Several different medications may be prescribed at different times to help manage fibromyalgia symptoms, including antidepressants, pain medications, and sleeping medications.
There are several medications that have been FDA-approved specifically for the treatment of fibromyalgia These have been shown to be effective at reducing pain and improving function in those with fibromyaglia. These include
- Duloxetine (Cymbalta®)
- Pregabaline (Lyrica®)
- Milnacipran (Savella®)
These medications act differently than other treatments by altering the way the body processes pain signals.
Other medications may also be prescribed to bring specific symptoms under control.
These have been prescribed for several years to help reduce the pain and improve sleep in those with fibromyalgia. Antidepressants elevate the levels of certain chemicals in the brain, including serotonin and norepinephrine (which was formerly called adrenaline). Low levels of these chemicals are associated not only with depression, but also with pain and fatigue. Increasing the levels of these chemicals can reduce pain in people who have fibromyalgia.
1) Tricyclic antidepressants
When taken at bedtime in dosages lower than those used to treat depression, tricyclic antidepressants can help promote restorative sleep in people with fibromyalgia. They also can relax painful muscles and heighten the effects of the body's natural pain-killing substances called endorphins.Tricyclic antidepressants have been around for almost half a century. Some examples of tricyclic medications used to treat fibromyalgia include amitriptyline (Elavil®) and cyclobenzaprine (Flexeril®). Both amitriptyline and cyclobenzaprine have been shown to be effective for the treatment of fibromyalgia.
2) Selective serotonin reuptake inhibitors (SSRIs)
If a tricyclic antidepressant fails to bring relief, doctors sometimes prescribe a newer type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). As with tricyclics, doctors usually prescribe these for people with fibromyalgia in lower dosages than are used to treat depression. By promoting the release of serotonin, these drugs may reduce fatigue and some other symptoms associated with fibromyalgia. The group of SSRIs includes fluoxetine (Prozac®) and sertraline (Zoloft®). SSRIs may be prescribed along with a tricyclic antidepressant. Because they make people feel more energetic, they also interfere with sleep, which often is already a problem for people with fibromyalgia. Studies have shown that a combination therapy of the tricyclic amitriptyline and the SSRI fluoxetine resulted in greater improvements in the study participants' fibromyalgia symptoms than either drug alone.
3) Mixed reuptake inhibitors
Some newer antidepressants, such as venlafaxine (Effexor®) raise levels of both serotonin and norepinephrine, and are therefore called mixed reuptake inhibitors.
Benzodiazepines help some people with fibromyalgia by relaxing tense, painful muscles and stabilizing the erratic brain waves that can interfere with deep sleep. Benzodiazepines also can relieve the symptoms of restless legs syndrome, which is common among people with fibromyalgia. Restless legs syndrome is characterized by unpleasant sensations in the legs as well as twitching, particularly at night. Because of the potential for addiction, doctors usually prescribe benzodiazepines only for people who have not responded to other therapies. Benzodiazepines include clonazepam (Klonopin®) and diazepam (Valium®).
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Over-the counter pain medications such as aspirin, ibuprofen and acetaminophen may help take the "edge" off of fibromyalgia pain and lessen stiffness. But the effects vary from patient to patient.
As their name implies, nonsteroidal anti-inflammatory drugs, including aspirin, ibuprofen (Advil®, Motrin®), and naproxen sodium (Anaprox®, Aleve®), are used to treat inflammation. Although fibromyalgia does not result from muscle inflammation, NSAIDs may be helpful for their ability to reduce pain. The drugs work by inhibiting substances in the body called prostaglandins, which play a role in pain and inflammation. These medications, some of which are available without a prescription, may help ease the muscle aches of fibromyalgia. They may also relieve menstrual cramps and the headaches often associated with fibromyalgia.
The doctor may prescribe other medications depending on a person's specific symptoms or fibromyalgia-related conditions. For instance, triptans that are typically prescribed for migraine headaches may be prescribed to reduce the frequency or intensity of headaches experienced by those with fibromyalgia.
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Last updated: 1/8/2019