Treatment Options for Fibromyalgia

Drug Therapy for Fibromyalgia

There are several classes of medications available in the pharmacological treatment of fibromyalgia. In most cases, a combination of medications is usually necessary to achieve optimal control of symptoms. The major types of drugs that are used as drug therapy for fibromyalgia include:

• Antidepressants
• Analgesics
• Anticonvulsants
• Muscle relaxants

Antidepressants

There are three types of antidepressant medications that are available for the treatment of fibromyalgia:

• Tricyclic antidepressants
• Selective serotonin reuptake inhibitors
• Serotonin norepinephrine reuptake inhibitors

Tricyclic Antidepressants

Tricyclic antideprssants (TCAs) are used in patients with fibromyalgia primarily to improve the quality of sleep, however, studies have shown that they are also beneficial for improving fatique, pain, and general well-being (e.g., depression).

Examples of tricyclic antidepressants that may be used for the treatment of fibromyalgia include:

• amitriptylene (Elavil) - most commonly used for fibromyalgia
• cyclobenzaprine (Flexoril)
• doxepin (Sinequan)
• nortriptylene (Pamelor)

Selective Serotonin Reuptake Inhibitors

Many people with fibromyalgia have lower than normal levels of a neurotransmitter (chemical messenger) called serotonin which plays an important role in regulating a variety of physiological functions including general well-being (e.g., depression) and sleep, and pain tolerance. A class of antidepressant medications known as selective serotonin reuptake inhibitors (SSRIs) is, therefore, used to help boost the levels of serotonin in people with fibromyalgia. These medications (SSRIs) are usually much more effective for controlling symptoms of fibromyalgia when used in combination with either another antidepressant, a muscle relaxant, or an analgesic medication.

Examples of SSRIs that may be used for the treatment of fibromyalgia include:

• fluoxetine (Prozac)
• paroxetine (Paxil)
• citalopram (Celexa)
• sertraline (Zoloft)
• escitalopram (Lexapro)

Serotonin Norepinephrine Reuptake Inhibitors

Another class of antidepressants that may be used for the treatment of fibromyalgia is known as serotonin norepinephrine reuptake inhibitors (SNRIs). These medications are used in fibromyalgia primarily to relieve symptoms of pain and depression. Commonly prescribed SNRIs include:

• duloxetine (Cymbalta) - in June 2008, this medication was approved by the U.S. Food and Drug Administration (FDA) for the treatment of fibromyalgia
• venlafaxine (Effexor)
• milnacipran

Analgesics

Analgesics are medications that are used to relieve pain. Commonly used analgesics to control mild to moderate pain include aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). Opioid-based analgesic medications, which carry the risk of addiction, are usually reserved for people with chronic, severe pain.

Analgesic medications that may be used for pain control in people with fibromyalgia include:

• Tramadol (Ultram) - may be used alone or combined with acetaminophen (e.g., Tylenol)

• Nonsteroidal anti-inflammatory drugs (NSAIDs)- These medications are rarely used alone to treat fibromyalgia pain but are usually more effective when used in combination with a tricyclic antidepressant (e.g., amitriptylene). Examples of commonly used NSAIDs include:

  • acetaminophen (e.g., Tylenol)
  • ibuprofen (e.g., Advil; Motrin)
  • naproxen (e.g., Aleve)
  • diclofenac (e.g., Voltaren; Cataflam)

Anticonvulsants

Although the older anticonvulsant medications such as gabapentin (Neurontin) have not been studied extensively in people with fibromyalgia, a newer anticonvulsant called pregabalin (Lyrica) has been found to improve pain, sleep, and fatigue in some patients with fibromyalgia.

In June of 2007, the FDA approved the use of pregabalin (Lyrica) for the treatment of fibromyalgia. It was shown to reduce pain and improve daily functioning for some patients with fibromyalgia.

Muscle Relaxants

Medications known as muscle relaxants are sometimes used in people with fibromyalgia to relieve severe muscle spasms. Muscle relaxants are usually combined with another type of medication such as an antidepressant or an analgesic. Examples of muscle relaxants include:

• carisoprodal (Soma)
• methocarbamol (Robaxin)
• metaxalone (Skelaxin)
• orphenadrine (Norflex)
• cyclobenzaprine (Flexeril)

Other Medications for Fibromyalgia

A variety of other medications may be used in select patients with fibromyalgia that include:

• Benzodiazepine sedatives - These medications are used primarily to control sleep disturbances in people with fibromyalgia. Examples include:

  • diazepam (Valium)
  • clonazepam (Klonopin)
  • alprazolam (Xanax)

• Nonbenzodiazepine sedatives - These medications are also used primarily to control sleep disturbances in people with fibromyalgia. Examples include:

  • buspirone (BuSpar)
  • zaleplon (Sonata)
  • zolpidem (Ambien)
  • hydroxyzine (Vistaril)

• Trigger point injections of either an anesthetic solution (e.g., Procaine) or botulinum toxin (Botox) may in some cases be used to relieve muscle pain at specific tender points in people with fibromyalgia.