Pain Management

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ANTI-EPILEPTIC DRUGS
Gabapentin – Neurontin is a useful drug to try for many with FMS pain that has proven intractable to other pain meds perhaps. However, it is important to recognise the inherent dangers in using such drugs for this purpose, namely that abuse can actually precipitate seizures as can sudden withdrawal of any reasonable dosage, so extreme care needs to be taken. Many have found that this drug has proven extremely good at relieving up to 85 percent of their pain to good effect, so a useful drug to try where others have failed perhaps.
Pregabalin - Lyrica - has been long hailed as a new 'wonder drug' of sorts, having had tremendously positive results in clinical trials, and reports of its efficacy were circulating in the UK long before it became available in 2004. As with neurontin, care must be taken in using this drug, as it will cause varied side effects at the outset, namely drowziness/mild dizziness/visual disturbances or other similar neurological upsets for a few days. Again, such drugs must be started and stopped slowly over a period of a week to 10 days for best outcome. Further information on this one in particular can be found elsewhere on the website (under research).

ANALGESICS
Mild to moderate pain:
Paracetamol
Paracodol
(Paracetamol/codeine mixes)
Co-Proxamol (Distalgesic)
Co-Dydramol
Co-Codamol

Severe pain:
These medications are generally prescribed for those requiring a greater analgesic effect than paracetamol alone can deliver and/or those who are allergic to, or cannot take, aspirin, so many combine the paracetamol with another substance e.g. codeine to provide better relief and this can cause difficulties with accidental overdosing if you are unaware.
DF118 *
Meptid *
Zydol (tramadol) *  - This should be started very slowly i.e. 50 mg or less once daily and build up to the stated dosage over a period of a week or more, otherwise you will most likely suffer a very bad headache and nausea the following day.  Once tolerance has built up though you may find it an excellent reliever of the bulk of your background pain.
Tylex * Kapake *  Both of these drugs contain a high quantity of codeine - highly addictive, and may have very severe side effects including heavy sickness and/or colic if you are sensitive or allergic to them.  However, it is important to be aware they also contain 500 mg of paracetamol so should not be taken with any other paracetamol painkiller.   Again, take a very small 1/2 dose if necessary to begin with and build slowly.  If sickness proves your only side effect and you find the pain relief reasonable then request an anti-emetic e.g. Motilium to take with them to settle the nausea.

Intractable pain and for short-term flare-up usage only where possible:
The role of narcotic pain relievers in fibromyalgia is to temporarily relieve an exacerbation of FMS pain, not as daily analgesics.  Analgesics generally considered for use are: morphine derivatives and pethidine. These medications are prescribed for pain at the physician's discretion. Please note that even strong analgesics may NOT alleviate pain in Fibromyalgia.

MST * Oral form of morphine.
OxyContin SR * (A morphine derivative that is proving useful for some types of pain.  Although not primarily given purely for FMS pain as it rarely helps, it may be prescribed where there is combination pain present (i.e. the patient has more than one chronic pain condition), and is good in that being slow acting it tends to provide more sustained pain relief than many of the shorter acting drugs.  OxyNorm is the fast acting alternate used mostly in conjunction with the OyxContin for breakthrough pain. )
Cyclimorph* (usually injectable)
Pethidine* (usually injectable)
Temgesic* (sublingual)
* These drugs are potentially addictive and if used frequently, may lose their effectiveness as well as causing rebound pain in certain people.  Your GP should also provide you with information on all possible side effects and restrictions, but the obvious ones of not using machinery or driving apply to these at all times.  See notes below.

Analgesic information:
Painkillers rank as the most common drug prescribed for fibromyalgia for obvious reasons but many people are very dependent on their doctors willingness and understanding in providing those drugs that will give reasonable pain relief without causing further problems or excessive side effects.  For more detailed information you should check out either the article on this site with respect to this subject or head off to some of the excellent pain links where you can obtain more specialised information than we can provide here. 

When first diagnosed most patients will usually be offered an SSRI (see above) and a mild painkiller e.g. Paracetamol or a paracetamol/codeine mix where the codeine component is quite low.  However, if you've had reason to take a lot of painkillers in the past or your pain is pretty entrenched, you will most likely find that these aren't really effective.   If so, it's worth discussing with your doctor the option on at least a trial of something stronger.  If you show understanding of both your own condition and the difficulties of taking chronic pain relief, your GP should hopefully be willing to work with you to help you obtain a better solution.  Be aware though that bit by bit you may progress up the 'analgesic ladder' and obviously may reach a point where there really is neither anything further to try nor anything that will better alleviate your pain.  Because this is a chronic condition you need to understand that there is a major issue about taking these types of drugs long term i.e. longer than 6 months.   When you first take any new drug, your brain responds by providing receptors for the drug to 'lock' into so that it can then break down the chemical and use it.  However, as you continue to take this drug these receptors become more in number, which equally requires a higher dose of the chemical to fill them (the brain doesn't like empty spaces!) - there is seemingly a finite limit on the number of receptors that can be produced so eventually you begin to get the symptoms of tolerance and dependence as the brain struggles to keep a chemical balance but can't.   The more important aspect of chronic medication and this is seen more commonly in the treatment of migraine headaches - the drugs themselves can cause what's known as rebound symptoms whereby if you don't take a dose the brain will respond by producing the symptoms (headache, pain etc) in order to provoke you to do so.  These issues are complex and sometimes hard to understand.   The important element therefore is to try not to hit the top rung of the 'ladder' too early on, and if you do get to that point, to be willing to have breaks from the drugs (wean off slowly) for a period to re-establish a new tolerance level.    This applies most to the full narcotics i.e. morphine, Pethidine etc.  These should preferably only be used on a very short-term or intermittent basis so that you at least have them to fall back on for a major flare-up.   However, it should equally be pointed out that even these at the regular dose won't really have a major effect on FMS pain.   You may have to trade off your life for a day or two and be willing to cope with rough side effects if you take a dosage high enough to actually stop the pain for any length of time.  Please also be aware that the heavier drugs will obviously cause more serious side effects, in particular drowsiness and you have a legal responsibility to inform the DVLNI in N. Ireland (or other relevant body in your area)  if you are placed on narcotics in particular and wish to continue driving.   You should discuss this issue with your GP beforehand. 

So, all these issues must be addressed by you and your doctor in assessing the best route of pain relief for you.  Just be aware that there ARE alternatives as shown in the list above, and if you're not happy with one drug, you should check if your doctor would consider a different one. 

Download the Meds brochure (PDF). 

A superb website with loads of additional information not only on the same drugs mentioned above, but also on many other aspects of pain is the Coventry Pain Clinic - operated by a Consultant in Pain Management and Medical Osteopathy.   You can download information and E-books at a minimal cost and get online help if you require it - HIGHLY RECOMMENDED!!

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.