Fibromyalgia Medication Options

Reducing the head to toe pain of fibromyalgia is the primary goal of most medications your doctor will prescribe. But not every drug works the same way. Some operate in the central nervous system to filter out pain, while others target the muscles to ease discomfort.

Aside from pain-focused treatments, medications can target your sleep problems and daytime fatigue, not to mention possible symptoms of co-occurring conditions like irritable bowel, bladder discomfort, jaw pain, or migraine headaches. If symptoms of arthritis or peripheral neuropathy persist, your doctor will prescribe medication to target your specific regional pains.

Your fibromyalgia treatment plan must be individualized according to your symptoms and response to previously prescribed therapies. However, a brief sampling of possible treatment options is given below.

Pain

• Boosting Your Brain Chemicals: Serotonin and norepinephrine work together in the brain and spinal cord to tone down pain-related messages. Ideally you would want to boost or increase these two substances to improve your body’s ability to fight pain. Medications that increase these two transmitters include two FDA-approved drugs for fibromyalgia: Cymbalta (duloxetine)¹ and Savella (milnacipran).² Other similar medications that are more sedating (so taken at bedtime) include amitriptyline and doxepin. While all of these agents are anti-depressants, they are prescribed for their ability to relieve fibromyalgia pain.³
• Slowing Down the Signals: Your muscles and other tissues that hurt send signals to your brain that are interpreted as pain. Certain anti-epileptic drugs, such as Lyrica (pregabalin) and Neurontin (gabapentin), work to slow down and minimize the impact of these signals to lessen the pain of fibromyalgia.⁴ They may also aid sleep.
• Relaxing the Muscles: People with fibromyalgia usually have tight, knotted muscles that refuse to completely relax. Treatment for this muscle tension may include a prescription for a muscle relaxant medication, such as Xanaflex (tizanidine) or Flexeril (cyclobenzaprine).⁵
• Opioid Analgesics: The mildest of all opioids, Ultram (tramodol) may reduce your fibromyalgia pain. Aside from working as a weak opioid, it also boosts the action of serotonin and norepinephrine to help further reduce discomfort.⁶ More potent opioids may be needed for the treatment of moderate to severe pain.
• Dopamine-like Drugs: When the body is subjected to pain, dopamine is released from the brain to ease the pain. Yet, for unknown reasons this dopamine release does not occur in fibromyalgia patients. So it’s possible that you may benefit from treatment with a dopamine-enhancing medication, such as Mirapex (pramepixole).⁷

Sleep

People with fibromyalgia wake up in the morning feeling unrefreshed because a night in bed does not restore or rejuvenate them.

• Insomnia Meds: Treatment of this non-restorative sleep quality often involves a medication used for people with insomnia, such as Ambien (zolpidem), Lunesta (eszipoclone), or trazodone.⁵
• Limb Movement Drugs: Restless legs syndrome or limb movements during sleep has been documented in one-third of fibromyalgia patients.⁸ Treatment of this disorder might include low doses of Mirapex (pramepixole) or clonazepam.

Fatigue

After pain, fibromyalgia patients rate fatigue as their second worst symptom.⁹ It is more severe than what people consider as ordinary tiredness and significantly impacts your quality of life. If fatigue is a factor in your fibromyalgia, talk to your doctor. You may be low on thyroid hormone, which is common in 20 to 30% of fibromyalgia patients and causes extreme fatigue.¹⁰ The good news is that this condition can be determined by a blood test and thyroid hormone can be supplemented. However, if your tests are all normal, your physician may prescribe one of the medications below to help reduce your exhaustion.

• Serotonin Boosters: Although a medication that only boosts serotonin without increasing norepinephrine does not help with pain, some agents can be highly alerting to reduce fatigue. Examples include Prozac (fluoxetine), Lexapro (escitalopram), and Zoloft (sertraline).
• Alerting Agents: Other alerting medication that works completely different from the serotonin boosters include Provigil (modafinil), Nuvigil (armodafinil), Symmetrel (amantadine), and Wellbutrin (buproprion).⁵

What about other treatment options?

If the side effects of medications bowl you over or you wish to limit drug use, read about nondrug therapies and self-help strategies for fibromyalgia.

References