Fibromyalgia Medications

There are many different medications used to treat fibromyalgia symptoms, including pain medicines, sleeping pills, and antidepressants. Some fibromyalgia medicines help ease pain. Others boost mood and improve sleep. Working with your doctor will help you find the right fibromyalgia medication to add to your treatment regimen. That way, you can manage your symptoms effectively.

What is the initial treatment for fibromyalgia?

The first medication doctors will often try for people with fibromyalgia is an antidepressant, which helps relieve pain, fatigue, and sleep problems. In addition, antidepressants help depression, which is commonly seen in people with fibromyalgia. Older antidepressants, called tricyclics, have been used for many years to treat fibromyalgia.

How do tricyclic antidepressants treat fibromyalgia symptoms?

The tricyclic antidepressants, including amitriptyline and nortriptyline (Pamelor), work by raising the levels of chemicals (neurotransmitters) in the brain.

Tricyclic antidepressants increase levels of serotonin and norepinephrine in the brain. People with chronic pain often have decreased levels of these calming neurotransmitters. Tricyclics can relax painful muscles and heighten the effects of endorphins -- the body's natural painkillers. While these medications are often very effective, the side effects can sometimes make them difficult to take, as they may cause drowsiness, dizziness, dry mouth, dry eyes, and constipation.

Do other antidepressants relieve the pain and fatigue of fibromyalgia?

There are several different types of antidepressants that have been shown to help relieve the pain, fatigue, and sleep problems in people with fibromyalgia.

The most well-studied antidepressants for fibromyalgia include duloxetine (Cymbalta), milnacipran ( Savella), and venlafaxine (Effexor). Cymbalta and Savella are specifically FDA-approved to treat fibromyalgia. There is less medical research to show that Effexor helps fibromyalgia. Other antidepressants that have also been studied for fibromyalgia and may help include citalopram (Celexa), fluoxetine (Prozac), and paroetine (Paxil).

Different antidepressants work differently in the body. In addition, what works for one person with fibromyalgia may not work for someone else. That's why people with fibromyalgia may have to try more than antidepressant to find the one that best relieves the pain, fatigue, and sleep difficulties associated with the condition. Your doctor may even want you to try a combination of more than one antidepressant at a time.

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Which fibromyalgia medications help relieve the pain?

Different types of pain relievers are sometimes recommended to ease the deep muscle pain and trigger-point pain that comes with fibromyalgia. The problem is these pain relievers don't work the same for everyone with fibromyalgia.

The over-the-counter pain reliever acetaminophen elevates the pain threshold so you perceive less pain.

Nonsteroidal anti-inflammatory drugs (NSAIDs), when taken alone, don't typically work that well for fibromyalgia. However, when combined with other fibromyalgia medicines, NSAIDs often do help. NSAIDs are available over the counter and include drugs such as aspirin, ibuprofen (Motrin, Advil), and naproxen (Aleve).

What are the side effects of pain relievers for fibromyalgia?

Be careful taking aspirin or other NSAIDs if you have stomach problems. These medications can lead to heartburn, nausea or vomiting, stomach ulcers, and stomach bleeding. This risk of serious bleeding is even higher in people over the age of 60. Don't take over-the-counter NSAIDs for more than 10 days without checking with your doctor. NSAIDs have been known to increase risk of heart attack and stroke, especially when taken in high doses. Aspirin and other NSAIDs can cause or worsen stomach ulcers. If you've had ulcers or any kind of stomach or intestinal bleeding, talk to your doctor before taking NSAIDs.

Acetaminophen is relatively free of side effects. But avoid this medication if you have liver disease. Taking more than the recommended dose can also lead to liver damage.

Are muscle relaxants helpful for fibromyalgia pain?

The muscle relaxant cyclobenzaprine has proved useful for the treatment of fibromyalgia. It's often prescribed to help ease muscle tension and improve sleep. Muscle relaxants work in the brain to relax muscles.

With muscle relaxants, you may experience dry mouth, dizziness, drowsiness, blurred vision, clumsiness, unsteadiness, and change in the color of your urine. These medications may increase the likelihood of seizures. Older adults sometimes experience confusion and hallucinations when taking them.

When are anticonvulsants used for fibromyalgia?

Pregabalin (Lyrica), originally used to treat seizures, is a newer drug for treating fibromyalgia. With fibromyalgia, Lyrica affects chemicals in the brain that send pain signals across the nervous system. It may reduce pain and fatigue and improve sleep.

Gabapentin (Neurontin) is another antiseizure medication that has been shown to improve fibromyalgia symptoms.

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Are there other fibromyalgia pain medications available?

Pain relievers such as tramadol (Ultram) may also be used to treat fibromyalgia. This narcotic-like medication acts in the brain to affect the sensation of pain. It is not as addictive as narcotics.

In addition, doctors may prescribe benzodiazepines such as alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan) to help relax painful muscles, improve sleep, and relieve symptoms of restless legs syndrome (unpleasant sensations in the legs that force you to move them constantly). Benzodiazepines are habit-forming and must be used with caution. Taking more than recommended increases the risk of serious side effects.

Powerful narcotic medications, such as hydrocodone (Lortab), oxycodone (OxyContin), oxycodone/acetaminophen (Percocet), and hydrocodone/acetaminophen (Vicodin), should only be considered if all other drugs and alternative therapies have been exhausted and there is no relief. However, they are addictive and must be prescribed under monitored medical supervision.

WebMD Medical Reference Reviewed by Jennifer Robinson, MD on September 28, 2015

Sources

SOURCES: Fibromyalgia Network: "Treatment Studies." National Institute of Arthritis and Musculoskeletal and Skin Diseases: "Fast Facts About Fibromyalgia." Arthritis Foundation: "Fibromyalgia: Treatment Options." McIlwain, H. and Bruce, D. The Fibromyalgia Handbook, Holt, 2007. UpToDate.

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