Fibromyalgia Information & Local Support
Information about Medications
Often, you may have to try many medications before you find the optimum
ones for you. We react differently to each medication, and there is no
"cookbook recipe" for FMS or MPS. What works well for one of us can
be ineffective for another. A medication which puts one person to sleep may
keep another awake. Each of us has our unique combination of neurotransmitter
disruption and connective tissue disturbance. We need doctors who are willing
to stick with us until an acceptable symptom relief level is reached.
These are not the only medications in use for FMS & MPS, but are simply
a selection to show what is available. It may be necessary to address each
perpetuating factor, such as pain, lack of restorative sleep, and muscle
rigidity, separately. Medictions should be used along with a program of proper
diet, life style changes, mindwork and bodywork.
Medications which affect the central nervous system are appropriate for
FMS&MPS Complex. They target symptoms of sleep lack, muscle rigidity, pain
and fatigue. Pain sensations are amplified by FMS, and so the pain of MPS pain
is multiplied. FMS&MPS Complex patients often react oddly to medications.
It is the rule rather than the exception that a FMS&MPS Complex patient
will save strong pain meds from surgery or injury for when they REALLY need it
-- for an FMS&MPS Complex "flare". This is a sign that your needs
aren't being met. I give you the following quotes. I hope you will pass them on
to your doctor. They are from "PAIN A Clinical Manual for Nursing
Practice", by McCaffrey and Beebe.
- Health professionals "often are unaware of their lack of knowledge
about pain control."
- "The health team's reaction to a patient with chronic nonmalignant
pain may present an impossible dilemma for the patient. If the patient
expresses his depression, the health team may believe the pain is psychogenic
or is largely an emotional problem. If the patient tries to hide the depression
by being cheerful, the health team may not believe that pain is a significant
- "Research shows that, unfortunately, as pain continues through the
years, the patient's own internal narcotics, endorphins, decrease and the
patient perceives even greater pain from the same stimuli."
- "The person with pain is the only authority about the existence and
nature of that pain, since the sensation of pain can be felt only by the person
who has it."
- "Having an emotional reaction to pain does not mean that pain is
caused by an emotional problem.
- "Pain tolerance is the individual's unique response, varying between
patients and varying in the same patient from one situation to another."
- "Respect for the patient's pain tolerance is crucial for adequate pain
- "THERE IS NOT A SHRED OF EVIDENCE ANYWHERE TO JUSTIFY USING A PLACEBO
TO DIAGNOSE MALINGERING OR PSYCHOGENIC PAIN."
- "No evidence supports fear of addiction as a reason for withholding
narcotics when they are indicated for pain relief. All studies show that
regardless of doses or length of time on narcotics, the incidence of addiction
is less than 1%."
This book is so clear and so well documented that I suggested my local
library buy it. I wanted everyone in the area to have access to this
information. Once you read this book, you get a greater understanding of pain
and pain medications, as well as coping mechanisms. Many non-pharmaceutical
methods of pain control are also described thoroughly in this reference.
It's normal to be depressed with chronic pain, but that doesn't mean
depression is causing the pain. Maintenance with mild narcotics (Darvocet,
Tylenol #3, Vicodin-Lorcet-Lortab) for nonmalignant (non-cancerous) chronic
pain conditions be a humane alternative if other reasonable attempts at pain
control have failed. The main problem with raised dosages of these medications
is not with the narcotic components, per se, but with the aspirin or
acetaminophen that is often compounded with them. For medical journal
documentation on the use of narcotics for non-malignant chronic pain, see
"The Fibromyalgia Advocate". Narcotics should not be given in
conjuntction with benzodiazepines, as the latter antagonize opioid analgesia.
Narcotic analgesics are sometimes more easily tolerated than NSAIDs, the
Non-Steroidal Anti-Inflammatory Drugs. Neither FMS nor MPS is inflammatory.
NSAIDS may disrupt stage 4 sleep. Prolonged use of narcotics may result in
physiological changes of tolerance or physical dependence (with- drawal), but
these are not the same as psychological dependence (addiction). Under-treatment
of chronic pain of MPS/FMS results in a worsening contraction which results in
even more pain. "Anti- anxiety" medications are not an indication
that your symptoms are "all in the head". These medications don't
stop the alpha-wave intrusion into delta-level sleep, but they extend quantity
of sleep, and may ease daytime symptom "flares".
Stay tuned to the Fibromyalgia Network for news of more medications of
possible use in FMS & MPS Complex.
- Guaifenesin appears to reverse the process of FMS. It is in experimental
use. I have a whole chapter in both books on it. A flawed study was done that
seemed to show it was no better than placebo.
Please see the frame on
- Folic acid:
- This vitamin is often in short supply in FMS & MPS. Drs. Travell and
Simons found it especially effective for Restless Leg Syndrome.
- Relafen (nambumetone):
- this is a NSAID that is often well tolerated because it is absorbed in the
intestine, sparing the stomach.
- a helpful sleep aid/antihistamine which is safe in pregnancy. This should
be the first sleep medication tried. some patients have reported urinary
retention. The starting dose is 50 mg 1 hr. before bed. Increase as tolerated
until symptoms are controlled or 300 mgs. About 20% of patients react with
excitation rather than sedation when taking Benadryl. (non-prescription)
- Desyrel (Trazadone):
- an antidepressant that helps with sleep problems. It must be taken with
- Atarax (hydroxyzine HCl):
- suppresses activity in some areas of Central Nervous System to produce an
anti-anxiety effect. This antihistamine and anxiety-reliever may be useful when
itching is a problem.
- a tricyclic antidepressant (TCA) is cheap and sometimes useful. It
generates a deep stage four sleep. Most patients will adapt to this med after a
few weeks. It can cause photosensitivity and morning grogginess. It often
causes weight gain, dry mouth, as well as stopping the normal movements of the
intestine. It may cause Restless Leg Syndrome.
- Wellbutrin (bupropion HCl):
- is a weak Specific Serotonin Reuptake Inhibitor (SSRI) and antidepressant
that is sometimes used in FMS&MPS Complex in place of Elavil. It can
promote seizures. It seems to be less likely to promote sexual dysfunction than
the most SSRIs.
- Ambien (zolpidem tartate):
- hypnotic -- sleeping pill, for short-term use for insomnia. There have been
reports of serious depression, but some people with FMS find it allows them to
experience restorative sleep.
- Soma (carisoprodol):
- acts on Central Nervous System to relax muscles, not on the muscles
themselves. It works rapidly and lasts from 4 to 6 hrs. It helps detach from
pain, and modulates erratic neurotransmitter traffic, damping the sensory
overload of FMS and muscular rigidity of MPS.
- Flexeril (cyclobensaprine):
- this medication can sometimes stop spasms, twitches and some tightness of
the muscle. It is related chemically to Elavil. It generates stage four sleep,
but it may cause gastric upset and a feeling of detachment from life.
- Sinequan (doxepin):
- heterotricyclic antidepressant and antihistamine. It can produce marked
sedation. This medication may enhance Klonopin, but can reduce muscle twitching
- Prozac (fluoxetine hydrochloride):
- anti-depressant that increases the availability of serotonin, useful for
those patients who sleep excessively, have severe depression and overwhelming
fatigue. Some people have reported profound depression from Prozac.
- Ultram (tramadol):
- non-narcotic, Central Nervous System medication for moderate to severe
pain, in a new class of analgesics called CABAs -- Centrally Acting Binary
Agents. Many people said it brought more alertness for longer times, and less
"fibrofumble" of the fingers. It can lower the seizure threshold.
Side-effects reported are grogginess, insomnia (may not be able to take at
night), headache or loss of sex drive. Some people have reported profound
depression resulting from Ultram.
- Hydrocodone/Guaifenesin Syrup:
- This medication is generally given as a cough supressant. Each teaspoon
contains 5 mg. hydrocodone and 100 mg guaifenesin. It has no aspirin or
ibuprofen. It may be effective for pain medication, and can be
"titrated" because it is in syrup form. The patient can take very
small amounts and can find the amount which works without causing undue side
- Xanax (alprazolam):
- an anti-anxiety medication, that may be enhanced by ibuprofen. It must not
be used in pregnancy. It enhances the formation of blood platelets, which store
serotonin, and also raises the seizure threshold. When stopping this
medication, you must taper it very gradually.
- a prescription only topical cream, that may help cutaneous TrPs. It is a
mixture of topical anesthetics.
- Pamelor (nortriptyline):
- this is used to help sleep. Some people find it stimulating, and must take
it in the morning. Others use it before bed to help sleep. Some reports of
depression with use.
- Klonopin (clonazepam):
- anti-anxiety medication and anticonvulsive/ antispasmodic. It is useful in
dealing with muscle twitching, Restless Leg Syndrome and nighttime grinding of
- BuSpar (buspirone HCl):
- may improve memory, reduce anxiety, helps regulate body temperature, and is
not as sedating as many other anti-anxiety drugs. This medication often takes a
few weeks to take effect.
- Zoloft (sertraline):
- this is an SSRI and antidepressant, and is commonly used to help sleep. It
has less of an effect on liver enzymes than other SSRIs.
- Tagamet, Zantac, Prilosec, Axid:
- often used to counter esophageal reflux. Tagamet may increase stage 4
sleep, and enhance Elavil. Acid supressors may interfere with B-12 absorption.
- Paxil (paroxetine HCl):
- serotonin and norepinephrine reuptake inhibitor, and may reduce pain. It
should not be used with other meds that also increase brain serotonin.
Suggested dosage is 10 mgs (half a scored tablet) may cause insomnia or
- Effexor (venlafaxine HCl):
- Fast acting antidepressant and serotonin and norepinephrine reuptake
inhibitor. Suggested trial dosage is 25 mg, taken in the morning. Food has no
affect on its absorption. When discontinuing this medication, taper off slowly.
May raise blood pressure.
- Inderal (propranolol HCl):
- sometimes helps in the prevention of migraine headaches, although blood
pressure may drop with its use. Antacids will block its effect, and should not
be used. May be very useful in decreasing "adrenalin rush".
- for Irritable Bowel Syndrome. It is a combination of antispasmotic plus
tranquilizer, that helps modulate bowel action.
- Diflucan (fluconazole):
- this antifungal penetrates all of the body's tissues, even the central
nervous system. Very short term use can be considered if cognitive problems
and/or depression is present, and yeast is suspected. Yeast may also be at the
root of irritable bowel, sleep dysfunction (muramyl dipeptides from bowel
bacteria induce sleep), and other common FMS problems.
- Imitrex (sumatriptan):
- this is available as an injectable solution or pill that will not prevent
migraines, but it is effective for migraine pain in many cases. Works on
serotonin release instead of blood vessel spasm, and may provide relief in less
than 20 minutes. It should not be used within 24 hours of ergot (a common
migraine drug) medications. It can increase blood pressure. It may cause spasm
of muscles in jaw, neck, shoulders and arms. Also reported were tingling
sensations, rapid heartbeat and the "shakes". Frequent use of Imitrex
may cause a rebound reaction, worsening migraines.
- Remeron (mirtazapine)
- tetracyclic antidepressant, which effects several neurtransmitters,
including serotonin and norepinephrine. May cause drowsiness and/or weight
gain. Reported increase in cholesterol with some patients.
- Zanaflex (tizanidine)
- is a relatively new medication for muscle tightness and pain. It also
reduces muscle spasm frequency and myoclonus. Effective dosage varies
considerably in patients. May cause drowsiness."
- COX-2 inhibitors
- These medications will be out shortly. They block cyclooxygenase-2, an
enzyme that helps create enormous mounts of prostaglandins. they not only seem
to be effective for inflammation (FMS & MPS are not inflammatory), but they
may be a promising alternative to narcotics for pain relief.
Fibromyalgia Support - Ottawa West