Fibromyalgia as a chronic condition
Fibromyalgia is a chronic condition, the primary symptom of which is pain. Pain may be described as sharp, burning, dull, aching or stabbing. It may come and go or may be present continuously throughout the day. Pain can make it difficult for those who suffer from the condition to get through their daily routine. In fact, many people with fibromyalgia find themselves unable to maintain their jobs, adding to the stress of this condition.
The American College of Rheumatology has set forth certain criteria that must be met in order for a person to be diagnosed with fibromyalgia. Although new criteria are being debated, the current criteria for diagnosis includes pain that is present for at least three months, is present in all four quadrants of the body (both the right and left sides and above and below the waist) and the presence of 11 out of 18 tender points. These tender points are located at various points of the body and should be painful on palpation, not just tender.
Pain relief in chronic fibromyalgia can be difficult due to the fact that fibromyalgia presents so differently in individuals with the condition. Pain management often requires a multi-pronged approach. Most individuals with fibromyalgia will be prescribed medication for their pain. There are several classes of medication prescribed for chronic fibromyalgia pain relief. Let’s examine some of these medications and their intended effect.
NSAIDs (non-steroidal anti-inflammatory drugs) include Ibuprofen, Naprosyn, Celebrex, Toradol and other drugs in this class that reduce pain and inflammation. Fibromyalgia is not a true inflammatory disease like arthritis, but some patients get relief from their pain when they use NSAIDs. NSAIDs should not be used for long periods of time due to the risk of gastrointestinal bleeding with long-term use, but they can be helpful for bad fibromyalgia flares.
OTC Pain Relievers
Tylenol and aspirin are sometimes prescribed for pain relief in fibromyalgia. These OTC (over-the-counter) drugs may be useful for mild pain but may not help when pain is severe. Even these relatively innocuous drugs can cause serious complications if used too much. Patients should follow dosing instructions carefully. Many pain relievers contain these products, so caution should be exercised when patients are taking more than one kind of pain reliever. It is dangerous to exceed the recommended doses of these medications.
Opioids, such as morphine, oxycodone, and codeine, are sometimes prescribed for severe fibromyalgia pain. However, studies have shown that people with fibromyalgia lack a chemical receptor in their brain that binds to opioids, rendering them ineffective. This may be why many people with fibromyalgia respond poorly to opioids or require very high doses to obtain pain relief. Opioids are generally only prescribed for short-term therapy due to their addictive nature. They may worsen gastrointestinal symptoms in fibromyalgia patients who have digestive issues. They also worsen fatigue, and as fatigue is one of the other primary symptoms in fibromyalgia, opioids may not be the best choice for pain relief.
Steroids are sometimes used to treat pain in fibromyalgia. They may be taken orally or they may be injected with a needle into painful areas. They are given to reduce inflammation, and since fibromyalgia is not an inflammatory condition, some patients may not respond well to this type of therapy. However, steroids may be useful for patients who also suffer from arthritis, bursitis or other inflammatory conditions in addition to fibromyalgia.
Tramadol is an opioid-like drug, but it acts a little differently in the brain than opioids do. It is commonly prescribed for fibromyalgia, and many patients get good relief of their chronic pain. It may cause some of the same side effects as opioids (drowsiness, constipation) and some studies state that it is addictive. However, it is not a controlled substance in many countries like the U.S.
In fibromyalgia, antidepressants are often prescribed to reduce pain, improve sleep and increase functional ability. For fibromyalgia patients who suffer from depression, antidepressants will also improve mood. There are many classes of antidepressants on the market, but two drugs have been approved by the FDA specifically for the treatment of fibromyalgia. These antidepressants are known as SNRIs (selective norepinephrine reuptake inhibitors). They work by increasing concentrations of norepinephrine and serotonin in the brain by blocking their breakdown. Fibromyalgia patients have low levels of these substances. Savella and Cymbalta are the two SNRIs approved for use in fibromyalgia. These drugs are prescribed even in the absence of depression.
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Strangely enough, drugs that combat seizures can help fibromyalgia patients with their pain. Lyrica has been approved by the FDA due to its ability to block pain signals from traveling to the brain. Neurontin is used to treat neuropathic (nerve) pain that sometimes feels like burning pain or “electric shocks” in the hands and feet. These drugs sometimes cause drowsiness, but sleepiness will usually fade over time. Anticonvulsants may also help those fibromyalgia patients who suffer from frequent headaches, as they are often prescribed for migraine prophylaxis.
Muscle relaxants can improve pain and sleep in patients with fibromyalgia. Robaxin, Soma and Flexeril are common muscle relaxants prescribed for this purpose. They may be useful for patients who also suffer from RLS (restless leg syndrome).
Pain, the primary symptom of fibromyalgia, can be difficult to treat. Finding the right medication can be hit-or-miss, and patients may need to try several medications, or combinations of medications, before hitting on the right one for them. It is important to take all medications exactly as prescribed. Intolerable side effects should be reported to the physician; however, some side effects are common, such as drowsiness, and will pass as the body adjusts to the medication. Many of these medications have drowsiness as a side effect, and caution should be exercised when performing activities that require concentration, such as driving.
Pain is a very subjective experience, and medications that work for one individual with fibromyalgia may have little or no effect on pain in other individuals. Persons with fibromyalgia must be prepared to be an active participant in their pain control, and good communication with their physician is important for obtaining chronic fibromyalgia pain relief.