The pharmacological treatment of fibromyalgia utilizes a combination of medications to include antidepressants, benzodiazepines, muscle relaxants, analgesics and nonsteroidal ant-inflammatory drugs. These drugs are used to help minimize and treat the known symptoms. The goals of this treatment are to control pain, improve sleep and assist in daily functioning.
The U.S. Food and Drug Administration has approved drugs such as pregabalin (Lyrica), milnaespran (Savella) and duloxetine (Cymbalta) to treat fibromyalgia. Randomized placebo-controlled trials of the drug Lyrica have revealed a reduction in pain. Additionally, pregabilin and duloxetine have had a positive impact on controlling sleep and the overall quality of life in fibromyalgia patients (Traynor et al., 2011).
Antidepressants elevate chemicals in the brain, such as serotonin and norepinephrine. An increase in the production of these chemicals has been known to reduce pain. Meta-analysis research has shown that antidepressants have had the greatest impact on blocking some of the symptoms associated with fibromyalgia when compared to other classes of medications (Hauser et al., 2009) (Traynor et al., 2011).
In these meta-analysis comparisons, tricyclic antidepressants were more effective than the placebo group for all clinical outcomes such as: improving sleep, lowering pain symptoms and helping to control pain.
The common categories of antidepressants that are frequently prescribed to fibromyalgia patients include:
- Tricyclic antidepressants (TCAs) - These drugs help to relax muscles, while heightening pain killing endorphins in the body. Examples of this medication include: cyclobenzaprine (Flexeril, Flexiban), amitriptyline hydrochloride (Elavil, Endep) and nortriptyline (Pamelor, Aventyl).
- Selective Serotonin Reuptake Inhibitors (SSRIs) - This newer type of antidepressant aims at fighting fatigue and elevating the mood of fibromyalgia patients. Examples of this drug include: paroxetine (Paxil), escitalopram (Lexapro) and fluoxetine (Prozac).
- Mixed Reuptake Inhibitors - These antidepressants increase serotonin and norepinephrine. Studies have shown that these drugs have been more effective at helping pain than SSRIs due to the role that norepinephrine plays in the transmission of pain. (Traynor et al., 2011). Examples of these drugs include: venlafaxine (Effexor) and duloxetine (Savella).
These drugs are prescribed to fibromyalgia patients to relax painful muscles. This class of drugs enhances the neurotransmitter gamma-aminobutyric acid (GAMA), which results in relaxing the muscles of the body and has anti-anxiety and sleep-inducing effects.
The American Psychological Association warns that this choice of pharmacotherapy is often best suited for short-term use due to concerns about withdrawal and dependence. Examples include: diazepam (Valium) and clonazepam (Klonopin).
Muscle relaxants are sometimes prescribed in low doses with TCAs or SSRIs. Meta-analysis has revealed favorable outcomes in fibromyalgia patients who were administered muscle relaxants as part of a treatment plan. The studies included 312 patients who were administered daily doses of 10 or 30 mg of cyclobenzaprine. Meta-analysis of these five studies revealed that fibromyalgia patients treated with the muscle relaxant-cyclobenzaprine were three times more likely to report overall improvement of symptoms than the placebo group (Traynor et al., 2011) (Peterson, 2007).
Examples of muscle relaxants prescribed for fibromyalgia patients include: cyclobenzaprine (Flexeril), carisoprodol (Soma), tizadine (Zanaflex) and orphenadrine citrate (Norflex).
These are painkillers that range from over-the-counter medications (Tylenol) to stronger prescription narcotics. The goal of this class of medications is to block pain signals going to the brain. Narcotic painkillers are typically prescribed short-term due to their tendency to become addictive in some patients.
During a 2006 meta-analysis conducted by Furlan et al, patients were administered an opioid painkiller for chronic pain related to fibromyalgia and other non-cancer conditions for a period of 8.8 weeks. The results of this study concluded that opioids were effective for pain relief and improving daily functioning; however, some experts discourage the use of opioids due to their concerns about potential dependence (Furlan, et al.) (Traynor et al., 2011).
Examples of narcotic analgesics include: hydrocodone (Vicodin), oxycodone (Percocet), MScontin (Morphine) and propoxyphene (Darvon).
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
These drugs are used to decrease inflammation and relieve pain. They work by inhibiting prostaglandins, which play a role in pain and inflammation in the body. The Furlan et al study showed that NSAIDs were not as effective as narcotic analgesics for relieving pain (Furlan et al., 2006). This is in part because inflammation is not a typical characteristic symptom of fibromyalgia (Traynor, 2011).
Examples of NSAIDs include: ibuprofen (Motrin, Advil) and naproxen sodium (Aleve, Anaprox).