About Fibromyalgia Drug Treatment

Fibromyalgia, a condition for which no cure exists, is characterized by pain, stiffness, numbness, tingling and areas of tenderness in the muscles, ligaments and tendons in the body. Other symptoms include restless extremities, headaches and gastrointestinal problems. Emotional distress and sleep disturbances often develop in response to these physical symptoms. Both conventional and alternative drug therapies may be utilized to relieve the many symptoms of fibromyalgia.

Treatment of Symptoms

According to Dr. Robert M. Bennett, professor of Medicine and chairman of the Division of Arthritis and Rheumatic Diseases at Oregon Health & Science University in Portland, and the leading fibromyalgia researcher in the United States, fibromyalgia is not always understood to a degree that allows for a definitive diagnosis. Even so, most patients do learn ways to control the symptoms that appear, even though the condition is poorly understood. Drug therapy is one of many ways with which this troubling syndrome can be managed.

SSRIs, SNRIs and Tricyclic Antidepressants

Cymbalta and Savella are both antidepressants in a class of drugs known as serotonin-norepinephrine reuptake inhibitors (SNRIs). Both drugs increase the amounts of the brain chemicals, serotonin and norepinephrine, helping to re-establish normal sleep patterns and improve mood.
Amitriptyline (Elavil), a tricyclic antidepressant, is often prescribed in low doses to relieve pain and to help with sleep.
Fluoxetine (Prozac), paroxetine (Paxil), and citalopram (Celexa) are selective serotonin reuptake inhibitors (SSRIs) sometimes given along with tricyclic antidepressants to restore healthy sleep and to improve moods in fibromyalgia patients.
SNRIs, SSRIs and tricyclic antidepressants are usually given in small doses when sleep or pain control is the primary therapeutic objective; however, when a person is suffering from depression in addition to fibromyalgia symptoms, dosages are calculated accordingly.

Muscle Relaxants and Non-Narcotic Pain Relief

Cyclobenzaprine (Flexeril) is a muscle relaxant that may be given to fibromyalgia sufferers in order to ease muscle spasms in specific areas of the body. Cyclobenzaprine is similar in composition to the tricyclic drug, amitriptyline, resulting in some of the same therapeutic benefits for fibromyalgia patients.
Procaine and Lidocaine, anesthetics that are injected into areas referred to as "tender points," are capable of providing pain relief for several months' duration. Lidocaine is also available in a patch.
Tramadol (Ultram) is a non-narcotic drug used to ease the painful symptoms of fibromyalgia. Tramadol, however, should not be used in conjunction with tricyclic antidepressants. Tramadol may be used with acetaminophen (Tylenol) for relief of mild pain.
Acetaminophen is sometimes used alone or with other medications to treat mild pain.

Sleep Aids and Drugs to Calm Restless Extremities

(Ambien) is a hypnotic drug given to promote sleep, but should be taken with caution to avoid dependency. Eszopiclone (Lunesta) and zaleplon (Sonata) are also prescribed for sleep problems.
L-dopa and Carbidopa (Sinemet), a medication usually prescribed for Parkinson's disease, may be given in very low doses to calm restless leg syndrome, a common complaint of fibromyalgia sufferers.

Anti-Seizure Drugs

Pregabalin (Lyrica), an anti-seizure drug that works on the nerve signals in the body, is beneficial to fibromyalgia sufferers for reasons that are not yet clear; however, it appears that the drug reduces and calms sensitive nerve signals which, in turn, alleviate pain.
Gabapentin (Neurontin) is an anti-seizure medication which may alleviate pain and fatigue and improve the quality of sleep in those affected with fibromyalgia. Although it is not approved by the FDA for the treatment of fibromyalgia, some doctors prescribe it off-label for the condition.

Narcotic Drugs

Controversy exists over the use of narcotic drugs to treat fibromyalgia pain. Because narcotics or opiates have the potential to cause dependence, doctors are wary of prescribing them for chronic conditions such as fibromyalgia. The threat of DEA interference is another reason medical practitioners often hesitate to prescribe opiates. However, for the patient who has tried the traditional methods of pain control for fibromyalgia and continues to suffer from pain, he might try presenting his case to the practitioner in a well thought-out, logical format, emphasizing his intention to use the medications only as prescribed and signing a contract agreeing to adhere to those conditions, if necessary. It might also help to specify to the doctor how inadequate pain control is preventing or hindering his participation in particular activities.

Aspirin and NSAIDs

Since fibromyalgia pain is not due to inflammation, aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) such as Motrin, Advil, Aleve, Naprosyn and others are not very effective in alleviating pain. Also, aspirin and other NSAIDs tend to cause stomach distress, diarrhea and ulceration of the stomach and duodenum in 15 percent of long-term users.

Resources

• National Fibromyalgia Association