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, there are several common medications for fibromyalgia that can effectively relieve your symptoms and improve your quality of life.
Chronic pain medications 101
Currently there are 3 drugs approved by the Food and Drug Administration (FDA) for fibromyalgia:
- pregabalin (Lyrica)
- duloxetine (Cymbalta)
- milnacipran (Savella)
There are several other medications that are commonly prescribed alone or in combination. They work to relieve pain and other fibromyalgia symptoms such as fatigue and muscle stiffness.
Antidepressants act by increasing the activity of chemicals called neurotransmitters in the brain. Neurotransmitters coordinate the transmission of signals between nerve cells. This, in turn, affects every system in your body, can improve sleep and energy and influence the perception of pain. People with fibromyalgia usually have low levels of neurotransmitters. It is believed that raising those levels may ease the pain associated with this condition.
There are different categories of antidepressants. Each one of them works in a different way:
- Tricyclic antidepressants: amitriptyline (Elavil) and nortriptyline (Pamelor)
- Serotonin-noradrenaline reuptake inhibitors (SNRIs): milnacipran (Savella), duloxetine (Cymbalta), and venlafaxine (Effexor)
- Selective serotonin reuptake inhibitors (SSRIs): fluoxetine (Prozac)
Anticonvulsants (also known as antiepileptics) were originally developed to treat epilepsy. But research has shown that they can be effective in people with fibromyalgia as well.
- slow down nerve signals from your muscles to your brain
- reduce pain and relieve muscle spasms
The most commonly used anticonvulsants for fibromyalgia are pregabalin (Lyrica) and gabapentin (Neurotontin).
#3) Muscle relaxants
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. They are typically taken at bedtime.
An example of a muscle relaxant for fibromyalgia is cyclobenzaprine (Flexeril). Some benzodiazepines such as diazepam (Valium) also have a muscle relaxant action.
Benzodiazepines are usually used in the treatment of anxiety. They can:
- be used to induce sleep
- help you relax by slowing down your central nervous system
Some of them, such as diazepam (Valium) and clonazepam (Klonopin) also have the ability to relax your muscles. They are usually prescribed for short periods of time.
Since fibromyalgia pain can lead to sleep disturbance, getting quality and restorative sleep can be helpful for you. A good night’s sleep can decrease widespread pain and help you achieve better daytime functioning.
Tramadol (Ultram) is an analgesic that acts in the central nervous system. It binds to receptors in your brain called µ-opioid receptors. It is also:
- used to relieve moderate to severe nerve pain
- a weak opioid analgesic
- decreases the pain messages your body sends to your brain
- can be used alone or in combination with acetaminophen
Tramadol also increases the action of two neurotransmitters: serotonin and norepinephrine. It’s similar to antidepressants in that way. These two mechanisms work together to change your perception of pain.
#6) Opioid analgesics
Opioid analgesics, also called narcotics, are a class of pain relievers. These include morphine (MS Contin) and oxycodone (OxyContin).
Opioids can be helpful when there is severe fibromyalgia pain. However, their use for pain management of this condition is controversial. They are highly addictive and should only be used when other medications are not effective. Additionally, opioid analgesics don’t address the musculoskeletal problems associated with fibromyalgia.
#7) Non-steroidal anti-inflammatory drugs (NSAIDs)
Non-steroidal anti-inflammatory drugs (NSAIDs) are effective for relief of pain caused by inflammation. Fibromyalgia is not caused by inflammation. However, the use is of NSAIDs to relieve fibromyalgia pain is prevalent.
NSAIDs such as ibuprofen and aspirin are not effective in treating symptoms of fibromyalgia when used alone. But they may reduce pain when used in conjunction with another fibromyalgia medication.
Your stomach may become irritated on these medications. Be sure to take them with food. Avoid using them in large doses or over long periods of time.
The bottom line
Your fibromyalgia treatment plan usually requires a combined approach. Some patients do not respond to a single drug. Your doctor may prescribe combination therapy to get you maximum pain relief.
The aim of your fibromyalgia treatment is to relieve pain symptoms in the most effective way. This may differ from person to person. Your health care team will choose the best option for you. Before starting these common medications for fibromyalgia (or any medication):
- discuss it with your doctor
- be open and honest about your concerns
- ask questions
- be sure to talk about any other medications you are taking
Which of these common medications for fibromyalgia have you used?
Tell us about your pain journey in the comments.
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Updated in February 2019 with new information and resources