Fibromyalgia - Treatments

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What are medications and other forms of treatment for fibromyalgia?

Traditionally, the most effective medications in the treatment of fibromyalgia have been the tricyclic antidepressants, medications traditionally used in treating depression. In treating fibromyalgia, tricyclic antidepressants are taken at bedtime in doses that are a fraction of those used for treating depression and actually can be beneficial as sleep aids. Tricyclic antidepressants appear to reduce fatigue, relieve muscle pain and spasm, and promote deep, restorative sleep in patients with fibromyalgia. Scientists believe that tricyclics work by interfering with a nerve transmitter chemical in the brain called serotonin. Examples of tricyclic antidepressants commonly used in treating fibromyalgia include amitriptyline (Elavil) and doxepin (Sinequan).

Studies have shown that adding fluoxetine (Prozac), or related medications, to low-dose amitriptyline further reduces muscle pain, anxiety, and depression in patients with fibromyalgia. The combination is also more effective in promoting restful sleep and improving an overall sense of well-being. These two medications also tend to cancel out certain side effects each can have. Tricyclic medications can cause tiredness and fatigue, while Prozac can make patients more cheerful and awake. A study of patients with resistant fibromyalgia found that lorazepam (Ativan) was helpful in relieving symptoms. Prozac has also been shown to be effective when used alone for some patients with fibromyalgia. Trazodone can be taken at bedtime to improve sleep when tricyclic antidepressants are not tolerated.

In 2007, pregabalin (Lyrica) became the first medication approved specifically for treating fibromyalgia. Lyrica may work by blocking nerve pain in patients with fibromyalgia. Lyrica has advantages of flexible dosing that can be adjusted according to persisting symptoms. A related medication, gabapentin (Neurontin), is also used to treat fibromyalgia.

More recently, drugs that simultaneously increase the amount of two brain nerve transmitters, serotonin and norepinephrine, have been approved to treat fibromyalgia in adults. These drugs include duloxetine (Cymbalta) and milnacipran (Savella). Research studies have shown significant effectiveness in decreasing pain and improving function in patients with fibromyalgia with these drugs. Cymbalta has been effective in treating depression and relieving pain in people with depression and is also used to treat anxiety.

Other fibromyalgia treatments

Local injections of analgesics and/or cortisone medication into the tender point areas can also be helpful in relieving painful soft tissues, while breaking cycles of pain and muscle spasm. Some studies indicate that the pain reliever tramadol (Ultram) and tramadol/acetaminophen (Ultracet) may be helpful for the treatment of fibromyalgia pains. The muscle relaxant cyclobenzaprine (Flexeril) has been helpful for reducing pain symptoms and improving sleep.

The nonsteroidal anti-inflammatory drugs (NSAIDs), while very helpful in treating other rheumatic conditions, have only a limited value in treating fibromyalgia pain. Narcotic pain relievers and cortisone medications have not been shown to be beneficial in this condition. Narcotics and cortisone medications are avoided because they have not been shown to be beneficial, and they have potential adverse side effects, including dependency, when used long term.

Both biofeedback and electroacupuncture have been used for relief of symptoms with some success. Standard acupuncture has also been reported to be effective in treating some patients with fibromyalgia. Massage therapy is beneficial for some.

Of note, there are many other modalities and medications that are touted to be helpful for patients with this chronic condition. Unfortunately, most have no scientific basis for their usage. This includes guaifenesin (Humibid, Humibid LA, Robitussin, Organidin NR, Fenesin), copper bracelets, and magnets. Consumers should be especially cautious when products come with marketing claims such as "will cure," "ancient remedy," "has no side effects," and "revolutionary new scientific breakthrough."

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See what others are saying

Comment from: DAVID, 55-64 Male (Caregiver) Published: April 11

In approximately 1997 I was diagnosed with fibromyalgia syndrome (FMS) by a rheumatologist mainly as a "diagnosis of exclusion" along with the bilateral sensitive points. The fatigue and pain sometimes sent me "up to the ceiling", and even though I needed to go somewhere and could see the car through the window, it might as well have been 25 miles away! The support group I attended had about 35 sufferers and all were on different drug regimes. I went to see a naturopath and he did various tests that discovered various minor causes but finally he found that my Krebs cycle was deficient in one particular substance and there was a supplement of that available alpha-Ketoglutaric acid. By this and an exercise program (supported by calcium, magnesium, MSM, food grade glycerin and other supplements) tailored by a physical trainer who was educated regarding FMS, my symptoms started to subside. After exiting from the chemical laden USA (the CDC recognizes both multiple chemical sensitivity (MCS) and FMS as bone fide diagnoses, they are often found together in patients who have FMS), I have been free of symptoms 97% percent of the time! This of course does not mean all FMS sufferers will have a deficiency in the Krebs cycle; but if you can convince your primary doctor to do the test, it could be worth it. Best to all of you.

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Comment from: lisa, 45-54 Female (Patient) Published: May 30

When I was diagnosed with fibromyalgia my doctor put me on gabapentin and it has worked well and it has also relieved the pain from sciatica. At night I take a low dose of amitriptyline to help relax me so I can sleep, but nothing helps the osteoarthritis in my knees which has put me in wheelchair.

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