Medications for the Treatment of Fibromyalgia

Talk to your doctor about these options

While there is no sure-fire cure for the pain and fatigue that accompanies fibromyalgia, certain medications may help you cope with the disease so that you can continue to participate in daily activities. Medications can help ease widespread pain, while also decreasing symptoms such as depression and sleep disorders. Hopefully with these medications in tow, patients with fibromyalgia, or FM, can live better, healthier lives.

When combining these medications with other treatments and lifestyle changes, such as working on your diet, maintaining a consistent exercise plan, and other self-care tips, life with FM may be easier. Physical therapy and mental/behavioral therapy also provide opportunities to help reduce the frequency of your symptoms.

Common Prescription Medications

Medications prescribed for FM work to turn down the “pain volume” in the central nervous system (CNS), according to the Arthritis Foundation. They can also help to aid common symptoms of the disease, such as reducing fatigue, improving mood, promoting consistent sleep, and easing other health problems that tend to co-occur with fibromyalgia, such as irritable bowel syndrome and restless legs syndrome. Currently, there are three FDA-approved medications to specifically treat fibromyalgia:

  • Duloxetine (Cymbalta) – a nerve pain and antidepressant medication (SNRI)
  • Milnacipran (Savella) – a nerve pain and antidepressant medication (SNRI)
  • Pregabalin (Lyrica) – a nerve pain medication (anticonvulsant)

Other medications may be used “off-label,” meaning they have observed benefits to fibromyalgia, but are not specifically FDA-indicated to treat the disorder, according to the Arthritis Foundation.

Antidepressants

Antidepressants are commonly prescribed for individuals with FM to increase the number of serotonin neurotransmitters, or brain chemicals, which help decreases one’s sensitivity to pain. There are currently three types of antidepressants, and they all have different effectiveness towards fibromyalgia, as described below:

  • Serotonin-norepinephrine reuptake inhibitors (SNRIs) raise the levels of two neurotransmitters—serotonin and norepinephrine—responsible for regulating mood and sensitivity to pain. This class of antidepressants is most commonly promoted for fibromyalgia management. Despite being specifically designed for the treatment of fibromyalgia, SNRIs have been shown to be, at most, mildly effective in reducing pain.
  • Selective serotonin reuptake inhibitors (SSRIs) are the second type of antidepressants and are a little older than SNRIs. While originally developed to treat depression, they can sometimes be prescribed for fibromyalgia. SSRIs have been shown to be mildly effective for reducing pain and depression, and have an insubstantial effect on sleep disturbance, according to the Institute For Chronic Pain.
  • Tricyclic antidepressants, which have a sedating effect that improves sleep, are the third and oldest class of antidepressants. While also originally developed for depression, they have been used frequently for FM patients, as well as for chronic pain and sleep disturbances in general. According to the Institute for Chronic Pain, these antidepressants are the most effective in managing FM. They are moderately effective in reducing pain, sleep disturbance, and mildly effective in reducing fatigue.

Other antidepressants, according to the Arthritis Foundation, that may provide relief include amitriptyline hydrochloride (Elavil, Endep), fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).

Due to the numerous side effects associated with antidepressants, they tend to have high rates of discontinued use. Possible side effects include drowsiness, dizziness, headache, dry mouth, weight gain, dry eyes, sexual dysfunction, difficulty urinating, and gastrointestinal discomfort, according to the NYU Langone Medical Center.

Antiepileptics (Anticonvulsants)

Typical antiepileptic/anticonvulsant medications used to treat epilepsy are useful to reduce certain types of pain as well, according to the Mayo Clinic. According to the Institute for Chronic Pain, analysis of antiepileptics show that they are only mildly effective for the treatment of fibromyalgia.

Pregabalin (Lyrica) and Gabapentin (Neurontin), for instance, work to calm overactive nerve cells that send pain signals throughout the body, while also improving sleep and anxiety, according to the New York University Langone Medical Center. Pregabalin, in particular, can help reduce pain by up to 25% and improve overall vitality, according to the John Hopkins Lupus Center.

Side effects of anticonvulsants may include drowsiness, dizziness, fluid retention, and weight gain.

Muscle relaxants

Muscle relaxers provide another option to reduce the pain commonly associated with fibromyalgia, and can also improve sleep in some patients, according to the NYU Langone Medical Center. One example of a muscle relaxant used in the treatment of FM is cyclobenzaprine (Cycloflex, Flexeril).

Common side effects of muscle relaxants include dizziness, drowsiness, blurred vision, difficulty urinating, constipation, and dry mouth, according to the NYU Langone Medical Center.

Beyond these three core types of medications, other typical medications for the treatment of fibromyalgia include benzodiazepines (such as Valium), non-narcotic analgesics (prescription painkillers such as tramadol [Ultram]), and opioids (such as Oxycodone) if the medications already listed do not work (or cannot be taken by the patient).

NSAIDs/OTC Drugs In Combination

Non-steroidal anti-inflammatory medications (NSAIDs), such as ibuprofen (Advil) and naproxen (Aleve), can be obtained over-the-counter or prescribed. Fibromyalgia patients can commonly take these medications to help ease deep muscle and joint pain caused by the disease, according to the NYU Langone Medical Center. However, taking large doses of NSAIDs for long periods of time can increase the risk of heartburn or gastrointestinal bleeding and lead to cardiovascular, kidney, and liver problems, as well as fluid retention.

Therefore, NSAIDs on their own are usually seen as an ineffective treatment, according to the Institute for Chronic Pain, and are more useful in relieving pain when combined with other medications used to manage the disease.

Talk with your doctor to figure out the best way to use these medications as part of your overall treatment plan. The Arthritis Foundation offers a breakdown of these common medications, their benefits and risks, and other things you need to know before taking them.

-Additional reporting by Steven Aliano

Updated on: 06/20/18
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