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| Analgesics |
Analgesics are used to treat or prevent pain. Analgesics are commonly used and may reduce the symptoms of pain in some but not all people with fibromyalgia.
Anti-inflammatories
In fibromyalgia, there is no sign of inflammation, but anti-inflammatories may provide partial pain relief to some people with fibromyalgia. A controlled study of their use for fibromyalgia has shown them to be no more effective in reducing pain than a placebo. Prolonged use of anti-inflammatories may cause gastrointestinal bleeding.
NSAIDs (Nonsteroidal Anti-inflammatory Drugs)
Aspirin, Sulindac (Bufferin, Ascriptin etc.), Sulindac (Clinoril, Diflunisal Dolobid), Piroxicam (Feldene), Indomethacin (Indocin), Ibuprofen (Motrin, Rufen, Advil, Nuprin), Fenoprofen (Nalfon), Naproxen (Naprosyn) and Tolmetin (Tolectin).
Acetaminophen (Tylenol, Panadol etc.): For mild pain
In a double-blind crossover study done in Italy, ultram was shown to effectively reduce pain in fibromyalgia patients. "...effective control of spontaneous pain was achieved with tramadol, which determined a reduction of 20.6% while with the placebo spontaneous pain increased by 19.8%." (Tramadol in the fibromyalgia syndrome: a controlled clinical trial versus placebo. Biasi G., et.al, Int J Clin Pharmacol Res 1998;18(1):13-9)
FDA Drug Class: Analgesics-Non-Narcotic
OxyContin Tablets Hailed by World Pain-Care Community
Long-Acting OxyContin Tablets Now Available To Relieve Pain
Ketamine:
was shown to benefit fibromyalgia pain in an experimental setting.
(Fibromyalgia, chronic fatigue syndrome, and myofascial pain. Bennett
R, Curr Opin Rheumatol 1998 Mar;10(2):95-103)
Morphine
Codeine
Propoxyphene (Darvon)
Hydromorphone (Dilaudid)
Methadone (Dolophine)
Hydrocodone (Vicodin, Lortab, Norco, Lorcet)
Oxycodone (Percodan, Roxicet)
Roxycodone (Percocet)
| Anticonvulsants |
Anticonvulsants are used as adjuvant drugs to help manage pain.
Anticonvulsants may provide effective pain relief for patients with chronic neuropathic pain, migraines, trigeminal neuralgia. Anticonvulsants have an analgesic effect, although at similar risk of minor adverse effects. Drowsiness, dizziness, and disturbance in gait were the common problems in controlled studies.
Anticonvulsant drugs have been used in pain management since the 1960s, soon after they were first used to revolutionise the management of epilepsy. The clinical impression is that they are useful for neuropathic pain, especially when the pain is lancinating or burning.
Carbamazepine
(Tetregol) is one of few
effective interventions for trigeminal neuralgia and is usually the drug
of choice. In controlled clinical trials, carbamazepine has been shown to
be effective in the treatment of psychomotor and grand mal seizures, as well
as trigeminal neuralgia.
FDA Drug Class: Antiarthritics; Anticonvulsants; Central Pain Syndromes
Clonazepam (Klonopin)
Gabapentin
(Neurontin)
FDA Drug Class: Anticonvulsants
To join the Neurontin email group, write:
neurontin-l-request@maelstrom.stjohns.edu
Phenytoin
(Dilantin)
FDA Drug Class: Anticonvulsants; Central Pain Syndromes
Also licensed for trigeminal neuralgia if carbamazepine is ineffective or
if a patient cannot tolerate effective doses.
Valproate (Depakene)
When anticonvulsants are used as adjuvant drugs in other pain syndromes valproate
is often preferred to carbamazepine because it may be better tolerated.
| Antidepressants |
The primary use of antidepressants in fibromyalgia is to improve sleep and lessen pain. Exactly how antidepressants influence pain and sleep is still unknown. Seratonin levels have been shown to be low in people with fibromyalgia. Theory suggests that increasing serotonin levels could reduce fibromyalgia symptoms. The sedative effect of some antidepressants can improve non-REM sleep.
The fact that antidepressants may help the chronic pain of fibromyalgia should not be misinterpreted that fibromyalgia is caused by depression. The dosages given to fibromyalgia patients are much lower than the effective dosages for depression.
Antidepressants
amitriptyline
(Elavil):
Patient Information:
Amitriptyline
Rx List Monograph
Bupropion (Wellbutrin)
cyclobenzaprine
(Flexeril):
Has fewer anti-depressant effects than other tricyclics and is often used
as a muscle relaxant.
desipramine (Norpramin):
doxepin (Sinequan):
Fluoxetine (Prozac): Studies of Prozac and fibromyalgia have shown mixed results, although many FM patients have reported an increase in energy with Prozac. The study "Fluoxetine and amitriptyline in the treatment of fibromyalgia" showed better results with a combination of Prozac and amitriptyline, however, did not show a decrease in fatigue.
Imipramine (Tofranil)
Luvox
Nefazodone (Serzone)
nortriptyline (Pamelor):
Patient Information:
Pamelor
Paroxetine (Paxil)
Remeron
Sertraline (Zoloft)
Trazadone (Deseryl) x
Venlafaxine
(Effexor)
Newer Antidepressant Medication:
Effexor
(venlafaxine)
Anti-Anxiety Drugs
Alprozalom (Xanax)
Buspirone (Buspar):
Drug InfoNet Buspar
FAQ
Clonazepam (Klonopin)
Diazepam (Valium)
Ativan
| Muscle Relaxants |
Carisoprodol
(Soma)
FDA Drug Class: Skeletal Muscle Hyperactivity
Flexeril
(Cyclobenzaprine)
FDA Drug Class: Skeletal Muscle Hyperactivity
| Sleep Medications |
Ambien:
Benzodiazepines: [diazepam (Valium), triazolam (Halcion)] Despite
benzodiazepines' ability to induce sleep, they impact negatively on the quality
of deep sleep, and are not recommended for treating fibromyalgia.
| Excercise |
An Exercise Program for Fibromyalgia
by the American Academy of Family Physicians
What is fibromyalgia?
Fibromyalgia is a disorder that causes pain in your muscles and the areas where they attach to bone. It may also cause poor sleep, headaches and stiffness or muscle aches. The symptoms of fibromyalgia may be made worse by stress or lack of sleep. More women than men have fibromyalgia, but the disorder is very common--it is seen in up to 5 percent of the population. It isn't life-threatening and it doesn't cause permanent damage.
If I have fibromyalgia, what can I do to help myself feel better?
The best thing you can do if you have fibromyalgia is exercise. Begin with stretching exercises and gentle, low-impact activity, such as walking or bicycling. Start your exercise program slowly, because at the beginning, exercise may make your pain worse. Some muscle soreness is normal when you're starting to exercise, but sharp pain may be a sign that you have overworked your muscles.
As you progress with exercise, it will become more comfortable for you. In
order for exercise to help, you must do it regularly. The goal is to get
started and keep going, to gain relief from pain and to improve sleep. Below
are some exercises you might want to try:
Walking: Start slowly by walking for five minutes the first day. The next day, add a minute or two to this total. Keep adding one or two minutes a day until you are walking 60 minutes a day. When you reach this point, walk for at least one hour three or four times a week. If you find yourself struggling as you're working your way up to walking 60 minutes, go back to a length of time that was comfortable for you and continue walking for this period of time for several days. Then continue to increase the minutes, again to a goal of 60 minutes. Try as many times as you need to reach the goal of walking 60 minutes. Try to work up to walking for 60 minutes three or four times a week.
Walking/jogging: After you feel comfortable with walking three or four times a week, you can alternate walking with slow jogging. Walk for two blocks, then jog for one block, walk for two blocks, jog for one block, and so on. Do this as often as feels comfortable, and extend your exercise for longer periods if you feel comfortable.
Bicycling: Stationary bicycles (exercise bikes) offer the benefit of exercising indoors. Keep track of your mileage, or set a goal of exercising for 60 minutes.
The type of exercise you choose is up to you. The important thing is that you start exercising and keep doing it. Exercise relieves much of the pain fibromyalgia causes. Some people find that exercise makes all their pain go away. You will also feel better if you have some control over your own care and well-being. For more information, contact the Fibromyalgia Network Newsletter, P.O. Box 31750, Tucson, AZ 85751, or call 602-290-5508.
This information provides a general overview on fibromyalgia and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.
For more information please visit:
Medications
prescribed for people with FMS
A Guide to Fibromyalgia Medications
Drug InfoNet Doctors' Answers to "Frequently Asked Questions" - Fibromyalgia