Treating Fibromyalgia Pain: Medication Options
5 types of medications help ease fibromyalgia symptoms.
Fibromyalgia Pain Treatment Options
If pain is the primary fibromyalgia symptom, Jones may prescribe a prescription pain reliever, an anticonvulsant, or an antidepressant.
Anticonvulsants, developed to treat seizures, help relieve many types of pain. Lyrica, an anticonvulsant, was the first medication approved by the FDA specifically for fibromyalgia pain.
Two more antiseizure drugs are being studied as fibromyalgia medications -- Neurontin and Ativan.
Antidepressants are very helpful in relieving fibromyalgia pain and improve deep restorative sleep. They work by balancing serotonin and other brain chemicals involved in pain processing.
The new selective SNRIs (serotonin and norepinephrine reuptake inhibitors) help relieve fibromyalgia pain, whether the patient is depressed or not. SNRIs include Cymbalta and Effexor. Cymbalta is the only antidepressant approved by the FDA to treat fibromyalgia pain. Effexor is also used to relieve fibromyalgia pain. The FDA has also approved the SNRI Savella to treat fibromyalgia. A caveat for SNRIs: These drugs cannot be used if the patient takes a type of drug called monoamine oxidase inhibitor (MAOI) or has narrow angle glaucoma.
- Research shows that SSRIs (selective serotonin reuptake inhibitors) such as Paxil and Zoloft can help with sleep, overall well-being, and pain relief -- with lesser effects on fatigue and tender points from fibromyalgia. However, research indicates the SSRIs aren’t as effective as the SNRIs in treating fibromyalgia.
- Amitril, Elavil, and other tricyclic antidepressants are often prescribed for fibromyalgia, but many people don't like their side effects (weight gain, dizziness, fatigue). At low doses, these medications don't help mood or anxiety disorders, which fibromyalgia patients often have. However, this type of antidepressant can help with sleep.
Combination antidepressants: At times, a combination of antidepressants can help reduce muscle pain, anxiety, and depression in fibryomyalgia. Patients also get more restful sleep, feel less fatigue, and have an overall better sense of well-being.
Pain relievers such as Ultram and Ultracet can help break cycles of fibromyalgia pain, relieve flare-up pain, and reduce muscle spasms. The muscle relaxant Flexeril can help reduce pain and improve sleep. Local injections of painkillers and/or cortisone at painful trigger points can be especially effective in breaking cycles of pain and muscle spasm.
Treating Insomnia From Fibromyalgia
Insomnia is a big problem in people with fibromyalgia. Research shows that frequent disruptions in sleep prevent growth hormone -- an important restorative hormone -- from being produced by the body. Without growth hormone, muscles don't fully heal and neurotransmitters (like serotonin) are not replenished.
Without deep sleep, the body can't recuperate from the day's stresses. This can overwhelm the body’s systems, creating a great sensitivity to pain.
In some patients with fibromyalgia, there is an underlying cause for insomnia, such as restless leg syndrome or sleep apnea. If it's not clear what's causing the sleep problem, Jones will prescribe one of several medications to help with sleep.
- A low-dose tricyclic antidepressant (like Amitril) can help improve deep, restorative sleep.
- A prescription sleep medication like Ambien, Lunesta, Rozerem and Sonata is not addictive in low doses. These are called "short-acting" drugs because they stay active in the body for the shortest amount of time. Each of these drugs works a bit differently. Some help people fall asleep more quickly; others make sure you stay asleep.
- The anticonvulsant drug Lyrica is also prescribed to treat other symptoms of fibromyalgia such as insomnia and fatigue.
- In small studies, the narcolepsy drug Xyrem has been reported to help both sleep and pain. Xyrem, a potent medication used to treat narcolepsy and help with daytime sleepiness, helps patients with fibromyalgia get the deep sleep they need.
Cope considers sleep aids to be a last resort. "We can give you medication for sleep, but we have to be careful," she tells WebMD. "We don't want to take over the body's ability to produce neurochemicals -- or it will stop producing them."