for other un-kosher reasons. In my opinion, and in the opinion of some of the top doctors that I have met and had the pleasure of speaking with in pain management, it is vital to remember that these are medications for patients in severe pain. All too often these medications are criminalized and they are only seen as drugs due to news items and celebrity mis-use and so on. In reality however, when all other avenues have been explored or when pain just can't not be managed in any other way, painkillers truly improve the quality of life for chronic pain patients. The criminalization of legal medications such as painkillers set a huge and upward battle of stigma for those already battling very large and painful issues in their lives. According to the book 'Healing Fibromyalgia' and the physicians at Whole Health Chicago however, opiates can offer the only bit of relief for some patients - a Godsend from the day-in and day-out pain we feel. This said, Opiates are a very serious medical road to go down as far as treatment, always discuss all options with your physician and by the same token never let anybody tell you that they won't work for FMS - BYOA and find what works for you.
Finding a physician to properly treat this puzzling condition can be absolutely exhausting and downright confusing - see my Good Doctor List for a list of healers throughout the US who are Fibro-specialized. Have a suggestion? Email me - I would love to hear it and post on the Good Doctor List.
Below are a few web resources that you may find helpful as well:
Arthritis Today on Fibromyalgia News and Treatment
Please See my Disclaimer. I am not a Physician and all information, medical or otherwise, should be read for 'Entertainment Value' only.