Antidepressants – are used to control the chemicals in the brain (serotonin and norepinephrine) that affect the way pain signals are interpreted by the brain. There are many types of anti-depressant, and many medications of each type. Commonly prescribed anti-depressants include SSRIs (selective serotonin reuptake inhibitors) like Zoloft and Paxil, SNRIs(serotonin-norepinephrine reuptake inhibitors) like Effexor, Cymbalta, and the new one, Milnacipran. Fibromyalgia patients often suffer from depression as well, so it is quite common for more than one antidepressant to be prescribed to manage different aspects of the illness.
SSRI Antidepressants include: Prozac, Zoloft, Aropax,
SNRI Antidepressants include: Cymbalta, Effexor, Pristiq, Milnacipran…
TCAs (Tricyclic Antidepressants): (Older type antidepressants)Endep (Amitriptyline), Clomipramine…
MAOI (monoamine oxidase inhibitor): moclobemide, Ginkgo Biloba, Amira…
Analgesics – Pain killers. The main types of pain killers are NSAIDs (non-steroidal anti-inflammatory drugs), paracetamol, and opioids. There are also steroidal anti-inflammatory drugs. As there is no actual damage to the body that is causing the pain felt by fibromyalgia patients, the effects of analgesics can be minimal. They can also have different effects on fibro patients than those without.
NSAIDS include : Aspirin, ibuprofen, naproxen, Flurbiprofen, Oxaprozin, Doclofenac, Mobic, Ponstan, etc. The benefits of over-the-counter meds like ibuprofen shouldn’t be undervalued.
Opioids include : Morphine, Fentanyl, Oxymorphone, Oxycodone, Codeine, Pethadine, tramadol, etc. Opioids, whether natural or synthetic, do have addictive properties.
Commonly prescribed pain medications include: Tramadol (analgesic and antidepressant effects), paracetamol, codeine, and the variations and mixes of them.
Anti-seizure Medications – Lyrica (pregabalin) and Neurontin (gabapentin) are anti-epileptic drugs that can slow down the pain signals and lessen their effect on the brain, therefore reducing pain. Lyrica is popular, but is not on the PBS in Australia and can be expensive. Many fibro patients get referrals to pain clinics or hospital outpatient’s services where it is possible to buy Lyrica at the PBS rate. These meds can also help with restless legs.
Medical patches containing anaesthetics or analgesics are another option. Lidocaine is a local anaesthetic that may help.
Others – Quite often medications that are prescribe for non-related illnesses are prescribed for fibromyalgia patents. Drugs used to improve cognitive dysfunction, muscle spasms, migraines, arthritis etc. can help some patients.
Steroid injections, nerve blocks and the like help some people, but as fibromyalgia pain is neuropathic, you can end up with numb areas that still have pain.
Some Common Fibromyalgia Medications
Some common fibromyalgia medications and what they are usually prescribed for:
Tramadol is a synthetic opioid. It is available in slow or fast release and in various strengths. It also has some anti-depressant qualities. Some people say they get a ‘lift’ or ‘buzz’ when they take tramadol. It can exacerbate problems with getting to sleep, so many patients do not take it late in the day.
Cymbalta (duloxetine) is a SNRI anti-depressant. It has shown effective improvement of pain in Fibromyalgia patients, but again, many have found that the side effects far outweigh the benefits. Some do swear by its effects though.
Lyrica (Pregabalin) is prescribed for neuropathic pain. It is an anti-convulsant medication that is used to treat Fibromyalgiaand spinal cord injury. Some people swear by it and get a great benefit from taking it. Others just get the side effects. Most are in-between. Research has shown that approximately 1 in 10 peaople get a benefit from Lyrica. About 1 in 10 of those get a benefit that outweighs the side effects. One of the main side effects of Lyrica is weight gain.
Milnacipran (called Savella in the US) is a new medication that is in the process of being approved for use in Australia. It is a SNRI (an anti-depressant). It inhibits neurotransmitters from taking up serotonin and norepinephrine, which makes it very effective in the treatment of depression and fibromyalgia. In studies Milnacipran has been shown that far less patients suffer from side effects than with other meds, and that patients had reduced pain and other symptoms.
Neurontin (gabapentin) has similar effects to Lyrica. It was originally an anti-epileptic medication. Studies have shown that in about a third of patients there is significant reduction in pain. It may also help with migraines, anxiety and tinnitus.
Naltrexone, in very small doses (LDN or low dose naltrexone) has been shown to reduce fibro symptoms by about 30%. It is hard to get prescribed in Australia in the small doses that are required as it must be made up by a compounding pharmacist.
Endep (Amitryptiline) is TCA antidepressant. One of the older types. As well as being an effective antidepressant, it has the added benefits of being able to ease migraines, tension headaches, anxiety attacks and help with mood swings.
Gabapentin (Neirontin) is a drug originally developed for epilepsy. It is often prescribed for neuropathic pain. Studies have shown that it improves pain levels in abou 30% of Fibromyalgia patients.