Fibromyalgia is a chronic (long-term) medical condition that causes widespread pain and stiffness in the muscles and joints, excessive fatigue/tiredness, migraines/headaches, depression and anxiety, poor sleep, and difficulty with memory and concentration. It is not known what causes fibromyalgia, but it is believed to be a functional problem with how the brain recognizes and responds to pain. Fibromyalgia is one of the most common pain syndromes in the world and is known to affect 3% of South Africans. It can be difficult to diagnose and can significantly decrease a person’s quality of life. Fortunately, there are several treatment options available to help improve fibromyalgia symptoms. Fibromyalgia treatment involves a combination of medication and non-medication therapies, and there is not one single treatment known to work for all patients. However, there are many treatment options that can help make fibromyalgia manageable, and your healthcare provider can help determine the best options for you. Non-medication treatments for fibromyalgia include cognitive-behavioural therapy (counselling to help change perceptions and behaviour), physical therapy, exercise, stress management, sleep therapy, prescription and over-the-counter pain medications, and antidepressants.
Serotonin Norepinehprine Reuptake Inhibitors, also known as SNRIs, are antidepressants that increase levels of the neurotransmitters serotonin and norepinephrine in the brain, which influence the perception of pain, fatigue, depression, and anxiety. Though there can be a component of depression in fibromyalgia, receiving an antidepressant for fibromyalgia pain treatment does not necessarily mean you have a depression diagnosis. Examples of SNRIs used in fibromyalgia treatment are duloxetine, milnacipran and venlafaxine.
Tricyclic Medications are a class of medication that includes antidepressants and muscle relaxers that increase brain chemicals known to relieve nerve pain and depression. These are not used as often due to side effects, mainly sedation. Examples include amitriptyline and cyclobenzaprine.
Gabapentinoids are anti-seizure drugs that have the well-known benefit of improving nerve pain. These medications do have the potential for addiction and abuse but can be very effective for fibromyalgia pain management. Examples include gabapentin and pregabalin.
Sedatives, or prescription sleep aids, are used to help improve sleep. Better sleep quality can help improve other fibromyalgia symptoms. These also have potential addictive qualities and may cause undesirable side effects such as sleepwalking or psychosis. An example is zolpidem.
Pain Medications provide relief of pain symptoms associated with fibromyalgia. Opioid medications such as morphine, hydrocodone, and oxycodone are NOT recommended, because they are highly addictive and have not been proven to give adequate pain relief in fibromyalgia patients. NSAIDs (non-steroidal anti-inflammatory medications) such as ibuprofen, celecoxib, meloxicam, and naproxen are not useful as anti-inflammatory medications because there is not a big inflammation component of fibromyalgia. However, they DO help provide analgesic/pain relief effects. Acetaminophen is another pain reliever used for fibromyalgia pain. It is available over the counter.
Selective Serotonin Reuptake Inhibitors (SSRIs), which are antidepressants that increase levels of serotonin to improve depression and anxiety symptoms, have also been found to help in fibromyalgia pain relief. However, they are not usually considered as effective as SNRIs. Examples include sertraline, citalopram, escitalopram, fluoxetine, and paroxetine.
Side effects associated with fibromyalgia medication treatments include:
-Drowsiness/Fatigue -Weight gain -Sexual dysfunction
-Dizziness -Headache – Increased heart rate/blood pressure
-Nausea -Diarrhoea
-Temporary memory loss -Constipation
-Dry Mouth -Agitation
Serious side effects that are rare, but possible, with these medications are discussed below.
Serotonin Syndrome is a serious health condition associated with increased doses or taking more than one medication that increases levels of serotonin. It is a medical emergency. Seek medical attention right away if you are experiencing nausea/vomiting/diarrhoea, high heart rate and blood pressure, confusion, stiff muscles, and tremors/shivering.
Suicidal Thoughts/Action- This can occur within the first few weeks of starting treatment with an antidepressant. Seek medical help right away if you experience this.
Addiction/Drug Abuse– This can be common with a few pain medications and sedatives used in fibromyalgia treatment. It is important you take medications exactly as prescribed and have close follow-up care with your doctor.
Organ Failure– Kidney and/or liver failure are possible with these medications. Symptoms include decreased urination, abdominal pain, and yellowing of the skin and whites of the eyes. If you have these symptoms, talk to your healthcare provider. It is important to follow up with your provider and have routine bloodwork done when taking medications long-term for fibromyalgia treatment. This can help detect problems with organ functioning.
The best treatment for fibromyalgia is a combination of physical activity, self-care, cognitive-behavioural therapy, and medications to help control symptoms. Remember that treatment regimens for fibromyalgia will vary from patient to patient and may require trying more than one medication or therapy to find something that is effective. Some of these medications should not be stopped suddenly, as this can cause a withdrawal/discontinuation syndrome with unpleasant flu-like side effects, which may increase seizure risk. It is important to follow up with your healthcare provider regularly and take medications exactly as described, as well as participate in other non-medication treatment programs.