Pain Management

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FIBROMYALGIA  AND MEDICATIONS

Presently, no single medication alleviates all of a Fibromyalgia patient's pain and accompanying symptoms. This makes it doubly important for physicians to keep updated regarding results of ongoing FMS research and current changes in recommended fibromyalgia treatments. Before prescribing a medicine for a patient it is the responsibility of the attending physician to elicit a comprehensive medical history. Because different symptoms accompany each FMS patent, the doctor needs to know what problems are specific to each individual. For instance, non-restful sleep is almost always a major concern for Fibromyalgia sufferers. Small doses, usually 10 mg, of an antidepressant seem to help many FMS people. It is important for the physician to encourage the patient to keep a detailed written journal of medicines, dosages, timing and side effects. This record will be beneficial to the patient as well as the doctor when writing a prescription. It takes time and communication between the health care professional -and patient to determine the correct FMS medication, proper dosages and appropriate time to take the prescriptions. Please ensure you take no drugs prescription or otherwise, without your doctor's knowledge and agreement - this applies equally to supplements, which can be harmful in certain instances.  All dosages are suggestions for physicians unfamiliar with using them, but caution should be applied to ensure that an individual obtains the right dose is given for their particular circumstances e.g. antidepressant dosages will be tailored according to the purpose given i.e. for sleep disturbance or actual depression.   As always we emphasise that this information is purely a guide - your GP may prescribe more or less of any particular drug in any given circumstance - if you wish to have more in-depth information on any particular drug please go to the Links page where you can visit the drug databases online and obtain fully up-to-date information. 

Prescription medications at doctor's discretion.

TRICYCLIC ANTI-DEPRESSANTS
Tryptizol (Amitriptyline) dose is typically 10 to 25 mg per night. Tryptizol is known for pain relieving effects and ability to help sleep. This medication should be taken early in the evening or half dose in the evening and the other half at bedtime to avoid morning hangover.
Sinequan (Doxepin) a typical dose would be between 2.5 and 50 mg. Also a tricyclic that functions in the body as an antihistamine. Available in both tablet and liquid form.
Allegron (Nortriptyline) is an antidepressant with a weak sedative or stimulating property which may be useful in people with severe fatigue. May help to lift depression quite quickly, but like all these tablets may also have many side-effects.  FMS dose ordinariliy around 10-20 mg, but higher if depression involved.
Molipaxin (Trazodone) the usual dose is 150 mg to 300 mg per night. Molipaxin is as effective as the other anti depressants, however, is chemically different and may be less likely to cause side effects. Molipaxin is a mild stimulant and may make a sleep problem worse if combined with a tricyclic anti-depressant at night.

BENZODIAZEPINES
Xanax (Alprazolam) - a typical dose of this would be between .25 and 1.5 mg taken at night. May be more effective if taken with Ibuprofen. However, it may actually cause depression in some individuals and may be addictive, but may also be effective in some cases of Fibromyalgia if taken in low doses.
Valium (Diazepam) can be used for short-term treatment of anxiety states associated with insomnia or depression.  However, its primary use is as a muscle relaxant.  Normal dose rates are between 2 and 5 mg a day for those with Fibromyalgia but may be higher if muscle spasticity is a problem.

The anti-depressant and anti-anxiety properties of these medications can cause the following effects: depression, drowsiness, impaired co-ordination, impaired memory, muscular weakness and concentration problems, and they are known to be addictive.

SEROTONIN- BOOSTING MEDICATIONS (SSRIs)
These are deemed particularly useful in helping with sleep disturbance, but also alleviate mood disorders sometimes associated with FMS.

Prozac (Fluoxetine) is available in liquid as well as tablet form. A typical dose is 1 to 20 mg in the morning. Prozac may cause insomnia, but it can be taken in combination with one of the sedating tricyclics such as Tryptizol or Sinequan. -
Seroxat (Paroxetine hydrochloride) the usual dose is 5 to 20 mg in the morning. This medication is the most potent of this type. A sedating medication may be needed at night in conjunction with Seroxat. It can cause nervousness, insomnia, nausea, sexual difficulties and sweating, although many patients report having fewer side effects with this as compared to Prozac
Lustral (Sertaline ) is similar in action to Prozac being less sedative than the Tricyclic drugs and shouldn't cause weight gain. Dose is initially 50 mg daily increased to a maximum of 100 mg unless side-effects such as gastrointestinal upsets are severe.
Prothiaden (Dothiepin hydorchloride). Similar to the others, this drug is often given if anxiety plays a large role in your Fibromyalgia. It has sedation as well as anti-depression properties. Dosages start around 50 - 75 mg, if given purely for the sleep deficit.
Effexor (Venlafaxine Hydrochloride) usual dose is 37.5 mg two times per day. This dosage can be adjusted, depending on the effects. Effexor is not related to the tricyclics or the Prozac like drugs, however, it does boost serotonin and has tricyclic properties. The typical side effects are nervousness, anxiety, insomnia, and increased blood pressure.
Cipramil ( Citalopram) Similar in effect to Lustral but smaller dosing.
Cipralex ( Escitalopram) Also similar to Lustral but with fewer side effects, which can make it useful for anyone finding the latter difficult to cope with. 

 

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MUSCLE RELAXANTS.

Zanaflex (Tizanadine) is a complex muscle relaxant working on specific areas of muscle, and more commonly used in those with multiple sclerosis, but has its place with some FMS sufferers. This type of drug must be carefully monitored as to its effects, and as with all of this particular type, should be started slowly, and never stopped suddenly.
Robaxin (Methocarbamol) is a muscle relaxant whose effects are not fully understood, but which may relax cramped muscles. Robaxin may be taken in combination with Tryptizol to provide maximum relief.
Baclofen (baclofen) is a strong muscle relaxant normally given for very severe muscle spasticity, but has recently been recognised to be of value for many FM sufferers, especially those who are suffering severe muscle cramps and similar problems.  This is a complex drug and care must be taken with its usage.  Side-effects are mainly nausea and drowsiness, especially in the early weeks, which may need other drugs to alleviate, but these tend to settle down after a maximum period of 6 weeks, after which benefit should be optimal.  Starting dose depending on severity will probably range from 10 to 30 mg twice daily.  Lower doses will give rise to less problems, but may be slower in providing relief.  Should never be stopped suddenly.

Patients should be cautioned that muscle relaxants can cause drowsiness and they should not operate a motor vehicle when taking this type of medication. There are other muscle relaxants to try if these do not work.

OTHER MEDICATIONS:
Sleep Medications may be used occasionally during flares or when the patient is having severe sleeping problems. They can be habit forming however and are not recommended even for insomnia.  There are options to take non-prescription sleep aids which may prove more useful in that they don't cause prolonged sedation into the next day.

NSAIDs (Anti-inflammatory Medications) All of these are nearly best taken with food to prevent gastric upset.
Feldene
Clinoril (sulindac)
Motrin
Naproxen
Brufen
Voltarol
Used alone, these anti-inflammatories have not proven effective in reducing FMS pain. However Amitriptyline and Xanax's effectiveness is increased when used in combination with Ibuprofen (2400 mg per day). If the patient has arthritis osteoarthritis or tendonitis these medications would be helpful in alleviating the pain.  Feldene, Motrin, Naproxen, Brufen etc. are non-steroidal anti-inflammatories. These medications can cause stomach upset and some patients have developed bleeding ulcers.

TOPICAL CREAMS:

Axsain cream (Capsaicin 0.075%) A topical analgesic that can be obtained either through a Pain Clinic or by prescription. Axsain is effective for relief of pain of arthritis in specific areas and has been shown to help FMS patients in a similar form in the US. It is suggested that it be used three to four times per day for maximum effectiveness. Axsain can be extremely irritating to the eye so hands should be washed well after application.
Biofreeze cream, spray and gel is a useful addition to provide anti-inflammatory topical relief - available from FMSNI or through any chemist or pharmacy.
Ibuleve, Traxam etc are topical creams aimed at relieving inflammation so are not always of value with fibromyalgia pain - however, if you know you've caused minor trauma to the muscles involved these creams may well alleviate a percentage of the discomfort at least, and so are worth trying.

Pharmacists may recommend other topical creams with similar properties. There are many on the market that may be just as effective as those listed.