People with fibromyalgia are usually prescribed pain relievers, sleep medicines, antidepressants, muscle relaxants, and anti-seizure medications to help with their symptoms. These medications all come with risks and side effects so they are just as likely to do harm as to help. In this guest post, Marco gives us some tips to treat fibromyalgia pain safely.
Fibromyalgia is a very distressing disease, and very challenging to treat. A vast number of interventions have been tried. Many have shown no evidence at all of their effectiveness, but for many others, the basic story is that they seem to produce good results for a small fraction of sufferers while the majority of sufferers see little if any reduction in pain.
This applies to treatments such as mind-body therapy, resistance exercise training, aquatic exercise training, acupuncture, and cognitive behavioral therapy, as well as a number of drug treatments. The unfortunate reality is for that the majority of people with fibromyalgia no available treatment causes the pain to go away.
Before going any further it is important to say clearly that every person is a unique individual and advice from a personal physician who knows the details of a specific case should always trump generic advice such as this article gives. With that in mind, let’s proceed.
The first point is that interventions that don’t involve drugs tend to be the safest. Even if exercise or cognitive therapy don’t alleviate the pain – and to be honest, there is a good chance they won’t – they aren’t likely to do any harm. Thus, it makes sense to try those sorts of lifestyle-related approaches first, and only turn to drugs if they don’t work.
In the United States, three drugs have been approved for the treatment of fibromyalgia: pregabalin, duloxetine, and milnacipran. The fact that they have been approved shouldn’t be overrated, though – all it means is that careful clinical trials have shown that averaged across the full population of patients they are more effective than a placebo.
As a matter of fact, they are just barely more effective than a placebo. Their effectiveness is so low that in Europe none of them has been approved for the treatment of fibromyalgia. (No drug has been approved for fibromyalgia in Europe, actually.)
Pregabalin, most commonly marketed as “Lyrica”, was the first drug approved in the US for fibromyalgia, in 2007. It falls into a broad family known as “antiepileptic” drugs because they reduce the likelihood of epileptic seizures.
People who take it generally find it to have moderate mood-elevating effects, and in the US it is classified as a “Schedule V Controlled Substance”, which basically means that it has a low but nonzero potential for abuse.
This is more of a potential than an actuality: there have been essentially no reports of addiction resulting from pregabalin use.
There have, however, been reports of withdrawal symptoms in people who stop taking it after a period of use, involving symptoms such as sleeplessness, headache , anxiety, etc.
A substantial number of people who try it experience side effects that cause them to stop using it: the most common are dizziness and drowsiness, but changes in vision, appetite, mood, and other functions can also occur. And it is rather expensive, typically costing $300-$400 per month out-of-pocket in the US.
Bottom line: Lyrica is not an innocuous drug, and probably won’t work, but it might be worth trying if nothing else works.
The other two US-approved drugs are duloxetine (usually sold as “Cymbalta”) and milnacipran (sold in the US as “Savella”). Both of these drugs fall into the broad family known as “antidepressants”, along with drugs such as Prozac and Effexor. Indeed, both can be used to treat depression as well as fibromyalgia.
However, for unknown reasons these two drugs seem to be somewhat more effective than other antidepressants against fibromyalgia. Again – to repeat the same sad refrain – “somewhat more effective” just means more effective than placebo: they really aren’t very effective at all, on the whole.
Antidepressants, including these two, present very little risk of addiction. Most users actually find their direct effects – including a reduction in appetite and reduction in sexual motivation – to be rather unpleasant.
There is a much greater risk that the drugs will have intolerable side effects, including sleep problems, anxiety, and even (though this is controversial) an increase in suicidal thoughts.
Although pregabalin, duloxetine, and milnacipran are the only drugs specifically approved in the US for fibromyalgia, they are not the only drugs that a doctor could theoretically prescribe. In the US the general rule – there are exceptions – is that if a drug is approved for one use, a doctor has the ability to prescribe it “off label” for other uses, at discretion.
This means that a doctor could, at least in principle, prescribe an enormous variety of drugs to a patient with fibromyalgia. And indeed, a number of other drugs are occasionally used that way. None is used at a high enough rate, though, to justify specifically discussing here.
Because they are so effective for some other types of pain, their effects have been examined in a number of high-quality studies, and the invariable conclusion is that for fibromyalgia they just don’t work.
If anything they make things worse. Even with this information at hand, people often use them anyway.
Surveys have found that as many as one-third of people with fibromyalgia regularly use opiates. The temptation is easy to understand: opiates are obviously very effective for some types of pain, such as cancer pain, so why not give them a try?
But pain is a very complex entity, and the pain of fibromyalgia is completely different from cancer pain: it comes from the nervous system, not from tissue damage. Drugs that work for cancer pain don’t work for fibromyalgia; drugs that work for fibromyalgia – such as they are – are completely ineffective against cancer pain.
If you are tempted to try an opiate, don’t (unless your doctor recommends it). Overlaying a possible serious addiction on top of a case of fibromyalgia won’t improve your life.
Already using an opiate, and finding it unhelpful? Withdrawing from an opiate on your own is very difficult, especially if you are hypersensitive to pain due to fibromyalgia; please consult a doctor. There are plenty of ways of escaping from that trap without the misery that goes with direct withdrawal.
To sum up, then, the best way to manage your fibromyalgia pain safely are as follows:
- Above all, discuss any change you want to make with your doctor.
- Focus first on lifestyle changes such as exercise, sleep, diet, or therapy.
- If those don’t work, consider trying one of the approved drugs, and discuss with your doctor which one is likely to work best for you.
- Stay away from opiates.
If nothing works, try to maintain a positive attitude and realize that a lot of research is going on in this area, so there is a good chance that better solutions will be available in the not-too-distant future.
As Chief Editor for a leading drug and alcohol addiction blog, Palo Recovery, I aim to deliver value in the topics that I write about. My aim is to help as many people as possible who are going through the same struggle. Staying true to A.A’s values about anonymity, the author uses the pseudonym Marco.
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