Treatment Options for Fibromyalgia: Medicine
Many people suffering from fibromyalgia have chronic pain all over their body. Unfortunately, there is no known prevention or cure. Research continues into the exact cause of the fibromyalgia syndrome of symptoms as well as what medications ease the debilitating muscle pain and fatigue. Doctors and caregivers often turn to prescription medications to treat fibromyalgia.
Relief for Fibromyalgia: What Medicines Are Available?
Three medications have been approved by the U.S. Food and Drug Administration (FDA) specifically for treating fibromyalgia.
These medications have been studied and carefully reviewed:
Antidepressants milnacipran (Savella) and duloxetine (Cymbalta).Milnacipran was developed specifically for fibromyalgia. Duloxetine was initially developed to treat depression and generalized anxiety disorder.
Taking an antidepressant for pain and fatigue may seem odd, but the active ingredient in antidepressants are used to treat a variety of conditions besides depression. Antidepressants work by balancing brain chemicals, including serotonin and norepinephrine, which affect mood. Studies have found that certain antidepressants may ease body pain, improve mood, and allow for more restful sleep in people with fibromyalgia. Many types of antidepressants are used to treat fibromyalgia including:
Tricyclic antidepressants, such as amitriptyline (Elavil, Endep), are typically the first medicine prescribed for fibromyalgia. These antidepressants can help ease pain and improve sleep in people with fibromyalgia. Tricyclic antidepressants are some of the oldest types of antidepressants developed and work similar to other types of antidepressants. If you are prescribed one of these medications for fibromyalgia and you don't have depression, the dose will probably be low and side effects kept to a minimum. Higher doses of tricyclic antidepressants can have undesirable side effects compared to other antidepressants, such as weight gain, dizziness and sleepiness.
Mixed-action antidepressants, also called serotonin-norepinephrine reuptake inhibitors (SNRIs), work by increasing serotonin and norepinephrine in the brain. SNRIs, such as duloxetine, milnacipran and venlafaxine (Effexor), have been found to reduce pain and improve sleep in people with fibromyalgia.
Selective serotonin reuptake inhibitors (SSRIs), such as paroxetine (Paxil), fluoxetine (Prozac), sertraline (Zoloft), and fluvoxamine (Luvox), can improve sleep and fatigue and promote a feeling of well-being in people with fibromyalgia. However, it is not clear if SSRIs offer relief for fibromyalgia pain.
Your doctor may prescribe a combination of these medications to relieve your symptoms.
Pain-Relievers, Muscle Relaxers and More
In addition to antidepressants, other types of medications are used to ease fibromyalgia symptoms. They include:
Anticonvulsants, such as pregabalin and gabapentin (Neurontin)
Benzodiazepines, such as clonazepam (Klonipin) and diazepam (Valium).These anti-anxiety medications can also relieve the symptoms of restless legs syndrome, a neurological disorder that is common in people with fibromyalgia. Because of the potential for addiction, doctors usually prescribe benzodiazepines only when other therapies don't work.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve, Naproxen), may relieve muscle pain, headache, and menstrual cramps—a common problem for women with fibromyalgia.
Pain relievers, such as over-the-counter acetaminophen (Tylenol) and prescription medications, such as tramadol (Ultram), can help relieve generalized body pain. If these don't work, your doctor may prescribe a narcotic pain reliever. Similar to benzodiazepines, doctors don't prescribe narcotic pain relievers as often since there is a risk of dependence.
Depending on your fibromyalgia symptoms, other medications may be prescribed. For example, if you have irritable bowel syndrome (IBS), your doctor may recommend you take fiber supplements or laxatives to relieve constipation, or medications such as diphenoxylate/atropine (Lotomil) or loperamide (Imodium) to treat diarrhea.
Falling asleep and staying asleep is a major problem for many people with fibromyalgia. There are many things you can do to improve your sleep. Practicing healthy sleep habits, such as going to bed and getting up at the same time each day can help. In addition, some of your fibromyalgia medications, like amitriptyline and pregabalin, may help you sleep better. Your doctor may prescribe other sleep medications including:
Finding the Right Fibromyalgia Healthcare Team
In order to manage your symptoms and get the most relief, you need a good healthcare team. Some family doctors, internists, and rheumatologists (doctors who treat people with arthritis) have experience treating people with fibromyalgia.
Call fibromyalgia organizations for a recommendation, or see if there are pain clinics in your area that work with people who have fibromyalgia. In addition to finding an experienced doctor who you like working with, you may want to add a counselor or psychologist and a physical therapist to your healthcare team.
Lastly, keep in mind that everyone responds to treatment differently. What works for one person may not work for you. You may have to try a number of medications before finding the right one or combination that treats your particular symptoms with the least amount of side effects.