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Fibromyalgia symptoms are chronic, which means they are persistent long-term. As there is no 'cure' the goal of medications is to ease and offer temporary relief from symptoms. While some patients cannot make it through a day without their medications others will only need them intermittently when they experience a flare-up. While most use over the counter remedies regularly, nearly all will need prescription medications at some time. Options for fibromyalgia treatment include painkillers, muscle relaxants, anticonvulsive drugs, NSAID's (non-steroidal anti-inflammatory drugs) and antidepressants.
Most patients will need to take prescription painkillers at some point to cope with the widespread pain of fibromyalgia. This does not mean they will need them every day. Some days they will be able to take milder alternatives like muscle relaxants or over the counter analgesics (Tylenol, Aspirin, Ibuprofen). The most common prescription painkillers for fibro patients are Ultram (generic name: tramadol) and Ultracet which combines Tylenol with Ultram. The main benefit of prescription painkillers is that the person knows they will work - they do stop pain and they do prevent it from becoming any worse. This is a sort of emotional security blanket. Prescription painkillers also help to protect the immune system because the body is not diverting all its energy towards pain management, so the immune system works more efficiently. Annoying side effects however include drowsiness and possibly constipation. You may need to combine the med's with laxative supplements or include more fiber in your diet. Additionally, due to federal laws on scheduled drugs which were designed to prevent drug abuse, many doctors are reluctant to prescribe narcotic painkillers on a regular basis. As narcotics can be addictive some physicians, fearing prosecution, may not prescribe them. While this may protect those with a potential for addiction, it can make life difficult for fibromyalgia patients seeking genuine pain relief. While Ultram is not a listed narcotic drug, many patients still report difficulties in getting a prescription for it from their doctor.
These are drugs which help to relieve muscle knots and tension, a common cause of fibro pain. Their primary benefit is that they soothe muscles, but they also have a sedation effect that can help improve quality of sleep and reduce depression. The most commonly prescribed drug is cyclobenzaprine (Flexeril). One study showed that 85 percent of people who took Flexeril experienced pain relief, a reduction in the number of fibromyalgia tender points and improved sleep. As it can cause drowsiness it is usually taken in the evening. Although Flexeril works well for many people, it may not for others. Other alternatives to try are Baclofen, Soma, Zanaflex and Skelaxin. The main disadvantage of muscle relaxants is their tendency to cause gastrointestinal distress such as diarrhea and stomach ache. In rare cases the side effects can be more extreme causing inflammation of the stomach (gastritis) and even stomach ulcers.
So what happens if pain becomes so bad (even with meds) that you can't manage to hold down a job? Check our article, can I go on disability for fibromyalgia?
Many fibro patients are prescribed one or more antidepressants. The most common brands prescribed are Desyrel and Elavil. Cymbalta, which was approved in 2004 by the FDA, also appears to offer significant pain relief for patients. It is a SNRI (serotonin norepinephrine reuptake inhibitor). This means it helps the body to retain its natural supply of serotonin and norepinephrine, both mood enhancing chemicals in the brain. It not only helps to reduce depression but also symptoms of chronic pain. It is also used by diabetics who suffer nerve pain. Some studies indicate that female fibro patients respond better to Cymbalta then men, although the reasons are not known. Effexor is another SNRI but the dosages required for the same pain relief are higher so the side effects are more frequent. Although it may feel strange to be prescribed antidepressants if you are not depressed, clinical studies do report significant benefits for those suffering chronic pain - particularly when more than one drug is used. One study showed patients prescribed a combination of 25mg of Elavil and 20mg of Prozac received twice the pain relief they would if either medication had been taken on its own. Although it might seem logical of course that 2 medication would give twice the relief, this rarely happens with other conditions. So it is a worthwhile finding. The side effects of antidepressants include weight gain/loss, tummy upset, insomnia and constipation, although these normally improve when the person becomes adjusted to the medication.
Occasionally, where pain seems to be isolated in one trigger point, a doctor may consider giving a trigger point injection (TPI). The injection usually contains lidocaine or ropivacaine and many patients receive an injection several times a year, sometimes into several points. Side effects are rare, although some people can have a slight allergic reaction to lidocaine. In such instances a dry-needle technique which involves no medications can be used. Injections should only be given by experienced consultants such as rheumatologists or anesthesiologists. A regular family practitioner is not usually experienced enough to identify the correct trigger points and may inject the wrong area. TPI is also administered to people with myofascial pain syndrome and tension headaches.
Anticonvulsant drugs are typically prescribed to treat seizure disorders such as epilepsy. However they are also prescribed to treat fibromyalgia as well as other conditions such as bipolar disorder and pain caused by nerve injuries. Clinical studies are mixed on the benefits of anticonvulsants and it appears other medications such as antidepressants may work better for fibro patients. Older drugs on the market had serious side effects although newer drugs introduced since the late 1990s appear to be safer. These include Lamictal, Topamax, Lyrica and Neurontin.
Some fibro patients suffer from anxiety. Anxiety can aggravate pain and cause sleep disorders. For this reason anti-anxiety drugs may be prescribed to help combat some of the stress fibro patients experience after years of chronic pain. So although they do not directly treat pain, they help reduce emotional anxiety levels which can contribute to pain. Commonly prescribed drugs include Valium, Prozac, Restoril and Klonopin. Generally they are prescribed in low dosages to fibromyalgia patients. However care has to be taken because they have the potential to become addictive.
Most people with fibromyalgia have sleep problems. As sleep is the body's way to recuperate its energy after the day, lack of sleep can lead to muscle pain, stiffness and fatigue. Pain can make it more difficult to sleep and so patients find themselves in a vicious cycle of sleep deprivation. Some medications such as antidepressants, muscle relaxants and painkillers do offer the additional benefit of inducing drowsiness. Yet, sometimes this is not enough and patients require something specifically to combat sleep deprivation. The most commonly prescribed sleeping pills are Ambien, Xyrem, Lunesta and Sonata. These drugs are considered low risk for dependence. Others include Klonopin and Tranxene. A 2010 study into Xyrem reported a 30 percent improvement in pain among participants who took the medication for 14 weeks. Downside, it is an expensive drug, and can cost $500 a month. A more recent arrival on the market is Rozarem which is not a scheduled drug. One issue with sleeping pills is that people can develop a tolerance, which means they become less effective over time. One way to combat this is to use a different brand of sleeping pill every night.
Non-steroidal anti-inflammatory drugs (NSAID's) are usually taken on a daily basis to dampen chronic pain. They can be prescribed or bought in a pharmacy over the counter. The most commonly taken drugs are Naprosyn, Ibuprofen, Feldene and Relafen. Some fibro patients are showing benefits from using the more recently introduced NSAIDS called COX-2 inhibitors (Mobic and Celebrex). These medications can moderately reduce pain and also act to combat muscle inflammation. The main problem with NSAID's is that they can cause stomach upsets, so they should be taken with a meal. Some people take Rolaids or Tums to counteract the effect. Other possible side effects if they are taken long-term include stuffy nose, rapid heartbeat, blurred vision and dizziness. For this reason they are not considered a long-term solution but rather a short-term method for coping with fibro flare-ups.
Although most fibro patients will use prescription drugs on a regular basis, some choose to use OTC medications to cope with pain between flare-ups. Tylenol (generic name acetaminophen) can give temporary relief from widespread pain and is generally considered safe. However long-term heavy use does increase the risk of liver damage. For this reason it is worth switching to ibuprofen every so often. Ibuprofen is the generic name for Motrin and Advil. It is also a pain relief medication. Its main drawback is its potential side effects including stomach upsets, ulcers, headaches and tinnitus. Aspirin is also an effective pain reliever and is used daily by people who have suffered heart attacks and strokes. Potential side effects from long-term use are gastrointestinal upset and inflammation of the stomach. Aleve is an over the counter form of naproxen which is also an effective pain relief medication. It should be taken with food or milk to avoid stomach upsets. It's main drawback is its potential to cause heart attacks in women if used long-term. It can also cause diarrhea and constipation. Another way to naturally manage long-term fibro pain is to take regular exercise, for more information see our article: What are the best exercises for fibromyalgia?
Guaifenesin is a cough medicine which has been promoted by some medics for the treatment of fibromyalgia. It is an expectorant which loosens mucous so that it is easier to cough up. Promoted originally by the American endocrinologist Dr St Armand, he suggested that guaifenesin can dramatically alleviate pain by gradually reducing the buildup of phosphates in the body. He observed this anecdotally in his patients, although he noted it can take up to a year before benefits are felt. Although no clinical proof can show that guaifenesin does alleviate pain, there is no conclusive research to say that it does not. For this reason, many doctors take a neutral stance on the subject and allow the patient to make up their own mind. The advantage of guaifenesin is that it is available without medication and is inexpensive. The key disadvantage is that you will need to take it for some time before knowing if you are experiencing any benefits. Some people even discover it exacerbates their symptoms. Although side effects are minor, it can cause skin rashes and nausea. Guaifenesin is normally only available as part of an OTC cough medication. However, you can ask your pharmacist to order a dose of guaifenesin alone.
Some treatments for colds and flus which are classified as antihistamines appear to help some people with fibro pain. These include Tylenol PM and Benadryl. This may be because they contain ingredients which increase serotonin levels and reduce sensitivity to pain. As antihistamines also cause drowsiness this may be an added benefit to those with sleeping problems. Another common symptom of fibromyalgia is nausea. Some antihistamines used for nausea relief such as Dramamine and Avomine have proven useful by blocking the area of the brain which prompts nausea and vomiting. They can also help to restore the body's natural balance.
For additional natural therapies, see also fibromyalgia diet and our tips on the best types of fibromyalgia exercises.
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