Fibromyalgia
Medications
There are many opinions about how effective some medicines are for FMS. There also are different classes of medicines that may be used. The following medicines have been found to be helpful for treating FMS:
- Tricyclic anti-depressants – You may be given one of these medicines whether or not you have depression. Research shows that this type of medicine may help you sleep better and feel an overall sense of well-being. Results also show that this medicine can decrease the intensity of pain but not the number of tender spots. Tricyclic anti-depressants are FDA approved but their treatment of FMS is called an off-label use. Some commonly used tricylclic anti-depressants are amitriptyline (Elavil), nortriptyline (Pamelor) and imipramine (Tofranil). Although these medicines can be helpful, you may have a problem with certain side effects. These may include weight gain (especially when taking amitriptyline), dizziness and dry mouth.
- Muscle relaxants – This type of medicine is often used for treating muscle spasm. However when given as treatment for FMS, this medicine may relieve pain and help you sleep better. Muscle relaxants are FDA approved but their treatment of FMS is called an off-label use. Commonly used muscle relaxants are cyclobenzaprine (Flexeril) and carisoprodol (Soma). Cyclobenzaprine is similar to a tricyclic anti-depressant and is sometimes used just at night to improve sleep. These medicines tend to lose their effectiveness over time.
- Pregabalin (Lyrica) – This is one of a few medicines approved by the US Food and Drug Administration (FDA) specifically to treat FMS pain. Lyrica is used to reduce pain associated with fibromyalgia and improve sleep and fatigue. In one study, patients taking pregabalin reported significant improvement in the quality of sleep based on daily sleep diaries and a sleep scale measurement. Also, patients taking pregabalin said they felt less tired and were better able to do their regular activities of daily living. Most common side effects of pregabalin include mild-to-moderate dizziness and sleepiness. It may also impair motor function and cause problems with concentration and attention.
- SNRIs – Serotonin and norepinephrine reuptake inhibitors (SNRIs) are used for both depression and pain management. SNRIs may be used to decrease pain and tenderness in FMS patients with or without depression. They may also help improve your sleep, concentration and moods. Examples of commonly used SNRIs are venlafaxine (Effexor) and duloxetine (Cymbalta). Duloxetine and another medicine called Milnacipran (Ixel) have recently been approved by the FDA specifically for treating FMS. All of these medicines have effects on the serotonin system as well as other neurotransmitters and are helpful in treatment of chronic pain. Side effects may include sleep problems, dry mouth and constipation.
- SSRIs – Selective serotonin reuptake inhibitors (SSRIs) are used for both depression and pain management. Research studies have shown that SSRIs are particularly helpful in treating FMS symptoms in women. These medicines are often given in combination with a tricyclic anti-depressant, as this makes them more effective in treating FMS symptoms. Commonly used SSRIs include fluoxetine hydrochloride (Prozac), paroxetine (Paxil) and sertraline hydrochloride (Zoloft). Side effects may include loss of appetite, anxiety and sleep problems.
- Tramadol – This is sometimes called a "weak opioid" or "narcotic-like" medicine. It works much like a regular opioid in relieving pain but has less severe side effects. It may be used alone or in combination with acetaminophen (Tylenol). Examples are tramadol (Ultram) and tramadol/acetaminophen (Ultracet). Side effects may include dizziness, nausea and constipation.
- Other medications – Trazodone is very effective for sleep and often has fewer side effects than the tricyclic anti-depressant medicines.
- NSAIDs – These are also called non-steroidal anti-inflammatory drugs. These medicines may help decrease inflammation if you have another disorder in addition to FMS. Examples of disorders that cause inflammation are arthritis and lupus. NSAIDs are not helpful if you have FMS alone because inflammation is not a symptom of FMS. NSAIDs are sometimes used as simple pain relievers, although acetaminophen (Tylenol) has less risk of complications and may be a better choice. Examples of NSAIDs are ibuprofen, naproxen and celecoxib (Celebrex). NSAIDs may be helpful for treating FMS pain when given together with other medicines, such as tricyclic anti-depressants.
- Opioids – These medicines are best avoided, but some providers may prescribe them as a last resort if other drugs and non-drug treatments do not help. Examples of commonly used opioids are acetaminophen with codeine, oxycodone (Percocet), morphine and hydrocodone (Vicodin). Long-term use of these medicines does not necessarily decrease pain associated with FMS. They can even contribute to more pain in the long run. More research is needed to learn about the effectiveness of opioids for treating FMS.