Over the past two or three weeks, several patients have asked me about different medications for fibromyalgia. Specifically, people wanted to know what medicine recommendations I generally make for treating this difficult and painful condition. The problem is, I don’t make any general recommendations for fibromyalgia, as I think that there are probably a few different, hard to differentiate conditions we have generally grouped together and labeled ‘fibromyalgia.’
This belief comes from clinical experience- there are some patients who respond well to a given medication, and those who have no response whatsoever. Others who find dietary links to their pain, and others who notice no relationship at all.
So, rather than making a blanket recommendation regarding medications for fibromyalgia syndrome or FMS, I thought I would review some of the broad categories of medications available and explain their use. Let’s take a look:
Pain medications: These drugs have a huge range of strengths, and their efficacy is highly variable from patient to patient. Mid potency non-narcotic pain killers such as Ultram and Ryzolt help some patients, and have the benefit of being less sedating and less assisting than narcotics. Commonly prescribed narcotics such as Percocet have more pain relieving ability, but are somewhat more addictive, and have other side effects including severe constipation and somnolence.
Interestingly, when I said there is variation from patient to patient, there is a subgroup of patients with FMS who get no relief from any pain medications.
SSRI’S and other antidepressant medications: This is always an interesting part of any discussion about FMS- as there is a contingency of physicians who believe strongly that FMS is a psychological condition- their argument being bolstered by the fact that some patients get relief from antidepressant medications. My response is this: if you are in pain 24/7 and you aren’t at least a little depressed, there is something wrong with you.
Doctors have been using these medications for chronic pain management for some time, and ‘old school’ medications such as Elavil have had some good effects for some of my patients. More recently, drug companies have started formulating SSRI medications specifically for the management of pain, such as Savella- which for the right patient is a wonderful drug.
These meds have the advantage of having a relatively low side effects profile when properly dosed.
Anti-inflammatory medications: Anti-inflammatories or NSAIDs have found some use in the treatment of FMS. Like pain medications, they seem to have a subgroup of patients for whom they work, and others for whom they do nothing. There is a huge select of different medications in this category, in various strengths. While these drugs are essentially safe, they can be hard on the stomach for some patients and should be taken with food. Also, since these medications are excreted by the kidneys they should not be used in patients with kidney issues or poorly controlled diabetes.
Neurontin / Lyrica: These medications work on the central nervous system, and they essentially raise the firing threshold- the minimal input from a nerve required for it to send a signal- of the nerves causing pain. Originally used as an anti-seizure medication, Neurontin has a relatively benign side effects profile- the most common problem being somnolence- which usually goes away after the initial dosing phase. There is a very wide range of prescription doses, and finding the right level can often take some trial and error. Another benefit of this type of medication is that they interact poorly with vey few drugs, making them a good choice for patients with other medical problems.
This is just an overview of the major groups. There are others, as well as some alternative and supplemental therapies which I won’t go into at this time.
What have your experiences been with FMS and medication? Have you found any ‘wonder drugs’? Please share your experiences here on the blog.
Best,
Andy
Only 4 weeks until Kylie returns to New York. Here she is singing with my daughter Ella. Who’s waiting in line with us?
