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Pain Management
What is pain?
Pain - where would we be without it??? Some would say in paradise, but believe it or not, our lives would be much worse if we couldn't feel this most basic of warning signals within the body. None of us appreciates pain, but lets face it - how else would we know there's a problem needing sorted? There are actually some people who because of yet another chemical abnormality, this time in DNA processing, who don't feel pain at all, but they suffer nearly more because they are forever burning themselves, breaking bones or suffering from undiagnosed serious ailments for months because of it. This article is too short to cover again all the aspects of pain processing abnormalities in Fibromyalgia – you can read about those in Dr. Bennett’s report in our main pack. Because it’s such an important issue I have been asked on numerous occasions to update people on what is available to help. Once again, I do so, under the condition that nobody reading this takes it to their doctor stating that “FMSNI says I should take ‘ X Drug’ for my pain” or anything remotely similar. All I seek to do in this article is to enlighten you as to the types and names of drugs you may be prescribed so that you are better informed. As always, please remember that what works for one may not work for another, and everyone will react differently to any drug as regards side-effects and efficacy. The following works on the premise that you haven’t taken pain-killers in any quantity before your diagnosis, so begins with the mildest analgesic (painkiller) most likely prescribed - up to the strongest ones for those who for whatever reason have found no benefit in the milder drugs. (Please note this information is primarily for those living in the UK, and particularly within N. Ireland).
ANALGESICS (Painkillers)
Mild but still often effective for many:
Aspirin, Paracetamol, Co-codamol, Fenbid - all these alongside others like Anadin extra, Neurofen etc, all are useful as a starter painkiller, especially in those who haven’t had the need for analgesics before to any great extent. Those who do find these drugs quite effective should not feel that their pain must therefore be less than others who require Pethidine or Morphine. It is more likely to do with drug tolerance than pain levels in some although not all cases.
Medium strength analgesics:
Co-proxamol, Co-dydramol, Meptid, Fortral, Kapake, Remedine, Tylex and Zydol. These usually combine weak opiods with mild analgesics and are given for moderate to severe pain. Depending on pain levels these drugs may be given up to their maximum dosage in order to be effective, and most people do find that they will develop a tolerance to their effectiveness over a period of 6 -12 months. Codeine based drugs e.g. Kapake are likely to cause constipation whilst others like Zydol may cause a lot of nausea and headaches initially. It should be noted that Kapake and co-codamol are similar only in their combination of codeine and paracetamol - Kapake has 30 mg of codeine while co-codamol only has 8 mg. There is thus a wide variation in effect of the two drugs. My suggestion with these drugs as with many others, is that you start on them slowly and build up your dose rate gradually especially if you know you react badly to drugs to start with. As always, discuss this issue with your doctor.
Strong analgesics given for short term (acute) severe pain:
Pethidine, Morphine, Sevredol, Clyclimorph, OxyNorm, MST, fentanyl. These really only can be given for acute episodes of very severe pain, and although for many of us can be really effective, GP ‘s by nature rarely prescribe them even for an acute flare-up because of the connotations of addiction and dependency. These really only should be considered as a last resort as if you start on them, you’ve nowhere else to go drug wise once you get tolerant to them as well. Side effects with these drugs tend to be heavier too, because they are narcotic/opioid mixes which not only alleviate pain but also produce many other unwanted symptoms due to their effects on the central nervous system. There is now another narcotic drug available that may provide slightly safer medication at this level, called OxyContin SR. It is by definition a slow-release drug which builds up slowly in the bloodstream to an acceptable level, often providing longer term pain relief than would otherwise be possible. Some pain clinics are prescribing this as an alternative when the usual pain relief drugs have proven ineffective. Again, though, this drug is also addictive being another form of morphine and thus not likely to be prescribed unless you really are at the top of the analgesic scale already.
If you want to know more about these drugs please click here to go to a Drug Information page.
There are other drugs being used in an effort to try and alleviate chronic severe pain as is found in some people with FM. Drugs such as Baclofen and Valium are muscle relaxants, particularly the former, and can in some cases be quite efficient. However, they are not the first drug of choice, as Baclofen in particular must be carefully prescribed and has to be withdrawn slowly or it can actually precipitate seizures. But it may well be worth looking at, particularly if you feel that much of your pain is definitely due to muscle spasms unalleviated by any other treatments. And of course, most of us have come across the SSRI's - antidepressants such as Prozac, Lustral and most usually Amitriptyline given to try and improve the sleep deficit. Here, again, it will really depend on each individual as to whether they are of any value or not. Some have found them brilliant while others, including myself, found them of no value, causing a lot of morning fatigue.
Another treatment used in a Pain Clinic setting and only by selected anaesthetists is lignocaine infusion therapy. It's relatively new in being used for fibromyalgia pain although has long been used for other types of pain with good success rates. Research is continuing with it, but those who've tried it have found it to be of varying benefit - if it does work, effects may last anything from a few days to 4-6 months or more depending on the individual. It's certainly one to think about though, and particularly when you've pretty much exhausted all other types of treatments perhaps.
So once again, please use the above as a Guide to your level of analgesia and what is available if your current level isn’t proving adequate. But your GP is the only one at the end of the day who can make an authoritative decision on what’s most likely going to be suitable for you to try, based on your medical history NOT anyone else's!!
Below is a short list of specific sites relating to pain issues. Please feel free to contact us if you would like to discuss your pain problems directly - can't promise to be able to sort them out, but we will certainly listen and see if we can provide you with suggestions for alleviating them.
ANALGESICS (Painkillers)
Mild but still often effective for many:
Aspirin, Paracetamol, Co-codamol, Fenbid - all these alongside others like Anadin extra, Neurofen etc, all are useful as a starter painkiller, especially in those who haven’t had the need for analgesics before to any great extent. Those who do find these drugs quite effective should not feel that their pain must therefore be less than others who require Pethidine or Morphine. It is more likely to do with drug tolerance than pain levels in some although not all cases.
Medium strength analgesics:
Co-proxamol, Co-dydramol, Meptid, Fortral, Kapake, Remedine, Tylex and Zydol. These usually combine weak opiods with mild analgesics and are given for moderate to severe pain. Depending on pain levels these drugs may be given up to their maximum dosage in order to be effective, and most people do find that they will develop a tolerance to their effectiveness over a period of 6 -12 months. Codeine based drugs e.g. Kapake are likely to cause constipation whilst others like Zydol may cause a lot of nausea and headaches initially. It should be noted that Kapake and co-codamol are similar only in their combination of codeine and paracetamol - Kapake has 30 mg of codeine while co-codamol only has 8 mg. There is thus a wide variation in effect of the two drugs. My suggestion with these drugs as with many others, is that you start on them slowly and build up your dose rate gradually especially if you know you react badly to drugs to start with. As always, discuss this issue with your doctor.
Strong analgesics given for short term (acute) severe pain:
Pethidine, Morphine, Sevredol, Clyclimorph, OxyNorm, MST, fentanyl. These really only can be given for acute episodes of very severe pain, and although for many of us can be really effective, GP ‘s by nature rarely prescribe them even for an acute flare-up because of the connotations of addiction and dependency. These really only should be considered as a last resort as if you start on them, you’ve nowhere else to go drug wise once you get tolerant to them as well. Side effects with these drugs tend to be heavier too, because they are narcotic/opioid mixes which not only alleviate pain but also produce many other unwanted symptoms due to their effects on the central nervous system. There is now another narcotic drug available that may provide slightly safer medication at this level, called OxyContin SR. It is by definition a slow-release drug which builds up slowly in the bloodstream to an acceptable level, often providing longer term pain relief than would otherwise be possible. Some pain clinics are prescribing this as an alternative when the usual pain relief drugs have proven ineffective. Again, though, this drug is also addictive being another form of morphine and thus not likely to be prescribed unless you really are at the top of the analgesic scale already.
If you want to know more about these drugs please click here to go to a Drug Information page.
There are other drugs being used in an effort to try and alleviate chronic severe pain as is found in some people with FM. Drugs such as Baclofen and Valium are muscle relaxants, particularly the former, and can in some cases be quite efficient. However, they are not the first drug of choice, as Baclofen in particular must be carefully prescribed and has to be withdrawn slowly or it can actually precipitate seizures. But it may well be worth looking at, particularly if you feel that much of your pain is definitely due to muscle spasms unalleviated by any other treatments. And of course, most of us have come across the SSRI's - antidepressants such as Prozac, Lustral and most usually Amitriptyline given to try and improve the sleep deficit. Here, again, it will really depend on each individual as to whether they are of any value or not. Some have found them brilliant while others, including myself, found them of no value, causing a lot of morning fatigue.
Another treatment used in a Pain Clinic setting and only by selected anaesthetists is lignocaine infusion therapy. It's relatively new in being used for fibromyalgia pain although has long been used for other types of pain with good success rates. Research is continuing with it, but those who've tried it have found it to be of varying benefit - if it does work, effects may last anything from a few days to 4-6 months or more depending on the individual. It's certainly one to think about though, and particularly when you've pretty much exhausted all other types of treatments perhaps.
So once again, please use the above as a Guide to your level of analgesia and what is available if your current level isn’t proving adequate. But your GP is the only one at the end of the day who can make an authoritative decision on what’s most likely going to be suitable for you to try, based on your medical history NOT anyone else's!!
Below is a short list of specific sites relating to pain issues. Please feel free to contact us if you would like to discuss your pain problems directly - can't promise to be able to sort them out, but we will certainly listen and see if we can provide you with suggestions for alleviating them.
External links
Dilemma of Narcotic Use
Partners against pain
Pain Clinic Therapies
Pain Resources
Lignocaine infusion research (UK) - research article
PLEASE NOTE: The above is provided for information purposes only, and FMSNI accepts NO responsibility for adverse drug reactions or other problems as a result of your being prescribed any of the above medications in any respect. We trust you will take note of all of the information provided in its proper context and especially the warnings also given regarding each type of medication.