By: Ana Valerio, Doctor of Pharmacy
Fibromyalgia can be difficult to treat because symptoms and response to the treatment vary from person to person. To date, no universally effective treatment for fibromyalgia has been found. Medication does not provide a cure for this disease; however, it does help to relieve symptoms and improve quality of life.
Currently, the three drugs that are approved by the United States Food and Drug Administration (FDA) for the management of fibromyalgia are: pregabalin, duloxetine and milnacipran. That being said, there are several other medications that are commonly prescribed alone, or in combination, to relieve fibromyalgia symptoms, such as pain, fatigue and muscle stiffness.
Common Medications for Fibromyalgia Pain
Believe it or not, antidepressants aren’t used exclusively to treat depression. They are actually among the most common treatment strategies to relieve fibromyalgia pain.
Antidepressants act by increasing the activity of chemicals called neurotransmitters in the brain. Neurotransmitters coordinate the transmission of signals between nerve cells, which in turn affect every system in your body, influencing sleep, energy and the perception of pain. People with fibromyalgia usually have low levels of neurotransmitters, and it is believed that raising them may ease the pain associated with this condition.
There are different categories of antidepressants, and each one of them works in a different way:
- Tricyclic antidepressants: amitriptyline (Elavil), nortriptyline (Pamelor)
- Serotonin-noradrenaline reuptake inhibitors (SNRIs): milnacipran (Savella), duloxetine (Cymbalta), venlafaxine
- Selective serotonin reuptake inhibitors (SSRIs): fluoxetine (Prozac)
Anticonvulsants (also known as antiepileptics) were originally developed to treat epilepsy, but they have also shown to be effective in patients with fibromyalgia.
They work by slowing down nerve signals from the muscles to the brain, relieving muscle spasms and pain.
The most commonly used anticonvulsants for fibromyalgia are pregabalin (Lyrica) and gabapentin (Neurotontin).
Muscle relaxants are used to relieve muscle tension. Your doctor may prescribe it to you if your muscles are frequently tight or stiff. Since they also have sedating properties, muscle relaxants can also help you sleep better, and are usually taken at bedtime.
An example of a muscle relaxant for fibromyalgia is cyclobenzaprine (Flexeril). Some benzodiazepines, like diazepam (Valium), also have a muscle relaxant action.
Benzodiazepines are usually used in the treatment of anxiety, and also to induce sleep. They help you relax by slowing down your central nervous system. Some of them, such as diazepam (Valium) and clonazepam (Klonopim) also have the ability to relax your muscles. They are usually prescribed for short periods of time.
Since fibromyalgia can affect sleeping patterns, getting quality and restorative sleep can be helpful for you. A good night’s sleep can decrease pain and help you achieve better daytime functioning.
Tramadol (Ultram) is an analgesic that acts in the central nervous system and is used to relieve moderate to severe pain. It acts in two different ways to relieve fibromyalgia pain.
Tramadol is a weak opioid analgesic. This means that it binds to receptors in your brain called µ-opioid receptors, decreasing the pain messages that your body sends to your brain. On the other hand, tramadol increases the action of the neurotransmitters serotonin and norepinephrine in the brain, in a similar way to antidepressants. These two mechanisms act in a synergic matter to change your perception of pain.
Tramadol is used alone or in combination with acetaminophen, a painkiller with no anti-inflammatory action.
Opioid analgesics, also called narcotics, are a class of pain relievers used to treat severe pain, such as morphine (MS Contin) and oxycodone (OxyContin).
Opioids can be helpful in episodes of severe pain associated with fibromyalgia, but their use in the management of this condition is controversial. They are highly addictive and they should only be used when other medications are not effective. Additionally, opioid analgesics don’t address the musculoskeletal problems associated with fibromyalgia.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective for relief of pain caused by inflammation. Although fibromyalgia is not caused by inflammation, their use is prevalent in patients, either as a prescription or as an over-the-counter medication.
NSAIDs, such as ibuprofen and aspirin, are not effective in treating fibromyalgia symptoms when used alone, but they may help decrease pain when used in conjunction with another fibromyalgia medication.
These drugs can cause stomach irritation, and should be taken with food. Their use in large doses or over long periods of time should be closely monitored.
A successful treatment for fibromyalgia usually requires a combined approach. These medications for fibromyalgia pain are the most commonly prescribed. Some patients do not respond to a single drug, and may need combination therapy to get maximum pain relief.
The aim of fibromyalgia treatment is to relieve symptoms in the best possible way. This may differ from person to person, and your doctor will choose the best option for you. Before starting any medication, discuss it with your doctor, and be sure to talk about any other medications you are taking.