Fibromyalgia: Medications

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Medications

Medications do not cure fibromyalgia. However, some medicines may help improve fibromyalgia symptoms, especially muscle pain and frequent waking during the night. Not all people with fibromyalgia will need, want, or benefit from medicines, but people with more severe pain, sleep problems, or depression that disturbs their daily life may find them helpful.

Antidepressants are often used to treat symptoms of fibromyalgia. This does not mean that the condition is "all in your head." Antidepressants may help by improving sleep and mood or by blocking pain signals. Many people with fibromyalgia appear to benefit from the use of these medicines.

Fibromyalgia symptoms in different people respond to different medicines. Your doctor may try more than one medicine before finding one that works best for you. You may also find that a medicine that has been helping to decrease your symptoms seems to become less effective over time. Talk with your doctor if you are not getting relief from your symptoms. He or she may try a different medicine or make suggestions for helping you continue to find ways to modify your activity, sleep, and stress.

Medication Choices

Often, medicines may be combined (such as fluoxetine and amitriptyline) for the most effective treatment of symptoms of pain and sleep disruptions. Certain types of antidepressants may be used to improve sleep, relieve pain, and, in some cases, treat depression.

• Serotonin and norepinephrine reuptake inhibitors (SNRIs)—also called mixed (or dual) reuptake inhibitors—such as duloxetine (Cymbalta) or milnacipran (Ixel) have not been used for fibromyalgia for very long yet, but research has shown some promising results.⁵ These may be most useful for people with both fibromyalgia pain and depression.
• Tricyclic antidepressants, such as amitriptyline (Amitril or Elavil, for example), imipramine (Tofranil), nortriptyline (Aventyl or Pamelor), or trazodone (Desyrel), may improve sleep and possibly provide pain relief.
• Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac, for example), paroxetine (Paxil, for example), or sertraline (Zoloft), may reduce depression or improve sleep.

A seizure medicine (anticonvulsant) called pregabalin (Lyrica) is approved to treat fibromyalgia. Pregabalin may help reduce pain, sleep problems, and fatigue.⁸

A muscle relaxant called cyclobenzaprine (Flexeril) may also be used for pain and sleep problems. This drug is very similar to certain tricyclic antidepressants.

Other medicines are being studied and used for treating fibromyalgia. Some drugs that show promise include:

• Seizure medicines (anticonvulsants), such as gabapentin (Neurontin).^{8, 2}
• Combinations of medicines, such as tramadol (Ultram) with acetaminophen.⁹

Nonprescription pain relievers, such as acetaminophen (for example, Tylenol), or nonsteroidal anti-inflammatory drugs (NSAIDS, such as ibuprofen or aspirin) usually are not very helpful in treating day-to-day symptoms of fibromyalgia. But they may be useful in reducing severe pain caused by a flare-up of symptoms. You should check with your doctor if you need to continue to take these medicines, because they may harm your stomach, kidneys, or in rare cases, your liver. Your doctor may want to monitor you if you take NSAIDs daily.

What To Think About

In general, medicines are only a part of the long-term treatment of fibromyalgia. They may help break the cycle of pain and sleep problems when symptoms flare up, but they usually are part of a larger treatment plan that focuses on exercise and other types of treatment.

Narcotic pain relievers and sleep aids that can lead to addiction are rarely used to treat fibromyalgia. Although they can be helpful in some people with severe symptoms, you can become dependent on them over time, and the treatment can become worse than the fibromyalgia symptoms.

FDA Advisories. The US Food and Drug Administration (FDA) has issued:

• An advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines, but to watch for warning signs of suicide in those using them. This is especially important at the beginning of treatment or when doses are changed.
• A warning about the antidepressants Paxil and Paxil CR and birth defects. Taking these medicines in the first 12 weeks of pregnancy may increase your chance of having a baby with a birth defect.

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Last updated:	November 10, 2005
Author:	Ralph Poore
Reviewed By:	Kathleen Romito, MD - Family Medicine, Benjamin Natelson, MD - Neurology, Chronic Fatigue Syndrome
Editors:	Kathleen M. Ariss, MS, Michele Cronen