Information for Pharmacists
©Devin Starlanyl, MD 1995-1998
Each of us needs a trustworthy pharmacist to coordinate our medications and keep us informed. Medications are coming out so rapidly that it is impossible for physicians to keep up with them all. Our health care team often comprises many specialists, and they don't always communicate with each other. Most of us are on many medications of different kinds, and people with FMS tend to react unusually to medications. Some of our medications can interact. For example, Soma (carisoprodol) can react with timed-release niacin if taken at the same time, producing nausea and a painfully hot flush and rash. Soma sometimes facilitates the release of other medications.
Often, people with FMS&MPS Complex may have to try many medications before they find the optimum ones. We react differently to each medication, and there is no "cookbook recipe" for FMS or MPS. What works well for one of us can be ineffective for another. A medication which puts one person to sleep may keep another awake. There is a whole subset of FMS&MPS Complex patients who find medications such as Benedryl, Ultram, Pamelor and Paxil stimulating.
FMS and MPS are separate and unique conditions which form a synergistic, mutually perpetuating FMS&MPS Complex. MPS is a chronic pain condition, and FMS, a neurotransmitter dysfunction, is a pain amplification syndrome. These people look healthy, but their suffering can be great. Each of us has our unique combination of neurotransmitter disruption and connective tissue disturbance. We need doctors who are willing to stick with us until an acceptable symptom relief level is reached. We need a compassionate and understanding pharmacist to work with us as well.
The most-studied medications that modulate neurotransmitters are psychoactive drugs. THIS DOES NOT MEAN THAT THE PATIENT'S CONDITION IS PSYCHOLOGICAL. Studies have shown that people with FMS have no more psychological problems than any other chronic pain patients. Medications which affect the central nervous system are appropriate for FMS. They target symptoms of sleep lack, muscle rigidity, pain and fatigue. These medications don't stop the alpha-wave intrusion into delta-level sleep, but they extend quantity of sleep, and may ease daytime symptom "flares".
Please read the definitions section and become as knowledgable as possible about these conditions. You see many FMS&MPS Complex patients, although many are undiagnosed or misdiagnosed. They all need your help to cope.
It is the rule rather than the exception that a FMS&MPS Complex patient will save strong pain meds from surgery or injury for when they REALLY need it -- for an FMS&MPS Complex "flare". This is a sign that their prescription needs aren't being met. Often, doctors don't understand chronic pain care. Chronic pain of a non-malignant cause is often treated less vigorously than cancer pain, although the level of pain may be equal or worse. I give you the following quotes. I hope you will pass them on to others. They are from "PAIN A Clinical Manual for Nursing Practice", by McCaffrey and Beebe.
"Health professionals "often are unaware of their lack of knowledge about pain control."
"The health team's reaction to a patient with chronic nonmalignant pain may present an impossible dilemma for the patient. If the patient expresses his depression, the health team may believe the pain is psychogenic or is largely an emotional problem. If the patient tries to hide the depression by being cheerful, the health team may not believe that pain is a significant problem."
"Research shows that, unfortunately, as pain continues through the years, the patient's own internal narcotics, endorphins, decrease and the patient perceives even greater pain from the same stimuli."
"The person with pain is the only authority about the existence and nature of that pain, since the sensation of pain can be felt only by the person who has it."
"Having an emotional reaction to pain does not mean that pain is caused by an emotional problem."
"Pain tolerance is the individual's unique response, varying between patients and varying in the same patient from one situation to another."
"Respect for the patient's pain tolerance is crucial for adequate pain control."
"THERE IS NOT A SHRED OF EVIDENCE ANYWHERE TO JUSTIFY USING A PLACEBO TO DIAGNOSE MALINGERING OR PSYCHOGENIC PAIN."
"No evidence supports fear of addiction as a reason for withholding narcotics when they are indicated for pain relief. All studies show that regardless of doses or length of time on narcotics, the incidence of addiction is less than 1%."
It's normal to be depressed with chronic pain, but that doesn't mean depression is causing the pain. Maintenance with mild narcotics (Darvocet, Tylenol #3, Vicodin-Lorcet-Lortab) for nonmalignant (non-cancerous) chronic pain conditions may be a humane alternative if other reasonable attempts at pain control have failed. The main problem with raised dosages of these medications is often not with the narcotic components, per se, but with the aspirin or acetaminophen that is often compounded with them.
Please keep an eye on the level of your patient's meds. Patients with FMS&MPS Complex need adequate pain control to break the pain/contraction/pain/contraction spiral. It does not serve them well if you treat them like drug addicts. They get no joy from their meds, just some symptom relief. The level of medication shouldn't be steadily rising, however. That is a sign that the perpetuating factors are not being dealt with. During a symptom flare, these patients will need more medications, but the level should decrease again after flare.
Narcotic analgesics are sometimes more easily tolerated than NSAIDs. Neither FMS nor MPS is inflammatory. NSAIDS may disrupt stage 4 sleep, and delta sleep is already interrupted in FMS. Prolonged use of narcotics may result in physiological changes of tolerance or physical dependence (withdrawal), but these are not the same as psychological dependence (addiction).
Ask the FMS&MPS Complex patients about multiple chemical sensitivities. Many of us are lactose intolerant, and can't deal with even the small amounts of lactose used as fillers in many medications.
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