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 medications will also help reduce the pain of irritable bowel, bladder discomfort, jaw pain, and migraine headaches. However, your doctor may have to prescribe additional therapies to get them under control because these conditions can 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. Medications that increase both transmitters include two FDA-approved drugs for fibromyalgia: duloxetine and milnacipran (Savella, no generic available). Other medications that are more sedating (so taken at bedtime) include amitriptyline and cyclobenzaprine. While all of 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 anti-epileptic drugs, such as pregabalin (Lyrica) and gabapentin (Neurontin), work to minimize the impact of these signals by increasing the pain-fighter, GABA. They may also aid sleep.
- 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, may reduce your 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. 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, if at all. Read more about how LDN works.
Sleep
If you wake up in the morning feeling stiff and achy (e.g., like roadkill), that’s because most fibromyalgia patients have disrupted sleep that fails to rejuvenate them.
- 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 have been documented in one-third of fibromyalgia patients. Treatment of this disorder might include gabapentin or pramepixole (a medication that increases dopamine).
Fatigue
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) could be a contributing factor and it is treated with hormone replacement therapy. However, if you are too tired to get through the day, one of the medications below may help.
- 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 fluoxetine, escitalopram, and sertraline.
- Alerting Agents: Other medications that don’t alter serotonin include modafinil and armodafinil. Both improve alertness but are regulated drugs. A medication that increases brain dopamine and norepinephrine, buproprion, may decrease fatigue and lift mood … and be more readily prescribed but much less effective.
Alternative Medications
- NMDA Blockers: The NMDA receptors are thought to magnify the incoming signals to the spinal cord, making pain worse. Dextromethorphan and memantadine may be prescribed to counter this problem. However, one must be careful with the dosing because too much of these medications can 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 restricted blood flow to the muscles (more pain). Low doses of propranolol (which is a “beta blocker” type of medication) may help counter the unwanted effects of an overpowering sympathetic system.
- IV Infusions: One medication given intravenously (IV) is lidocaine. It has been shown to be successful for treating some fibromyalgia patients, but more research is needed. While lidocaine is a cheap drug, the IV infusions are very expensive. Plus, you will likely need multiple treatment sessions to get your fibromyalgia symptoms under control. Lidocaine patches and gels can be applied topically to the skin and may help reduce muscle pain. It is a more affordable option, but less effective.
- Cannabis/Cannabinoids: Although controversial, medical cannabis might help with pain and sleep in fibromyalgia patients. Cannabis has been approved in Canada for use in the treatment of fibromyalgia patients, and the drug is also legal in more than half of the states in the U.S. Further studies to evaluate the benefits and side effects of medical cannabis are needed.