Medications & Fibromyalgia – Why Is It so Complicated?
People often ask "what medications are best to treat fibromyalgia?"
We know that fibromyalgia is a complex condition that typically involves widespread pain, as well as other symptoms such as fatigue, ‘brain fog’ and emotional disturbances and also has a number of co-occurring conditions. While medication can play a role in your overall pain management program, in this article we highlight why the relationship between medications and fibromyalgia is so complicated.
Medication as an enabler – the table leg analogy
Now, you can’t lift a table by just one corner can you? In the same way, medication shouldn’t be relied on as the first or only source of treatment – it is just one corner of the table.
The unfortunate truth is that medication will not magically ‘cure’ your symptoms. Instead, medication is an enabler; something that can remove blockers from your life so that you do other things in an effective pain-management approach that will help to improve your condition. These include education, lifestyle changes and psychological support.
Do you have debilitating pain that impacts your ability to participate in regular movement? If so, that pain is a blocker. Medication that takes the edge off the pain is an enabler and being more active is the thing that will make the biggest improvement to your wellbeing.
Or perhaps you experience a lot of nausea that stops you from eating a balanced diet, are very tired due to insomnia, or have depression or anxiety. In these cases, anti-nausea medication, sleep aids, or antidepressants, can remove the blockers so that you can eat more healthily, get better rest, or seek support in the form of social connections and professional therapy.
So, back to the table – if medication is just one leg, what else is needed?
In another corner we have education – understanding what pain actually is, why and how it exists, and what we can do about it. In a third we have lifestyle changes. This might include being more active, taking a look at what we’re eating, getting better quality sleep and so on. And in the fourth corner is support – having personal and emotional support, such as through a coach or someone else who can give you a sense of cautious optimism, keep you on track and help out when times are a little tougher. For you, maybe you’d benefit from seeing a psychologist who is specifically trained in pain-management. Or perhaps you want to see an exercise physiologist or a dietitian.
For more ideas on some of these lifestyle changes, see our Top 5 pain-management techniques article which talks about the importance of a biopsychosocial approach to pain management (which includes more than just a biomedical approach of medication based symptom management).
What medications are common enablers?
The following is a list of medications commonly prescribed to people with chronic pain.
Antidepressants. Most antidepressant medications aim to lift and stabilize a person’s mood (reducing mood swings) and reduce anxiety. Sometimes, we can use antidepressants for pain and sleep, which makes them useful for people who don’t have depression or anxiety. For example, Amitriptyline is a tricyclic antidepressant that can also help pain management by increasing the levels of brain chemicals that help regulate mood and pain perception. Duloxetine is a type of selective serotonin and norepinephrine reuptake inhibitor (SNRIs) and helps to regulate neurochemicals that are involved in mood, pain and sleep.
Pain and inflammation modulators. We know that the pain in fibromyalgia is largely linked to changes in the body (e.g. low grade inflammation) and changes in the nervous system (e.g. central sensitization). A medication like, low dose Naltrexone affects the body's immune system and reduces inflammation. It can also help to reduce pain and improve sleep and overall wellbeing. It's important to note that standard doses of Naltrexone are usually used to help people with drug and alcohol dependencies, whereas in fibromyalgia treatment we are talking about much smaller doses, that assist the body in different ways.
Pain killers. There are over the counter medications that can reduce pain such as aspirin and ibuprofen. Prescription based pain killers aim to reduce pain. Previously opiate painkillers were prescribed for chronic pain and while they can be effective for acute pain, because of their side effects and addictiveness, opioids are not recommended for long-term pain relief.
Anti-seizure medications. These can be prescribed to assist in dampening the over sensitized nervous system. Examples include Pregabalin and Gabapentin.
According to recent studies, Duloxetine and pregabalin were found to lead to the greatest improvement in symptoms and the lowest rate of adverse events and amitriptyline was associated with greater efficacy in improving sleep, fatigue, and the overall quality of life, but its acceptability was similar to that of placebo1. Latest research suggests some improvement in symptoms from ketamine infusion.
The down side – side effects
Have you been on a medication that fixed some things but made others worse? What was the solution? Did your doctor change what you were taking? Did they give you a second medication to counter the side effects of the first? If so, perhaps that additional medication had other knock-on effects too!
Unfortunately, this is a common experience for someone with fibromyalgia. Being such a complex condition with multiple symptoms to be managed and likely a diverse care team, without a holistic or whole-person approach, you might end up on a whole cocktail of different medications and supplements. So how can you tell what is a symptom of your condition and what is a side effect of a medication?
Getting your medications right for you can be very difficult. People can respond differently to the same medication. Some medications can interfere with others, either changing their effect or reducing their overall efficacy so you have to take a higher dose.
You may need to try several different medications, at different dosages, and in different combinations, before you find what really works. It’s very important that you work closely with your doctor and don’t make any changes without consulting with them first.
Common side effects of medications commonly prescribed for fibromyalgia include drowsiness weight gain, nausea, fatigue, dry mouth, Blurred vision, constipation, dizziness, change in appetite and complications with other existing medications for co-occurring conditions. In a study examining the side effects of medications on fibromyalgia (including the drugs amitriptyline, duloxetine, milnacipran and pregabalin) between 5 to 12 out of 100 people stopped taking the medication because the side effects were so strong2.
What medication is right for you?
Hopefully by now you have realized that the answer to this is super complicated! If you take several different medications or supplements, it can be tricky to identify what is – and isn’t – working for you. The MoreGoodDays® program dives deeper into medications for fibromyalgia symptoms, how to know if they're working for you, and how best to work with your doctor to get this right.
It is very helpful to keep a medical diary, listing your symptoms – including what the symptom feels like, how it impacts you, how severe it is and when you experience it – and your medications – including what you take, what doses, and at what times of day – so that you can track changes over time.
Working closely with your healthcare team and ensuring that you are still attending to those other parts of the table (education, lifestyle changes and support) is important. If you want access to a supportive group who understands your condition consider joining our ‘Living well with fibromyalgia’ Facebook community.
If you would like more information on medications and fibromyalgia, we will shortly be launching a new additional program all about it.
