Medications Prescribed for Fibromyalgia by Karen Lee Richards Prescribed medications are a key component of most fibromyalgia treatment plans. Since there is currently only one FDA approved medication for fibromyalgia, most medications are prescribed off-label. That means the drug is prescribed for a use other than that for which it is approved. Since numerous studies have been published showing that various medications can be beneficial for people with fibromyalgia, physicians are able to prescribe those medications off-label. Keep in mind that no single medication works for every fibromyalgia patient. Also, FM patients are often more sensitive to medications than the average person, so great care and consideration should be taken when prescribing drugs for fibromyalgia. Sometimes it’s necessary to start with lower doses to prevent adverse reactions. Since it’s frequently a matter of trial and error, it’s important for the patient and the doctor to work together to find the best possible treatment plan. Following are the seven categories of medications most often used to treat fibromyalgia: 1. Analgesics Analgesics are pain killers. They include: - Over-the-counter medications like aspirin, acetaminophen, ibuprofen and naproxyn. (Ibuprofen and naproxyn are also anti-inflammatories)
- Nonsteroidal anti-inflammatories (NSAIDs) such as etodolac, nabumetone and Cox-II inhibitors (for example, Celebrex).
- Corticosteroid anti-inflammatories like prednisone and dexamethasone.
- Opioids such as codeine, hydrocodone, oxycodone, morphine and fentanyl.
- Tramadol, a narcotic-like opiate agonist.
Since fibromyalgia is not a true inflammation, anti-inflammatories may be less effective in reducing pain. They can, however, be helpful in reducing pain flares brought on by strenuous physical activity, tendonitis or bursitis. Because many of the NSAIDs carry a serious risk of gastrointestinal bleeding and some also have a cardiovascular risk, they should be taken with great caution and care. Recent studies have indicated that opiate pain medications often do not relieve FM pain. It appears that the mu-opioid receptors in people with fibromyalgia have a reduced ability to bind to the drugs targeting them. There is also emerging evidence that over the long term, the use of high-dose opioids may actually increase an FM patient’s hypersensitivity to pain. Another promising SNRI currently being studied for the treatment of fibromyalgia is milnaciprin. Although milnaciprin is approved in many countries for depression, it is not currently available in the U.S., and therefore cannot even be prescribed off-label. Late in 2007, Forest Laboratories and Cypress Bioscience filed an application for FDA approval of milnaciprin for the treatment of fibromyalgia. 3. Anti-convulsants Two anti-convulsant or anti-seizure medications that have been used to treat fibromyalgia are Lyrica and Neurontin. Lyrica has the distinction of being the first medication ever to receive FDA approval for the treatment of fibromyalgia. It works by affecting chemicals in the brain that send pain signals across the nervous system. In clinical trials, Lyrica reduced pain and improved sleep, fatigue and general health perception in 30 to 40 percent of FM patients. The most common side effects were dizziness and sleepiness. Neurontin has been found to help neuropathic pain. Fibromyalgia patients who have burning or pain that feels like electric shocks in their hands and feet have reported improvement when treated with Neurontin. 4. Muscle Relaxants Muscle relaxants like Flexeril, Soma, Skelaxin and Robaxin are sometimes prescribed for fibromyalgia pain. Although they may not actually stop muscle spasms, they appear to have a central neurological mechanism that reduces muscle pain. The most common side effect is drowsiness. If muscle spasms are a particular problem, antispasmotic medications such as Zanaflex and Baclofen can be helpful in reducing the spasms and the pain. Since Zanaflex seems to be effective in improving sleep, blocking pain and reducing headaches, it is sometimes prescribed even if muscle spasms are not the primary problem. 5. Anti-anxiety Medications Anxiety in fibromyalgia patients can increase pain, muscle tension, irritability and sleep problems. If anxiety is a problem, benzodiazepine medications like Klonopin, Ativan and Xanax can help reduce pain and improve sleep. They work by improving the balance of inhibitory and excitatory receptors in the central nervous system. (Most FM patients have too much activity in their excitatory receptors.) Klonopin taken in the evening can be particularly helpful for patients who have a lot of leg problems, including pain and restless or jerking legs 6. Sleep Modifiers The inability to get deep, refreshing sleep is a major problem for most people with fibromyalgia. Although many of the medications already discussed can help improve sleep, sometimes a medication specifically designed to induce sleep is necessary. There are two types of sleep modifiers: - Benzodiazepines like Restoril can be used to treat insomnia. The biggest concern about using benzodiazepines is their habit-forming potential.
- Hypnotics such as Ambien, Lunesta and Rozerem cause relaxation that helps patients fall asleep and stay asleep. Ambien is less habit forming than the benzodiazepines but can cause rebound insomnia when it is stopped. The newer hypnotics Lunesta and Rozerem are not habit-forming and do not produce rebound insomnia.
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7. Other The neurologic medication Provigil, originally developed to treat narcolepsy, is sometimes also used to treat the fatigue of fibromyalgia. In a 2006 study, two-thirds of the fibrromyalgia patients taking Provigil experienced a 50 percent reduction in fatigue levels.
Sources: Pellegrino, M (2005). Fibromyalgia: Up Close & Personal. Anadem Publishing. Ervin, J.E., Dyer, D., Fox, C. (2007, Sept. - Nov.). Medication Update. Fibromyalgia AWARE, 14, 60-61.
Last updated 11/30/07 -
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