Welcome back!
I hope you all had a great Valentine’s Day and Chinese New Year. We celebrated both events yesterday with the whole family in Chinatown, where we saw the Dragon traveling up and down Race Street ushering the new year. I attached a short video of the dragon leaving one of the restaurants in the city (It was WAY too crowded to try and capture the Dragon in the restaurant- but it was really a beautiful spectacle.)
Onto Fibromyalgia Part 3: Medications for Fibromyalgia…
Thanks for returning for Part 3 of the fibromyalgia mini-series- So far we’ve covered what fibromyalgia syndrome (FMS) is, how it is diagnosed, some lifestyle modifications and considerations which can help FMS, as well as some psychological approaches to dealing with the discomfort of FMS.
As you may be aware if you are a regular visitor to BackWords, I generally try to find the most conservative ways of dealing with pain, so it is no surprise that I have saved the medications portion of the series for last.
I should start off by saying that there are no great medications for FMS- just a few things which can help the symptoms to varying degrees. I group then broadly into three categories: Pain medications, Neurological medications, and ‘others.’
Pain Medications:
Several weeks ago, I did a post about pain medications which you can review here. Any of the categories of pain medications can be used to help reduce FMS pain- although as a rule, these medications, regardless of category seem to be less effective for FMS pain than they are for other pain conditions/syndromes.
I will often meet new patients with FMS who have come from other physicians with myriad prescriptions for everything from anti-inflammatory (such as ibuprofen) to narcotics (such as Percocet or Oxycontin), and pretty much all of them are frustrated with the poor level of pain relief they get, and are also often saddled with all of the side effects which go along with those medications. I discussed the side effects at length in the aforementioned post. As you already know, FMS carries with it a whole host of symptoms, and the side effects are not a welcome addition to the discomfort patients are already suffering.
That being said, I will still use pain medications during a ‘fibro flare’ where patients have a severe exacerbation of their symptoms due to drastic changes in the weather, increased stress, or other factors.
Neurological Medications:
There are several medications which work on the neurological component of FMS- the four most common are Nuerontin (gabapentin), Lyrica (pregabalin), Klonopin, and Savella (milnacipran.) These drugs all began their lives as anti-siezure medications, and found their way into the FMS world over time.
These medications work by raising the firing threshold of a nerve, or the minimal amount of stimulation required to cause a sensory nerve to respond. The theory is that ‘fibromites’ have increased sensitivity to pain because their firing threshold is too low.
These drugs are a mixed bag in terms of efficacy. They seem to be really effective for some people, and provide practically no results for others. The most common side effect for all of them is fatigue and somnolence- which is a problem in itself as fatigue is already one of the most prevalent symptoms of FMS. The good things about this group of medications is that they are pretty benign (Neurontin in particular), in as much as they don’t interfere with many medications. A key recommendation I make to patients is that if they try these medications (Neurontin and Lyrica in particular) is that they should start with a low dose and taper up slowly. In this way you can a) get away with the smallest dose possible and b) minimize the side effects.
Others:
There are several other medications and supplements which patients have used with varying efficacy for their FMS symptoms, and they are in several categories- let me just give you a couple of examples…
Guaifenesin is a mucolytic / expectorant medication common in many cold medications. Many physicians feel it helps lubricate soft tissue and improve flexibility by reducing stiffness. I have had some success with patients utilizing this medication- and here, the good news is that this med is relatively low in side effects. For most patients there is no real down side to trying it.
Patients with the worst fatigue symptoms have reported success utilizing a medication known as Provigil (modafinil) to help reduce their fatigue. I personally have little clinical experience with this medication. If you are considering it, be sure to have a conversation with your physician to understand its use/ benefits/ and risks.
There are many other medications and nutritional supplements out there with claims to be beneficial for FMS. There are too many to review here. The bottom line here is that there are lots of options, all with varying degrees of efficacy, and highly variable side effects profiles- so my parting though with medications is that if you are trying medications, try one at a time in order to really gauge what they are or aren’t doing for you.
Conclusion:
I hope this 3 & 1/2 part introduction to FMS has given you some useful information. In my clinical experience treating this enigmatic condition, it has slowly become clear to me that the thing we are calling Fibromyalgia is likely several separate conditions that we do not yet possess the knowledge to accurately differentiate. This is supported by the observation that things that can provide fantastic benefit to some patients have absolutely no benefit for others.
One thing is abundantly clear: no matter what the ‘flavor’ of FMS a patient is experiencing, all forms benefit from an active lifestyle.
Thanks for visiting. Look for my series on spinal surgeries to begin later this week.
Be well!
-Andy
