What are the best medications for fibromyalgia?

Disclaimer: This content should not be substituted for medical advice. Please seek the advice of your doctor if you have any questions or concerns. The content in this posts links to many NIH studies, but I am no expert on these topics. This blog  is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. 

When receiving a new diagnosis of Fibromyalgia, it’s overwhelming and hard to know what your treatment options are. Many doctors aren’t experts on medications for Fibromyalgia, and may not give you correct or current information. However, patients with Fibromyalgia have long been treated with a mix of antidepressants, muscle relaxers, sleep medication, and pain medication. I thought it would be helpful to discuss all the options in one place. 

FDA approved medications for Fibromyalgia

There are three main medications for Fibromyalgia that the FDA approves:

• Lyrica (Pregabalin) 2007
• Cymbalta (duloxetine hydrochloride) 2008
• Savella (milnacipran HCI) 2009

All three drugs claim to reduce pain and improve function in some with Fibromyalgia. 

1. Lyrica as a medication for Fibromyalgia

Lyrica is the only drug of the FDA three that is not an anti-depressant. It’s usefulness for Fibro is middling according to a 2016 study². 

The side effects from Lyrica are legendary in the Fibro community. Common side effects include:

• Breathing problems
• Vision changes
• Memory loss
• Muscle pain and weakness
• Thoughts of suicide
• Anxiety
• Constipation or diarrhea
• Headache
• Insomnia
• Nausea
• Weight gain

My experience with Lyrica

For a drug that doesn’t even seem to work that well, that’s a long list of side effects. There are many horror stories, so I’ve stayed away from Lyrica.  I’ve heard the weight gain is a nightmare. And when you have Fibro and have to deal with fatphobic doctors who blame you for your own suffering, that’s the opposite of helpful.

2. Cymbalta as a medication for Fibromyalgia

Cymbalta was originally approved to treat depression, anxiety, and peripheral neuropathy. It’s an SNRI. What that means is Serotonin affects your sleep-wake cycle and pain processing while Norepinephrine helps you feel alert. 

Common side effects include:

• dizziness
• dry mouth
• hyperhidrosis (excessive sweating)
• fatigue 
• headache
• insomnia
• digestive problems
• sexual side effects

For Cymbalta, it’s usefulness for Fibromyalgia seems to be somewhat in doubt, depending on the study you look at. 

Despite the evidence for safety and effectiveness² there remains some controversy around the safety and efficacy of duloxetine to treat FM pain. Specific to the heterogeneous symptoms that accompany FM, duloxetine may effectively diminish pain and increase physical function in some, although unsurprisingly, not in all.  

My experience with Cymbalta

Cymbalta did nothing for my pain. Though it provided some gross side effects, like a crazy amount of sweating. However, I know that it does work for some with Fibromyalgia. 

My experience was that Cymbalta did nothing for my pain. Though it provided some gross side effects, like a crazy amount of sweating. Click To Tweet

3. Savella as a medication for Fibromyalgia

This was the first drug approved specifically for Fibromyalgia and is also a SNRI. It’s similar to Cymbalta, but it increases norepinephrine more than serotonin.

Basic side effects include:

• Constipation
• Decreased sexual desire
• Dizziness
• Dry mouth
• Headache
• Increased sweating
• Loss of appetite
• Nausea
• Trouble sleeping

In trials³ with Fibromyalgia patients, twice as many patients compared to the placebo reported overall improvement. Mental health scores, pain levels, and fatigue also improved with treatment. However, the daily life of patients had not improved (i.e. ability to physically function, work skills etc.)

In trials of Savella for Fibromyalgia, the patients' daily lives did not improve. Click To Tweet

My experience

Savella was my first introduction to medications for Fibromyalgia. It helped some, but the cost was exorbitant and the side effects (excessive sweating) were miserable. It’s hard to explain how disabling excessive sweating can be. When sweat is just pouring out of your body every time you move, you stop appearing in public because it’s so embarrassing and hard to explain. The last thing anyone with Fibro needs is another reason to not appear in public!

Other medications for Fibromyalgia

The FDA hasn’t approved any of these medications for Fibromyalgia. They are prescribed as off label. 

4. Muscle Relaxants 

Though experts don’t seem to know why, muscle relaxers can help with Fibromyalgia pain. In my opinion they help because pain causes your entire body to tense, and you need something to ease the tension. For me, muscle relaxants worked effectively. Unfortunately, I found I had an extremely rare side effect: kidney stones. Don’t worry though, that isn’t common. 

5. Tramadol

Tramadol (ultram) is now considered an opioid and is a controlled substance in the U.S, though it wasn’t always that way.  Because it’s 1/10th as powerful as morphine many believed it was fairly safe. With the opioid crisis  that’s being hotly debated. 

6. Gabapentin

Gabapentin is somewhat related to Lyrica, so the idea isn’t out of nowhere. It’s is technically a anti-seizure drug, but in studies with Fibromyalgia participants said they had improved sleep and less fatigue. Unfortunately for patients,  prescriptions have gone down due to it’s popularity with those experiencing addiction. 

7. Low Dose Naltrexone

Low Dose Naltrexone isn’t an option you hear about often, but it has been found to reduce symptoms in Fibromyalgia. For more information on LDN see:

Melissa’s post: My Low Dose Naltrexone (LDN) for Fibromyalgia One Year Experiment

Katie’s post: Tentatively Ecstatic: My experience with Low Dose Naltrexone  

Donna’s post: Low Dose Naltrexone, Fibromyalgia and ME/CFS

Julie’s post: Low Dose Naltrexone for Fibromyalgia

8. Opioids

Now we get to the most demonized off label treatment of Fibromyalgia, opioids. With the opioid crisis we often hear discussion that opioids don’t work for long term pain like Fibromyalgia. Patients of course will say differently, because we’re the ones suffering in constant pain. 

With the opioid crisis we often hear discussion that opioids don't work for long term pain. Patients of course will say differently, because we're the ones suffering in constant pain.  Click To Tweet

Fed Up with Fatigue did a great post in 2016 addressing this topic and the problematic studies that are often cited. The general problem in addressing whether are not opioids are effective in Fibromyalgia is that the obsession with overdoses and chronic pain are all tied up in one package. It’s hard to unravel all the many studies conducted under this assumption. If you google “do opioids work for fibromyalgia” every single result will assure you they do not. If you talk to any person with Fibromyalgia, almost every patient will say that they do.

Additionally, there have been very few studies of long term opioid therapy and evidence is very limited⁴. At one point it was considered too cruel to allow people in the control group to suffer (I know, the irony). 

 

Medications for Fibromyalgia

Overall, there are several options for treating Fibromyalgia, even beyond the big 3. If you’re new to fibro, or your medication isn’t working for you, it’s worth asking your doctor about your options

Have you found anything else that helps you with your Fibromyalgia?

 

 

 

Sources:

1. Pregabalin for pain in fibromyalgia in adults. Sheena Derry 1, Malene Cording, Philip J Wiffen, Simon Law, Tudor Phillips, R Andrew Moore. National Library of Medicine.
2. Duloxetine for the treatment of fibromyalgia. Cheryl L Wright, Scott D Mist, Rebecca L Ross, and Kim D Jones. U.S. National Library of Medicine. National Institutes of Health. 
3. A double-blind placebo-controlled trial of milnacipran in the treatment of fibromyalgia
   Olivier Vitton, Michael Gendreau, Judy Gendreau, Jay Kranzler, Srinivas G Rao. National Library of Medicine
4. The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain
   Roger Chou, Rick Deyo, Beth Devine, Ryan Hansen, Sean Sullivan, Jeffrey G Jarvik, Ian Blazina, Tracy Dana, Christina Bougatsos, Judy Turner. National Library of Medicine.