Fibromyalgia (FM)
How is it treated?
Physicians treat FM with a combination of drugs that are used for other purposes. There are currently no medicines that cure the disease. Drugs commonly used for FM include:
Treating Pain from FM
Analgesics
Analgesics or "pain relievers" interact with receptors in the body to stop the sensation of pain from various sources. Analgesic drugs vary in strength and addiction potential from over-the-counter Tylenol to stronger prescription medications such as propoxyphene/acetaminophen (Darvocet) and tramadol (Ultram). Although narcotic analgesics are prescribed for some FM patients with severe muscle pain, there is no evidence that narcotics are effective for treating chronic FM-associated pain. In addition, addiction and/or dependence may develop with the use of narcotic medications; so they should be used with caution in long-term treatment. Non-steroidal anti-inflammatory drugs (NSAIDs), which are another type of pain reliever, can also be used to treat the symptoms of FM. NSAIDs, such as aspirin, ibuprofen (Advil, Motrin), and naproxen (Anaprox, Aleve) relieve pain and inflammation to help reduce muscle aches, menstrual cramps, and headaches associated with fibromyalgia.
Muscle Relaxants
Muscle relaxants such as cyclobenzaprine (Flexeril) may also be used to help relieve pain and stiffness and muscle spasms.
Muscle Stretching
A physician may also stretch affected muscles that are causing pain. Stretching involves a technique that helps to relax tense muscles prior to an injection. The muscle is then injected with a local anesthetic such as lidocaine to provide longer-lasting pain relief. The downside is that this procedure is initially painful and injections of local anesthetics are not always effective.
Another procedure, called "spray and stretch" involves the same stretching technique and the application of a cooling agent such as ethyl chloride or flouri-methane to the affected area. This works to cool the blood vessels, providing pain relief. The spray and stretch technique must be performed by someone other than the patient, usually a close friend or family member. The benefits of these procedures can last anywhere from a few days to several weeks.
Treating Other Symptoms of FM
Antidepressants
Antidepressants increase the levels of certain chemicals, such as norepinephrine and serotonin, in the brain. Low levels of these chemicals can cause depression and are believed to be associated with the pain and tiredness experienced by FM patients. Sometimes treatment of coexistent conditions such as depression and sleep disorders improve the symptoms of fibromyalgia. Tricyclic anti-depressants (TCAs), which are used in low doses to promote sleep, are usually taken at bedtime. Some of these medicines include amitriptyline (Elavil), doxepin (Prudoxin, Sinequan), and nortriptyline (Aventyl, Pamelor).
If TCAs are not effective at treating the symptoms of FM, doctors may prescribe another type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI). Like TCAs, SSRIs are also prescribed for FM treatment in lower doses than those used to treat depression. SSRIs may improve fatigue, depressive symptoms, and pain by increasing the amount of serotonin in the brain. SSRIs may also increase energy, which can be a problem in FM patients who usually have trouble sleeping.
Combination therapy with more than one type of antidepressant has been shown to be more effective in reducing FM symptoms than using either a TCA or an SSRI alone. As a result, for treating FM, an SSRI is almost always given in combination with a TCA. Currently being researched for FM are antidepressant drugs that increase both serotonin and norepinephrine. Called mixed reuptake inhibitors, these drugs are also believed to be effective in the treatment of FM symptoms. One mixed reuptake inhibitor, duloxetine (Cymbalta), already FDA-approved for depression, has been shown to be effective in the treatment of FM pain symptoms. Venlafaxine (Effexor), another mixed reuptake inhibitor, is also thought to effective but more studies are needed to prove its effectiveness.
Benzodiazepines
Drugs in the benzodiazepine class can help to relax tense, painful muscles as well as improve sleeping difficulties. Many FM patients experience restless leg syndrome (RLS) which is characterized by unpleasant sensations, including muscle twitching in the legs at night. Benzodiazepines have been shown to relieve these symptoms. Due to their potential for addiction, however, benzodiazepines are not usually given until a patient with FM has tried and failed other medicines and therapies. Some benzodiazepines include clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan).
Anticonvulsant medications
Pregabalin (Lyrica) is the only medication that has been approved by the FDA for the treatment of fibromyalgia. Prior to its approval, pregabalin had been used to treat pain associated with other conditons. Gabapentin (Neurontin), another anticonvulsant medicine, also used to treat diabetes and nerve related pain following a herpes zoster infection (shingles), has also been investigated for its effectiveness as a treatment for fibromyalgia. The study is called the GIFT trial and was set up to determine if gabapentin was useful for treating the pain associated with fibromyalgia. The study found that at higher doses (1200-2400mg/day) of gabapentin helped reduce the pain with FM.
Miscellaneous Therapies
Other drugs include those that are given to treat the specific symptoms of FM. One of these is called alosetron (Lotronex) which are used to treat gastrointestinal symptoms such as diarrhea, cramping, bloating, and constipation or Irritable Bowel Syndrome (IBS), which are often seen with fibromyalgia. Tegaserod (Zelnorm), another medication that has been used to treat gastrointestinal symptoms, was recently removed from the market due to an increased risk of side effects; however, Zelnorm may still be available for certain individuals who do not get gastrointestinal symptom relief with any other medication.
The treatment of FM usually involves a strategy for each patient that is specific to his or her symptoms and can involve many healthcare professionals such as physicians, psychiatrists, and physical therapists. Many times a rheumatologist (a physician who specializes in conditions, such as arthritis, that affect the joints and soft tissues) is required to treat fibromyalgia.
To learn more about the medications used to treat symptoms of FM, click on the drug class links below.
Drug classes used to treat Fibromyalgia (FM) Anticonvulsants Benzodiazepines Central Analgesics Miscellaneous Analgesics and Antipyretics Muscle Relaxants Narcotic Analgesics Narcotic Combinations Non-steroidal Anti-inflammatory Drugs Selective Serotonin Reuptake Inhibitors Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRI) Tricyclic Antidepressants
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How is it treated?
