Medication options abound for treating fibromyalgia, however, many do not work really well and are not FDA approved. Simply not being FDA approved is not necessarily a litmus test for success. Also, a medication may be used “off label” from its FDA indication successfully if a physician deems it appropriate.
Fibromyalgia is very difficult to treat. It causes diffuse pain in patients, so a lot of doctors treat it with narcotics. A growing body of literature now shows that to generally be a bad idea and can make fibromyalgia patients worse. This is termed opioid induced hyperalgesia. Chronic narcotic usage that makes patients worse is probably not the best option.
In addition, we know that chronic usage of opioid medications represents a poor choice for most patients. Chronic pain medications may cause a patient to become depressed, they may cause constipation, they may cause addiction, and eventually they can cause a significant withdrawal if a patient decides they want to just get off of the medication.
Tramadol is one medication that has been shown to be very helpful for fibromyalgia patients. The trade name is Ultram, and it is a non-narcotic analgesic. It has dual action, one being tricyclic activity, which blocks the release of epinephrine and serotonin, and on top of that it has opioid agonist activity. This double mechanism of action works really well for fibromyalgia people.
Another class of medications that can be very beneficial for fibromyalgia are tricyclic antidepressants. These include such medications as nortriptyline, amitriptyline, and cylobenzaprine. These medications were not originally indicated for fibromyalgia but numerous studies have shown that they do work fairly well.
One of the FDA approved medications for fibromyalgia is milnacipran. In the US, it is an approved medication for fibro. The side effects of the medication are similar to another fibro medication called duloxetine. Milnacipran is typically combined with pregabalin for treatment.
A second FDA approved medication for fibromyalgia is the duloxetine. This medication is also utilized in United States for anxiety, depression, and painful diabetic neuropathy. This medication is a serotonin and norepinephrine reuptake inhibitor. A common side effect for duloxetine is nausea. Another is being sleepy or paradoxically one can see insomnia.
The third medication that is FDA approve for fibromyalgia is called pregabalin. The brand name is Lyrica. This medication was initially FDA approved for painful diabetic neuropathy, epilepsy, and postherpetic neuropathy. Side effects that can be seen with pregabalin are swelling in the extremities, dizziness, and drowsiness. It is not clear why pregabalin works, but significant research has shown great results.
Thankfully, better medication options exist for patients with fibromyalgia.
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