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Arthritis Today

Fibro Medications are Not a Cure All

Researchers and doctors recommend a multifaceted approach to fibromyalgia treatment.

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When dealing with the pain, fatigue and frustration of fibromyalgia, you might yearn for a magic pill. Unfortunately, studies show that it likely doesn’t exist. Instead, patients should explore various types of therapies to experience relief.

There are currently three FDA-approved drugs for use specifically as fibromyalgia treatments.

  • Pregabalin (Lyrica) has shown some benefits in relieving anxiety, some sleep problems and pain in people with fibromyalgia. Another related medication, gabapentin (Neurontin), is sometimes used off-label (meaning it is used for but not FDA-approved for a condition) as a fibromyalgia treatment.
  • Duloxetine (Cymbalta) and milnacipran (Savella) are dual-acting norepinephrine and serotonin reuptake inhibitors (antidepressants). They raise levels of neurotransmitters known to prevent pain transmission. Other antidepressants that may provide relief include amitryptiline hydrochloride (Elavil, Endep), fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft), but they are not approved specifically for use with fibromyalgia.

Although the approval of duloxetine, milnacipran and pregabalin might indicate progress in the treatment of fibromyalgia, a 2014 review of them in Arthritis Research and Therapy says that for most people living with this condition, the medications either didn’t provide relief or were stopped due to side effects.

“Both physicians and patients should have realistic expectations about the potential benefit of these drugs,” says Winfried Häuser, MD, one of the authors of the review and an associate professor of psychosomatic medicine at the Klinikum Saarbrucken in Germany. “Although patients may initially experience symptom relief with good tolerance, the majority will ultimately discontinue therapy because of inadequate response or unacceptable side effects.”

Side effects of pregabalin include weight gain, swelling, dizziness and drowsiness, among others. Both duloxetine and milnacipran have been known to cause nausea, drowsiness, dry mouth, constipation and increased sweating. Remember that medications affect everyone differently. It’s important to work with your doctor on weighing the benefits and risks of each of your medications.

“Even though I have had a few patients experience modest benefits from them, I rarely prescribe these medications to my patients,” says Robert Keenan, MD, MPH, an assistant professor of rheumatology at Duke University School of Medicine. “Many of my patients experience significant weight gain and other side effects that counteract any benefit they might see otherwise.”

Although pregabalin, duloxetine and milnacipran are the only drugs approved specifically for fibromyalgia, doctors also use other medications to treat fibromyalgia to manage symptoms such as pain, fatigue and sleep challenges, including:

  • Analgesics, including tramadol (Ultracet, Ultram)
  • Muscle relaxants, such as cylobenzaprine (Cycloflex, Flexeril)
  • Fatigue medications, such as modafinil (Provigil)

A Multidisciplinary Approach is Best

“In the absence of a single gold standard medication, patients are treated with a variety of drugs from different categories, often with limited evidence,” Dr. Häuser says.

Dr. Häuser says if a patient isn’t responding to drug treatment after four weeks, it should be stopped. He believes physicians should be discouraged from treating fibromyalgia with medication alone, instead also incorporating exercise and counseling into their approach.

Carmen Gota, MD, a rheumatologist at the Cleveland Clinic in Ohio agrees that a multidisciplinary approach is essential in treating fibromyalgia patients.

“Drugs alone are not sufficient,” Dr. Gota says. “You have to look at the whole patient and combine treatment with aerobic exercise and a comprehensive approach that includes cognitive-behavioral therapy and occupational therapy.”

Although studies show that a well-rounded approach helps fibromyalgia patients, Keenan says that in many of his patients, their attitude is their best asset.

“My patients with a positive mental approach to their fibromyalgia typically do better than those who focus on the negative,” says Keenan. “A good attitude can take you a long way.”

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