Fibromyalgia: Pain Management, Medications, and their Effectiveness

Fibromyalgia: Pain Management, Medications, and their Effectiveness

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If you have Fibromyalgia, you’ve probably tried a lot of different treatments and medications that are supposed to help, and you’ve probably found that they either didn’t work or stopped working over a period of time. The truth of the matter is that most medications used for Fibromyalgia don’t work for some people at all, and for others, your brain gets ‘used to’ the medication, and makes adjustments in its pain receptors and serotonin center. The brain is ‘plastic,’ meaning it’s capable of adapting and changing, and growing and losing neurons all the time. When we learn, our brain forms new neural pathways. When we take medications, it can change and adapt to the medication, sometimes to the point of no longer being effective.

ANTIDEPRESSANTS

Antidepressants are usually the first medication you may be offered when you are diagnosed with Fibromyalgia. These include meds such as:

  1. Amitriptyline (aka Elavil) and other tricyclic antidepressants help with pain, depression, and difficulty sleeping. Very sedating.
  2. Cymbalta (aka Duloxetine) is an SNRI, or a Serotonin Norepinephrine Reuptake Inhibitor is one of the few medications that have been studied and has been shown to be somewhat useful for Fibro. May cause some sleepiness, but often interferes with sleep.
  3. Savella (aka Milnacipran) is also an SNRI, and it has also been found to be somewhat useful in treating Fibromyalgia pain, but it does not treat depression. Helps with pain and improves physical function.

Many of these have a lot of side effects that can cause issues with your appetite, cause headaches, dry mouth (which can lead to cavities in your teeth) make you sleepy or interfere with your sleep, and come with a plethora of other side effects. With Fibromyalgia, you need to decide whether any side effects you’re experiencing are worth taking the medication, and the relief you are getting. If the side effects make your quality of life worse than without the medication, it probably isn’t worth taking it. Also, cost can become an issue, with some antidepressants being very inexpensive, and some (like Cymbalta) being quite expensive. Your brain can adapt to these medications, so effectiveness can diminish or the medication can become completely ineffective over time, so be aware if you start experiencing more/worse/longer-lasting flareups.

ANTI-SEIZURE MEDICATIONS

Yes, you read that right! Both Gabapentin and Pregabalin (aka Lyrica) are sometimes used to treat Fibromyalgia, however, while studies have shown that Gabapentin may help alleviate pain, the results of studies are actually quite underwhelming. Pregabalin comes with a host of serious side effects, including weight gain and swelling, so again, it’s really important to weigh the costs and benefits of taking either. Lyrica seems to work better than Gabapentin, however, most patients find the weight gain and other side effects to be intolerable.

OPIOIDS

  1. Codeine, Morphine, Oxycodone, and Dilaudid (hydromorphone) are examples of opioid pain medications that patients often start treating their pain with. Because the pain receptors in the brain of a Fibro patient are constantly firing, contrary to some beliefs, these do actually seem to work for some patients. The problem with these is that it doesn’t take long at all for the brain to adapt to them, leaving you looking for a new solution as it stops being effective.
  2. Kadian (extended-release morphine sulfate capsules) – effective particularly for FM patients who did not experience relief with other medications and treatments, has less potential for abuse
  3. Pain patches: Fentanyl patches, BU, or Butran patches, and other patches that work for a week at a time are a big step up from oral opioids and can be extremely dangerous, but for those that have been through the gamut of medications over many years, it may be an excellent solution. Unfortunately, patches are very expensive, so if you don’t have a drug plan, they can simply be cost-prohibitive. You don’t want to start using these unless your pain is so severe that it’s better for you to suffer from the drowsiness and fogginess than to suffer from the pain.

Opioids are very frequently used in the treatment of Fibromyalgia pain, but a recent study (check it out here) seems to point to no improvement in pain over the long term. The problem with opioids is that there is definitely a risk of dependency and over time, your brain’s pain receptors get used to the chemicals as well as the dose, therefore, over time, you may need to increase the dose (which risks an overdose) or switch to a stronger opioid. The study also points to fewer opioid receptors in patients with FM compared to those with other chronic pain conditions, and those without. This means that no matter how strong or how much of an opioid an FM patient takes, it may make no difference in their pain levels because the brain is incapable of processing it; therefore, opioids don’t work as well in FM patients than in the general population. The study also noted that part of the problem for FM patients is that they already have a heightened sensitivity to pain. Despite this study, patient reporting in other studies have shown that opioids work; but this study has also pointed to a connection between patients with depression, disability, and socioeconomic problems in the lives of these FM patients compared to those without or with lower rates of these factors, which could lead to the misuse of opioids. This suggests that those who continue to report high levels of pain (unchanged over time) despite having been on opioids for 1-4 years may actually be abusing these drugs. Because these life factors have not been studied in the accuracy of pain reporting, I would be concerned that no study was done to determine rates of pain reporting in those with depression, higher rates of disability and socioeconomic issues compared to those who do not. It’s important to note that studies, even when peer-reviewed, may not give a full picture of causality and may have flaws in their design and interpretation. At any rate, high rates of prescribed opioids for FM patients, combined with this, and similar, studies, has led the medical community to call for more training for doctors in FM treatment and the use of opioids. The study’s conclusion is, essentially, that opioids do not work for FM patients and should not be prescribed. Sadly, this has led doctors to simply stop prescribing FM patients their pain meds cold turkey, which can lead to serious withdrawals, and illegal drug-seeking behavior (caused by the negligence of doctors that have left patients with no other choice and a dependency in the brain) that can cause much bigger problems for these patients; recently, there have been a lot of complaints from FM patients who have been using opioids because their doctors did not bother to taper them off their meds, leaving them in a lurch.

MEDICINAL MARIJUANA AND SYNTHETIC MARIJUANA

Look around on the internet, and you’ll find multitudes of studies that show that using marijuana oils, tinctures, edibles, and flower help with some of the symptoms of FM. Sleep is improved in many patients, anxiety is decreased, and pain from flare-ups is reduced. Studies have shown that the best use of marijuana is to use 1:1 mixtures of THC and CBD regardless of the delivery method; the two work much better together than separately. Also, the drug Nabilone (aka Cesimet) has been used for the treatment of pain and other symptoms of FM, however, their efficacy seems to be low compared to the aforementioned delivery methods of the real thing.

OTHER MEDICAL TREATMENTS

There is a myriad of alternative treatments for FM patients, some of which that do seem to be quite effective, and others that have been proven to be useless:

  1. Exercise – exercise seems to be the number 1 treatment for FM. While it doesn’t seem to make sense that someone in a lot of pain should do aerobic exercise, it really, really works.
  2. Nerve Blocks – these are injections of a medication that numbs the nerves in the areas where patients are experiencing pain. The blocks can work over the short-term (about 3 weeks) up to several months, but the real benefit seems to be that over time, with repeated blocks in the same locations, FM (and other) pain is reduced as the nerves are no longer over-reactive. What’s in them? It depends on what your doctor or anesthesiologist chooses, but Botox is one of the commonly used substances to numb nerve bundles. It can even be used for migraine sufferers! The downside? It’s very expensive. I highly recommend exploring this option with your doctor as it seems to be extremely effective both in the short- and long-term for FM patients.
  3. Sleep aids, such as Ambien (zopiclone), Trazadone (which is also an antidepressant) and other sleep meds are very effective in helping FM patients get a proper night’s sleep.
  4. Other drugs – muscle relaxants such as Flexeril (aka Cyclobenzaprine) are sometimes prescribed, but there is no evidence that they actually work. Anti-inflammatories such as Advil and Celebrex may work on comorbid conditions such as arthritis, however, there is no evidence to support its use in effectively treating FM symptoms. Recently, the use of low-dose Naltrexone, (LDN) has shown very promising results in treating Fibromyalgia. This may seem counter-intuitive, but it seems to work because of the way the brains of FM patients differ from those of non-FM patients. Pain centers that fire for no real reason, a lowered number of Serotonin receptors, and the lowered production of Serotonin in the brain, combined with other issues in the brain seem to make this a good choice for those who are looking for relief.
  5. Ketamine – used as a very last resort, ketamine is an anesthesia medication that is actually prescribed in rare cases for those who suffer from FM. Very dangerous to use when you’re alone, this drug comes with some serious potential side effects including death.
  6. Diet – some believe that changing your diet will help with the symptoms of FM, however, there are no studies that have demonstrated what kinds of changes are actually effective for FM  patients.
  7. Acupuncture and electronic acupuncture – while some report relief from various FM symptoms, studies have shown that it is not an effective treatment for FM.
  8. Massage – there seems to be some evidence that some symptoms of FM are effectively treated with just 20 minutes of moderate-pressure massage, including relief of anxiety, better sleep, and reduced pain. More studies need to be done to determine just how well it works before we can say it’s an effective treatment.
  9. Electronic devices such as Tens machines, and the Quell pain relief device have shown efficacy in treating Fibromyalgia pain by confusing and overwhelming nerves and nerve bundles that are sending false pain messages to the brain. Look for a device that is convenient for you, and comes with a good warranty if possible.

This is by no means an exhaustive list of possible treatments for FM, but it touches on most of the treatments you can explore to relieve your symptoms. While everyone wants a magic treatment for FM, it simply doesn’t exist. What works for one person may not work for another, and even those that work for you, including antidepressants, will likely stop working with long-term use. A combination of home remedies, medications, and exercise is still the best approach for the treatment of FM at this point in time, but hopefully, more options will become available soon.

Using a treatment that isn’t listed here? Share it in the comments and I’ll do a review including your input!

2 thoughts on “Fibromyalgia: Pain Management, Medications, and their Effectiveness

  1. Great post. You offered a well balanced and honest account of these medications! Getting pain relief with this condition can be really tough. Have you ever heard about fasciablasting? I was floored by how much of my fibro pain it conquered, even most of my tenderloins are gone. I’m not sure I’d even qualify for the dx anymore if tested today. If you’re interested let me know or search fascia treatments for EDS and Fibromyalgia on my page.

    1. No, fasciablasting is a new term to me! I’m in the midst of moving/dealing with a death in the family, so I’ll have to wait to look it up, but I would love to hear your story with this treatment, and add it to an updated post later on! I love it when people share what’s worked for them!

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