Information about Medications For Fibromyalgia
by © Devin Starlanyl, 1995-1999
ImmuneSupport.com
01-25-2001 (Editor's Note:This information may be freely
copied and distributed only if unaltered, with complete original
content including: © Devin Starlanyl, 1995-1999.)
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
(fibromylagia syndrome) or MPS (myofascial pain syndrome).
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.
Medications should be used along with a program of proper
diet, life style changes, mind work 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 problem."
* "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 control."
* "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 conjunction 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".
Guaifenisen: Guaifenisen 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.
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.
Benedryl (dyphenhydramine):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 (Trazodone): an antidepressant that helps with sleep
problems. It must be taken with food.
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.
Elavil (amitriptyline): 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 by
itself.
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/Guaifenisen Syrup: This medication is
generally given as a cough suppressant. Each teaspoon
contains 5 mg. Hydrocodone and 100 mg Guaifenisen. 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 effects."
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.
EMLA: 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 teeth.
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 suppressors 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
drowsiness.
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".
Librax: for Irritable Bowel Syndrome. It is a combination of
antispasmodic 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 neurotransmitters, 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.
©2000 Pro Health, Inc.
(http://www.ImmuneSupport.com)
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