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Fibromyalgia Basics

Fibromyalgia Medications

Photo of fibromyalgia medications.

A combination approach using medications, nondrug therapies, and self-help strategies is the best way to tame the symptoms of fibromyalgia. However, the advantage of medications is that they don’t consume precious time and many are covered by insurance.

Most medications work in the central nervous system (CNS) reduce pain, boost alertness, or help with sleep. Although you may be eager for symptom relief, it is best to try only one medication at a time. Otherwise, you will not know which drug is helping and which medication might be causing side effects. And don’t expect one drug to do it all. Most fibromyalgia patients require two to four different medications.

Many of the CNS-acting fibromyalgia medications also help reduce the pain of irritable bowel, bladder discomfort, jaw pain, and migraine headaches. However, your doctor may prescribe additional therapies to get them under control because these conditions will exacerbate fibromyalgia. When trying a new drug, chart your progress and move on if it doesn’t work within a month. See our article: Considering a New Med?

Below is an overview of your medication options, along with links to articles on how to use specific drugs.

Pain-Relievers

  • 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 these two substances to improve your body’s ability to fight pain. Two fibromyalgia medications that increase both transmitters are: duloxetine and milnacipran (Savella, no generic available).1,2 Both are FDA-approved for fibromyalgia. Other medications that are more sedating (so taken at bedtime) include amitriptyline and cyclobenzaprine. While all these agents are anti-depressants, they are prescribed for their ability to relieve fibromyalgia pain.
  • Slowing Down the Signals: Your muscles and other tissues that hurt send signals to your spinal cord that are interpreted as pain. Certain anticonvulsant drugs, such as pregabalin (Lyrica) and gabapentin (Neurontin), work to minimize the impact of these signals by increasing the pain-fighter, GABA. Pregabalin is an FDA-approved fibromyalgia medication and it may also aid sleep.3
  • Relaxing the Muscles: People with fibromyalgia have tight, knotted muscles that refuse to relax. Treatment for this muscle tension may include a prescription for a muscle relaxant, such as tizanidine or cyclobenzaprine (beware that both are sedating).
  • Opioid Analgesics: The mildest of all opioids, tramadol, can reduce fibromyalgia pain. Aside from working as a weak opioid, it also increases serotonin and norepinephrine in the CNS to help further relieve discomfort. Many patients find them helpful, but opioids are tightly regulated and the fear of addiction is real.
  • Low-Dose Naltrexone (LDN): Instead of targeting the neurons, LDN works to quiet down the immune cells in the CNS.4 These cells are activated in fibromyalgia patients, making your neurons malfunction and ramping up your pain. An AFSA-funded trial shows LDN benefits one-third of patients, and the side effects are mild. Read more about how low-dose naltrexone works, as well as advice on giving LDN your best shot.

Fibromyalgia Medications for Sleep

Most fibromyalgia patients wake up in the morning feeling stiff and achy (e.g., like roadkill). This is due to disrupted sleep that fails to be rejuvenating. Patients often benefit from medications targeting insomnia and limb movements.

  • Insomnia Meds: Treatment for non-restorative sleep often involves medications used for people with insomnia, such as zolpidem, eszipoclone, doxepin, or trazodone. Cyclobenzaprine, a sedating muscle relaxant may also help.
  • Restless Legs Syndrome Drugs: Restless legs syndrome and associated limb movements during sleep occurs in one-fourth of fibromyalgia patients. Treatment of this disorder might include gabapentin or pramepixole (a medication that increases dopamine).

Fatigue Busters

After pain, fibromyalgia patients rate fatigue as their second worst symptom. It is much more severe than “ordinary tiredness” and significantly impacts daily function. An underactive thyroid (common in 20 to 30 percent of fibromyalgia patients) may contribute to fatigue and is treated with hormone replacement therapy. However, if you are too tired to get through the day, one of the medications below can help.

  • Serotonin Boosters: Certain medications that raise serotonin are highly alerting and can reduce fatigue. Examples include fluoxetine, escitalopram, and sertraline.
  • Alerting Agents: Other medication options include modafinil and armodafinil. Both raise dopamine and other neurotransmitters to improve alertness and cognitive functions but are regulated drugs. Buproprion is another medication that increases brain dopamine and norepinephrine. It improves mood and mildly relieves fatigue.

Alternative Medications

  • NMDA Blockers: The NMDA receptors can magnify the incoming signals to the spinal cord, making pain worse. Dextromethorphan and memantine are prescribed to counter the pain-enhancing impact of the NMDA receptors. However, one must be careful with the dosing because too much of these medications will wipe out cognitive functions.
  • Beta Blocker: The body’s sympathetic branch of the nervous system is overly active in fibromyalgia patients. This system is part of your body’s automatic “fight or flight” response. Researchers suspect the sympathetic system is partly to blame for your disrupted sleep and reduced blood flow to the muscles (more pain). Low doses of propranolol (which is a “beta blocker” type of medication) can counter the unwanted effects of an overpowering sympathetic system.
  • Lidocaine: Giving this medication intravenously (IV) shows promise but it’s costly and more research is needed. Alternatively, lidocaine patches and gels applied topically to the skin reduce muscle pain in the area beneath the skin.5 It is the more affordable option, but the patches/gels are not practical for relieving the body-wide pain of fibromyalgia. On the plus side, patches and gels are available over the counter, so you can test them out to determine if they help.
  • Cannabis/Cannabinoids: Although controversial, medical cannabis might help with pain and sleep in fibromyalgia patients. Cannabis has been approved in Canada as a fibromyalgia medication. The drug is also legal in more than half of the states in the U.S. Studies show that 25 percent of fibromyalgia patients reap significant benefits from cannabis.6 In fact, the drug appears to reduce two key symptoms: pain and sleep disruption. Further studies to evaluate medical cannabis for treating fibromyalgia are needed. Fortunately, one large AFSA-funded cannabis trial is already underway.

For information about the symptoms that the above fibromyalgia medications treat, check out our symptoms page.

References

  1. Migliorini F, at al. J Orthopaed Surg Res 18:504, 2023. Free Report
  2. Pickering G, et al. Drug Des Dev Ther 12:2485-2496, 2018. Free Report
  3. Harris RE, et al. Anesthesiology 119(6):1453-64, 2013.
  4. Aitcheson N, et al. Aust J Gen Pract 52(4):189-195, 2023. Free Report
  5. Affaitati G, et al. Clin Therapeutics 31:705-720, 2009.
  6. Giorgi V, et al. Clin Exp Rheum 38(Suppl 123):53-59, 2020. Free Article