Drugs used to treat fibromyalgia
Introduction
Unfortunately there is as yet no cure for fibromyalgia. In addition, although many drugs are used to help treat the symptoms, none have been found to be especially helpful.
The drugs that are used can be divided into standard painkillers, and those that are used to treat pain from damaged nerves (anti‐neuropathics).
It is advised to read the information on what has gone wrong with your body before reading this section.
Standard Analgesics.
Overall the effectiveness of these drugs varies from patient to patient and depends on how much pain is arising from the body tissues.
Paracetamol. Widely available and considered to be a weak analgesic. It works best when taken in combination with an opiate drug. Side‐effects are rare, and the drug does not cause addiction.
NSAIDS – or anti‐inflammatory drugs. This group includes ibuprofen (commonly known as Nurofen), diclofenac, naproxen, and celecoxib. These drugs work by reducing inflammation and are very effective when there is tissue damage from conditions such as arthritis, and after surgery. Although they are not addictive and remain effective after many years of use, side‐effects are common and potentially life‐threatening. The most common side‐effects are stomach pains and indigestion, which if left untreated can cause bleeding from the stomach and ulcers. Long term use has also been shown to increase the risk of kidney failure.
Opiates. These can be further divided into strong, intermediate or weak. Strong opiates include morphine, oxycodone, fentanyl and buprenorphine. Tramadol is an intermediate strength opiate. Codeine and dihydrocodeine are weak opiates. All opiates have similar side‐effects, and these commonly include drowsiness, constipation and sickness. They can all be addictive, and their effect weakens over time, leading to an increased dose. Lots of studies have shown that patients on high dose opiates complain of as much pain as those on none, or low dose. Long term use has been associated with decreased immunity hormone function (especially the sex hormones), and an increased sensitivity to pain.
Anti‐neuropathics
Most anti‐neuropathics cause significant side‐effects, including sedation and sickness. Everyone reacts differently and just because you experience side‐effects with one, does not mean that you will get side‐effects from another. Patients are usually prescribed a low starting dose of these medications, and asked to slowly increase the dose over a few weeks, to allow their body to adjust to the side‐effects. Pain relief can take at least 2 weeks to start. Some research suggests that the pain relieving effect may wear off after 6 months, and that increasing the dose does not reduce patient’s pain. It is therefore important to monitor the effect of these drugs, and see your doctor if you feel that they are no longer effective. Tricyclic antidepressants. This group contains amitriptyline, nor‐triptyline, and imipramine. The commonest side‐effect is sedation, and this can often last into the morning, even after taking the tablets the previous night. The maximum dose used is generally a lot lower than that was used to treat depression.
Serotonin and Nor‐Adrenaline re‐uptake inhibitors. Duloxetine has been shown to improve pain and functioning in patients with fibromyalgia. Common side‐effects include sedation, and dry mouth.
Anti‐epileptics. The commonest anti‐epileptics used to treat fibromyalgia are gabapentin and pregabalin. Both commonly cause sedation, sickness and weight gain. Gabapentin needs to be taken three times a day, whilst pregabalin can be taken either twice a day, or three times a day. If there is any weight gain as a result of taking this medication, then you will lose this extra weight when you stop taking the tablets.
Summary
It is useful to try these drugs, but remember they are not the answer for fibromyalgia, for the majority of patients who take them. Overall a combination of treatments including pain management strategies, alongside medication, have been shown to have the most impact.