Pain relief, improved
sleep, and improved mood are examples of goals that prescription medicines can
help you reach. As a group, those of us with fibromyalgia do not tolerate
We are very sensitive to medications and often experience side effects such as
nausea, drowsiness, or lightheadedness. One person may tolerate a particular
medicine, but the next person will get sick on it.
Prescribed medicines can provide great benefits to many, however.
This article is an excerpt
from a chapter of "Inside
Fibromyalgia With Mark J. Pellegrino, MD"
Categories of drugs used in the
treatment of fibromyalgia can include:
2) Anti-inflammatory medicines
3) Antidepressant medicines (tricyclics and selective serotonin reuptake
4) Muscle relaxants
5) Sleep modifiers
6) Anti-anxiety medicines
7) Other medicines used to treat chronic pain
1) Analgesics: Analgesics are pain
killers and can include over-the-counter medicines such as aspirin and
acetaminophen, or prescription-strength pain pills like narcotics (opiates),
codeine, Vicodin, Darvocet, Oxycontin and Percocet.
Ultram is a pain reliever that differs from narcotics in its action on the
central nervous system. These medications do not alter the fibromyalgia, but
they can help take the edge off of pain.
Narcotic medications have potential for adverse side effects including
drowsiness, difficulty with concentrating, and addiction, so they should be used
Many people with fibromyalgia are sensitive to codeine medicines, which can
cause nausea or an allergic reaction.
Ultram can cause allergic reactions in people sensitive to codeine, and a small
number of people taking Ultram have seizures. As a pain specialist, I will
frequently prescribe analgesics, including narcotics, for patients experiencing
2) Anti-Inflammatory Medicines:
Anti-inflammatory medicines include aspirin, nonsteroidal anti-inflammatories (NSAIDs)
such as ibuprofen, Naprosyn, Lodine, Daypro, and the newer Cox-II inhibitors,
and corticosteroids such as prednisone or dexmethasone.
These medications are both anti-inflammatory and analgesic. Some of these
medicines, such as ibuprofen, are available both over the counter and by
Because fibromyalgia is not a true inflammation, these drugs may be less
effective in reducing pain. However, these drugs can be helpful in reducing pain
that flares up with excessive physical activity, tendonitis, or bursitis, and
should be used only as needed.
If the NSAIDs are helpful for overall fibromyalgia pain, they can be continued
on a regular basis as long as there are no major side effects.
The major side effect of the anti-inflammatories is bleeding from
gastrointestinal ulcers. This problem is more common the longer the medicine is
However, a new medication class is available, Cox-II inhibitors, which include
Celebrex (Searle Pharmaceuticals), and Vioxx (Merck).
This new form of NSAID selectively blocks only the Cox-II enzymes, which control
the production of chemicals that cause inflammation and pain (prostaglandins).
Good prostaglandins that help the stomach lining, kidneys, and platelets are
formed by the Cox-I enzyme system and are not affected by the Cox-II inhibitors,
thus avoiding gastrointestinal bleeding.
I prescribe various types of anti-inflammatories on a regular basis. To avoid
risk of bleeding or other side effects, patients must not take over the counter
anti-inflammatory medicines if they are taking them by prescription.
3) Antidepressant Medicines: The
antidepressant medicines include tricyclics (for example, amitriptyline,
nortriptyline, doxepin, and trazodone), and selective serotonin reuptake
inhibitors (Prozac, Zoloft, Paxil, Effexor, Serzone, and Celexa).
These medicines can treat pain and alter sleep and mood disturbances seen in
fibromyalgia. The tricyclic medicines are effective, but frequent side effects
include dry mouth and drowsiness.
Sleep disturbances can be reduced by using low doses. Carefully controlled
studies have shown that low doses of tricyclic antidepressants can benefit
fibromyalgia patients (Karette et al, 1986, Goldenberg et al, 1986).
Because of the extreme sedation and morning hangover effect common with
amitriptyline, I've found that nortriptyline or trazodone has fewer side effects
but gives the same benefit.
Even though the sedation side effect of the tricyclic medicine may have worn off
by morning, the other benefits of the drugs (decreased pain, muscle relaxation,
and improved mood) can continue throughout the day.
Because the tricyclic can provide more than one beneficial effect, I think these
medicines are handy in fibromyalgia treatment. The selective reuptake inhibitors
work well in treating depression.
They also block the breakdown of serotonin, the brain hormone that is low in
persons with fibromyalgia and depression. Serotonin is important in the brain's
regulation of pain and sleep.
By selectively inhibiting the breakdown of serotonin, these medicines increase
the serotonin concentration in the body and its beneficial side effects.
These medicines have fewer side effects than the tricyclics, although Zoloft and
Paxil can cause sexual dysfunction.
Some of the newer medicines, Effexor and Serzone, for example, do not inhibit
sexual function. Using a combination of a serotonin reuptake inhibitor during
the day and a tricyclic at nighttime can be an effective combination medicinal
approach (Goldenberg, 1996).
4) Muscle Relaxants: Muscle relaxants
can decrease pain in people with fibromyalgia. Medicines in this family include
Flexeril, Soma, Skelaxin, and Robaxin. The most common side effect is
drowsiness, although Soma and Skelaxin cause less of it. I have found that
muscle relaxants do not really decrease muscle spasms or truly "relax"
muscles, because the painful area still has palpable spasms. Rather, the
medicine appears to help by a central neurologic mechanism that reduces muscle
If drowsiness is a side effect, this medicine should only be taken in the
evening so it doesn't interfere with driving or concentration. Flexeril is a
popular medicine for evening. Although it is a muscle relaxant, it is very
similar to amitriptyline in structure and effect, hence the benefits reported.
Medicines in the antispasticity category can be used to treat muscle spasms. Two
of these medicines, Zanaflex and Baclofen, have been shown to help reduce back
muscle spasms and pain. Antispasticity medicines are primarily intended for
people who have neurologic conditions causing involuntary muscle spasms (such as
spinal cord injuries, multiple sclerosis, or strokes). However, they may have a
role in patients with fibromyalgia who have numerous muscle spasms.
5) Sleep Modifiers: Various medicines
including those already mentioned, can treat insomnia (analgesics,
antidepressants, and muscle relaxants). True sleep modifiers include
benzodiazepines like Restoril and the hypnotic non-benzodiazepines such as
The most common reported concern about using sleep modifiers, especially
benzodiazepams, is the habit-forming potential. Ambien is reported to be less
habit-forming but can cause rebound insomnia when it's stopped. Sonata is a
newer sleep modifier that is not habit forming and doesn't cause rebound
Sometimes sleep modifiers are prescribed in short intervals only. I have found
that sleep modifiers improve deep sleep, and particularly improve the morning
perception of a good night's sleep. This improved sleep can carry over into a
better day. Sleep modifiers are short-acting medicines, so they work during the
night and are usually eliminated from the body by morning, hence the low chance
of a morning hangover.
Some people report nightmares with these medicines, but usually these medicines
are "silent," that is, one doesn't realize any medicine was taken,
other than knowing that sleep was better. I've devoted a chapter of Inside
Fibromyalgia (Chapter 26) to review the sleep problem so many of us have.
6) Anti-Anxiety Medicines: Anxiety is a
common problem in fibromyalgia and contributes to pain, muscle tension, and
It can make depression and insomnia worse. Various medicines including
antidepressants and muscle relaxants treat anxiety. Benzodiazepines such as
Klonopin, Ativan, and Xanax, are commonly used medicines. These medicines also
cause sedation and thus can improve sleep.
Possible side effects include depression and decreased memory.
Sometimes it is hard to determine whether symptoms are due to fibromyalgia or
are side effects of medication. I have found Klonopin to be a particularly
useful medicine in the evening, especially when there are leg symptoms (pain,
restless leg syndrome, jerking of the legs called myoclonus) that interfere with
sleep. Low dose Klonopin therapy is one way to improve the balance of the
inhibitory receptors (GABA) and the excitatory receptors (MMDA) in the central
nervous system. Most fibromyalgia patients have too much activity in the
excitatory receptors (MMDA receptors), and Klonopin can increase the pain
inhibitors' activity to achieve a more normal balance, improving sleep and
7) Other Medicines Used to Treat Chronic
Pain: Other medicines can be used to treat pain. Some pain medicines were
originally developed for a different purpose. For example, anti-seizure
medicines known as neuroleptics (including Neurontin, Dilantin, Depakote, and
Tegretol) were later found to be helpful in treating pain, particularly
neuropathic pain. People with fibromyalgia who have a lot of burning or electric
shock feelings in their hands and feet may improve from a trial of neuroleptic
Headaches are a common problem with fibromyalgia, and various headache medicines
are available. In addition to the medicines described above, headache medicines
include ergot alkaloids, sumatriptan, calcium channel blockers, and beta
blockers. Other conditions associated with fibromyalgia such as irritable bowel
syndrome can cause severe cramping pain and may require separately prescribed
Medicines used to treat irritable bowel syndrome include Metamucil, Levsin, and
Levbid. In addition to the variety of medicines available for fibromyalgia
treatment, a variety of doctor "strategies" are also available.
Doctors who prescribe medicine will usually find, through trial, and error, an
effective and favorite strategy.
There is no single right way to prescribe medicines for fibromyalgia, and more
than one strategy may work for difference people and different doctors. Over the
years, I have discovered basic strategies that seem to work best for me when
using prescription medicines. Antibiotics can have a role in treating
fibromyalgia. Dr. Garth Nicolson has isolated a microorganism, Mycoplasma
fermentens, as a possible infectious cause of Gulf War Syndrome (remember, this
may be a type of fibromyalgia).
Some patients had less pain and fatigue after taking antibiotics (for example,
doxycycline, Zithromax), presumably due to the eradication of the Mycoplasma.
Antibiotics may also inhibit certain enzymes that cause inflammation
(anti-inflammatory mechanisms) rather than by acting as an anti-infection
I have had some patients who improved after a course of antibiotics and many who
did not, so I'm not convinced that these drugs are helpful for the long term.
Antibiotic use increases one's chance of getting a Candida yeast infection,
which can increase fibromyalgia symptoms.
Over time, we may identify a specific subgroup of fibromyalgia patients who have
antibiotic-responsive symptoms. As with prescribed oral medications, therapeutic
injections [Trigger Point Injections] can be considered on an individual basis
as part of a multi-disciplinary treatment approach.
I use a combination of prescription medicines and injections along with other
We need a lot of weapons to go after
this "enemy" of our state of well being!
Fibromyalgia Survival Strategies:
• Understand there is no magical pill
that will get rid of all fibromyalgia symptoms. • Experiment with your doctor
to determine which medicines can help "control" your symptoms.
• Responsibly use analgesics and
narcotics to take the edge off the pain. These medications will not relieve all
your pain but may improve symptoms and comfort.
• Educate yourself about expectations
• Use the lowest effective dose of
medicine; wean off whenever possible [and discontinue any medication that is not
• Be flexible with medications. Keep
This article is reprinted with
permission from the author, excerpted from Chapter 13 (pp.95-102) of "Inside
Fibromyalgia With Mark J. Pellegrino, MD"
(c) 2001 Mark J. Pellegrino, M.D., and
Anadem Publishing, Inc. All Rights Reserved.
Mark J. Pellegrino, M.D., is Board
Certified in Physical Medicine and Rehabilitation and Electrodiagnostic
Medicine, and is one of the nation's leading experts on fibromyalgia. Dr.
Pellegrino is the author of numerous books and articles on fibromyalgia, and
despite having fibromyalgia, he maintains an active medical practice with over
10,000 patients cared for. He was recently named in "Best Doctors in
Current Research Articles:
Identify A Key "Brake" Of The Immune Response
of the Chronic Fatigue Syndrome
3. Prescribed Medications for Fibromyalgia
4. SOME FACTS ABOUT ME/PVFS/CFS
Health Site Index
- Top of page - Permacult Project
Probiotics, Other Nutritional Factors, and Intestinal Microflora
by Lars Hanson, Robert Yolken, Nestle Nutrition
Health Site Index
- Top of page - Permacult Project
The books featured here are from Amazon - they ship internationally,
however, if you'd prefer to deal with Amazon in Europe - click
I am NOT a medical professional.
I am a CFS - EBV sufferer who is relaying some of his experiences and
None of the information on these pages is to be construed as medical advice.
Please see a doctor for such advice.
Due to the nature of my illness, I am unable to work for a
regular employer in my former occupation as a journalist, and have started this Website, it's mirror
sites and others, as an information resource and business.
Principles of this site & Privacy
Marcus Webb, Webmaster
1Earth Media. All Rights Reserved. Last update 26th January 2013
PO Box 311, Wingham, N.S.W, Australia, 2429.