Approximately 2% of the U.S. population suffers from fibromyalgia. Fibromyalgia is a chronic condition that is characterized by generalized muscle and skeletal pain. There may also be muscle weakness present. This chronic pain and weakness can lead to stiffness, sleepless nights and depression. Unfortunately, we do not know what causes fibromyalgia. This makes the condition difficult to treat. 

 Before trying medications to treat fibromyalgia, your doctor may have you try other therapies like sleep improvement and low-impact exercise.  Your doctor may also try to treat any possible depression that is present first as well. If you and your doctor decide that medication is necessary, there are a few medication treatment options available. Let’s take a look at these options.

Antidepressants

Believe it or not, some antidepressants can be used to treat certain types of pain, as well as depression. Certain antidepressants can be particularly effective in treating nerve pain. This is because many of the chemicals in our bodies involved with depression may also be partly responsible for the sensation of pain. Now, studies are looking to see if antidepressants can help treat the pain related to fibromyalgia. Unfortunately, these studies are showing mixed results.  

Most studies have shown that antidepressants are not very effective in treating the pain associated with fibromyalgia. Other studies have shown conflicting results.¹  Since most antidepressants have not overwhelmingly been proven to be helpful in treating the pain of fibromyalgia, they are usually given to instead promote sleep , ease depression and create an overall feeling of general well-being.  In fact, they have been shown to be quite helpful in easing these types of symptoms. Antidepressants that are typically prescribed for this purpose include amitriptyline , cyclobenzaprine and duloxetine (Cymbalta®). 

Traditional Pain Relievers

Tramadol (Ultram®) can be used with or without acetaminophen (Tylenol®). Both options have shown some benefit in treating the pain of fibromyalgia.¹ There is actually a product available that combines both of these ingredients called Ultracet®. NSAIDS (nonsteroidal anti-inflammatory agents) like ibuprofen and aspirin, have not been shown to be very effective for the treatment of fibromyalgia in trials.^1-3

Other Medications

Some medications that are traditionally used for seizures have been studied for fibromyalgia.  These medications include gabapentin (Neurontin®) and pregabalin (Lyrica®).   Lyrica® is the first drug officially approved by the FDA for the treatment of fibromyalgia. About 28% of patients get a 50% reduction in fibromyalgia pain.  One must remember, however, that just because it is labeled for use for the treatment of fibromyalgia, it should not necessarily be used first-line. Lyrica® is considerably more expensive than other treatment options. Neurontin® is much cheaper and has shown some benefits at higher doses. Both Lyrica® and Neurontin® can make you very sleep y and impair concentration. In fact, they may impair sleep and concentration so much so, they can interfere with everyday activities such as driving and going to work. Other medications have been looked at, but have not been well-enough studied to recommend their use.

Non-drug Treatments

Many non-drug treatments have been looked at. Some have shown more benefits than others. There has been evidence to support the use of biofeedback, hypnosis and acupuncture to treat fibromyalgia.  Aerobic exercise and muscle strengthening have been shown to help as well. Behavioral therapy may also improve pain, fatigue, mood and function.

 There have also been some supplements that have been promoted to treat fibromyalgia. S-adenosylmethionine (SAMe) is one of these supplements. SAMe is thought to have some antidepressant, anti-inflammatory and pain relief properties. There have been some smaller studies that suggest SAMe might be helpful for fibromyalgia.⁴

There is also some evidence that shows another supplement, 5-hydroxytryptophan (5-HTP), may be helpful in treating fibromyalgia. However, this substance has been linked to a serious syndrome that causes irregularities in the cells of the blood. It is recommended that this substance be avoided until there is further information on the safety of its use available.⁵

Another product that has shown some promising preliminary results is called Super Malic®. This product is a combination of malic acid and magnesium .  The safety of this product has not been established, however, thus it should be used with caution.

If you are looking for an over-the-counter remedy that is safe, capsaicin cream applied to tender points may provide some relief.  Since it is applied to the skin and is not taken internally, it is generally considered safer than many other over-the-counter or prescription medications.

The Bottom Line

Fibromyalgia is a difficult condition to treat. Different people respond to different therapies. Therefore, it is important to work closely with your doctor to find out what works for you.  When considering medications, amitriptyline and cyclobenzaprine have perhaps the most evidence of being able to help with symptoms. Non-drug therapies such as exercise and behavioral therapy also have a strong body of evidence to support their use. Typically, if these therapies don’t work, other antidepressants and pain relievers may be tried.¹

Author: Christi Larson, Pharm. D.

References

        1.  Goldenberg DL, Burckhardt C, Crofford L. Management of fibromyalgia syndrome. JAMA 2004;292:2388-95

2.       Kehoe   WA . Fibromyalgia. Pharmacist's Letter/Prescriber's Letter 2000;16(12):161201.

3.       Simms RW. Treatment of fibromyalgia syndrome. American   College of Rheumatology. http://www.rheumatology.org/publications/primarycare/number1/hrh0004-98.asp. (Accessed July 14, 2007 ).

4.       Jellin JM, Gregory PJ, Batz F, et al. SAMe monograph. Pharmacist's Letter/Prescriber's Letter Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. (Accessed July 14, 2007 ).

5.       Jellin JM, Gregory PJ, Batz F, et al. 5-HTP monograph. Pharmacist's Letter/Prescriber's Letter Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. (Accessed July 14, 2007 ).