If you or a loved one is struggling with fibromyalgia, understanding the different fibromyalgia medications, how they work, and the evidence behind their use is crucial to making informed treatment decisions.
Fibromyalgia is a chronic pain disorder that affects millions of people worldwide. Its symptoms are complex and can be very personal from patient to patient, but most frequently it is characterized by widespread muscle pain, fatigue, cognitive difficulties, and sleep disturbances.
While there is no known cure for fibromyalgia, the good news is that treatment can make a significant difference in improving symptoms, particularly when delivered by a doctor who specializes in fibromyalgia. A comprehensive treatment approach that combines medication with non-drug approaches has been shown to be the most effective course of care and improve overall well-being.
In this article, we’ll explore the most commonly prescribed fibromyalgia medications, how they work, the clinical evidence supporting their use, and what you need to know when discussing treatment options with your doctor to find an effective treatment plan for you.
Fibromyalgia Medication List
Fibromyalgia medications can be categorized into several classes based on their mechanism of action. These include pain relievers, antidepressants, anticonvulsants, and muscle relaxants. These medications are often used in combination to address fibromyalgia’s primary symptoms: pain, fatigue, cognitive function, and mood.
Let’s take a closer look at each category and the specific drugs used in fibromyalgia treatment, of which three are approved by the Food and Drug Administration (FDA) specifically for fibromyalgia (Pregabalin, Duloxetine, and Milnacipran).
Keep in mind that this list is not inclusive of all medications that are used for fibromyalgia. Other medications, particularly those with similar profiles to those listed here, may be used for fibromyalgia symptoms; always check with your doctor to discuss new medications or changes.
Over-the-Counter Pain Relievers
Acetaminophen (Tylenol)
When people are first experiencing fibromyalgia pain and flares, over-the-counter pain relievers are often a first-line option. Acetaminophen is a commonly used pain reliever that can help manage mild to moderate pain associated with fibromyalgia. It works by inhibiting pain signals in the brain, but does not address the underlying cause of pain.
Studies suggest that acetaminophen is generally effective for mild pain, but it is often not sufficient for more severe fibromyalgia pain. A study published in the Journal of Clinical Rheumatology found that acetaminophen provided limited relief for fibromyalgia patients compared to other medications, including antidepressants or anticonvulsants [1].
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
You’re likely also familiar with this class of drugs since they are so commonly used: NSAIDs like ibuprofen (Advil) and naproxen (Aleve) reduce inflammation and pain. Although inflammation has not been shown to be a primary driver of fibromyalgia in clinical studies, these drugs may still be helpful for some patients in managing musculoskeletal pain.
However, research also shows mixed results for NSAIDs in treating fibromyalgia. A Cochrane review found that NSAIDs provided modest pain relief for people with fibromyalgia, but were not particularly effective compared to other treatments [2].
Anticonvulsants
Anticonvulsants, or anti-seizure medications, are commonly used to treat nerve-related pain. They are often prescribed to fibromyalgia patients because of the underlying basis in the central nervous system, known as central sensitization. This class of drugs works to “correct” some of the heightened pain processing signals that fibromyalgia patients experience.
Pregabalin (Lyrica)
Pregabalin works by inhibiting the release of neurotransmitters involved in pain transmission signals in the brain. It was the first medication specifically approved by the FDA for the treatment of fibromyalgia, making it one of the most widely prescribed medications for fibro.
Pregabalin’s efficacy in treating fibromyalgia was established in a 2008 study published in The Lancet, which demonstrated a significant reduction in pain and improvements in function [3]. Subsequent trials have confirmed its benefit;pregabalin was found to significantly reduce pain and improve physical functioning in fibromyalgia patients.
However, some people experience side effects like dizziness and fatigue when taking pregabalin, which can limit its use. Finding a healthcare provider experienced in pregabalin can help patients find an individualized dose if medically beneficial.
Gabapentin (Neurontin)
Gabapentin is the other most commonly used anticonvulsant for fibromyalgia. Like pregabalin, It works by altering the way the brain processes pain signals. A 2007 study published in Arthritis and Rheumatology found that gabapentin can be moderately effective for treating pain as well as improving sleep in fibromyalgia patients [4].
However, some patients do also find similar side effects to pregabalin, including dizziness and trouble concentrating (which is also a fibromyalgia symptom to begin with).
Antidepressants
Antidepressants are some of the most-commonly prescribed medications for fibromyalgia; in fact, two of the three FDA approved medications for fibromyalgia treatment are in this category. If you have fibromyalgia, this can be extremely frustrating and even gaslighting: If fibromyalgia is not in my head, why is my doctor prescribing an antidepressant?
However, stay with us: these fibromyalgia medications not only help treat the mental health effects of living in chronic pain, but also can have a chemical effect on how the brain regulates pain. Read on to learn more about how they work.
Duloxetine (Cymbalta)
Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI) that helps increase levels of neurotransmitters called serotonin and norepinephrine in the brain. These neurochemicals play a crucial role in how the brain regulates pain responses, so it makes sense that increasing them can help moderate the pain response in people with fibromyalgia.
Multiple clinical trials have demonstrated the effectiveness of duloxetine in fibromyalgia treatment. A multicenter study published in Arthritis and Rheumatology found that duloxetine significantly reduced pain and improved quality of life in fibromyalgia patients compared to a placebo [5]. The drug is FDA-approved for fibromyalgia and is considered a first-line treatment.
Milnacipran (Savella)
Milnacipran is another SNRI that is specifically approved for the treatment of fibromyalgia. It works similarly to duloxetine, but has a stronger effect on norepinephrine, which can be particularly helpful for reducing pain.
A 2008 study published in Clinical Therapeutics found that milnacipran reduced pain and fatigue in fibromyalgia patients [6]. Milnacipran was FDA-approved for fibromyalgia in 2009 based on these findings.
Amitriptyline (Elavil)
Amitriptyline is a tricyclic antidepressant (TCA) that is often prescribed off-label for fibromyalgia. It also works by increasing levels of serotonin and norepinephrine, as well as has sedative properties, which can help with the sleep disturbances that come with fibromyalgia.
A systematic review in the Cochrane Database found that amitriptyline can be effective in reducing pain and improving sleep in fibromyalgia patients, though its side effects (such as weight gain and dry mouth) may limit its use [7]. In addition, those sedative side effects that can help with sleep also make it less ideal for daytime use.
Muscle Relaxants
Muscle relaxants are sometimes prescribed to help manage the muscle spasms and stiffness associated with fibromyalgia. These fibromyalgia medications can provide relief by relaxing the muscles and reducing pain.
Cyclobenzaprine (Flexeril)
Cyclobenzaprine is a muscle relaxant commonly used to treat fibromyalgia-related muscle stiffness and spasms. It works by blocking the nerve impulses that cause muscles to contract.
Clinical studies have shown that cyclobenzaprine can help with fibromyalgia-related muscle pain and stiffness. A meta-analysis published in Arthritis and Rheumatology found that cyclobenzaprine provided significant improvements in pain, sleep, and muscle tension in people with fibro [8].
Other Medications
In some cases, other medications may be prescribed based on an individual’s specific symptoms.
Low Dose Naltrexone (LDN)
In recent years, Low Dose Naltrexone (LDN) has gained attention as a promising treatment option for fibromyalgia, particularly for those who don’t respond well to traditional fibromyalgia meds.
LDN is believed to work by temporarily blocking opioid receptors in the brain, which stimulates the production of endorphins. This brief “blockage” is followed by a surge in endorphins, the body’s natural pain-relieving chemicals. Naltrexone is typically used in much higher doses in most medical settings, but in low doses (typically 1-5 mg per day), it has been found to have immune-modulating effects and may help alleviate fibromyalgia symptoms. [9]
Increased endorphin levels may help reduce pain, improve sleep, and enhance mood. That’s one reason why people with fibromyalgia are often given advice to move, even when that can be challenging.
A 2013 study published in Arthritis and Rheumatology found that LDN significantly reduced pain and improved quality of life in fibromyalgia patients [10]. In another study, The Clinical Rheumatology Journal in 2014, LDN showed promise in reducing pain and fatigue in fibromyalgia patients who had not found relief from conventional treatments [11].
LDN is not FDA-approved for fibromyalgia, but it has become increasingly popular as an off-label treatment, particularly for those seeking a more holistic or alternative approach.
Corticosteroids
Corticosteroids are a class of steroid hormones that can reduce inflammation. They mimic cortisol, a hormone naturally produced by the adrenal glands, and help control inflammation and pain.
While fibromyalgia is not an inflammatory condition in the traditional sense, corticosteroids are sometimes used for short-term flare-ups of pain or other inflammatory-related symptoms, particularly in patients with other co-occurring inflammatory conditions like rheumatoid arthritis. However, there is a lack of evidence that this is an effective treatment for fibromyalgia, and due to the risk of side effects, such as weight gain, osteoporosis, and immune suppression, corticosteroids are generally used sparingly in fibromyalgia treatment.
Magnesium
Although considered a supplement and not a medication, magnesium plays a role in muscle relaxation, nerve function, and the regulation of pain, making it a potentially beneficial treatment for fibromyalgia patients as part of diet and supplement guidance.
Magnesium helps regulate muscle contractions and nerve impulses, which may reduce the muscle spasms and nerve pain often experienced by fibromyalgia patients. It also plays a role in modulating the body’s response to stress, which can alleviate some of the anxiety and sleep disturbances associated with fibromyalgia.
Several studies have suggested that magnesium supplementation may improve fibromyalgia symptoms. A 2009 study in The Journal of Nutritional Medicine found that magnesium levels were significantly lower in fibromyalgia patients compared to healthy controls [12]. A 2022 study published in Nutrients showed that magnesium supplementation improved pain, fatigue, and sleep disturbances in fibromyalgia patients [13]. While magnesium is not a cure, it can provide symptom relief, particularly when combined with other treatments.
How to Choose the Right Fibromyalgia Medication
Choosing the right fibromyalgia medications depends on a variety of factors, including:
- Symptom Severity: Medications like duloxetine or pregabalin are often preferred for patients with moderate to severe symptoms, while mild cases may benefit from over-the-counter pain relievers.
- Side Effect Profile: Side effects like dizziness, weight gain, or sedation can impact a patient’s choice of medication. Discuss these factors with your doctor.
- Co-existing Conditions: If you have other conditions like depression or anxiety, medications like SNRIs may offer dual benefits for both pain and mood regulation.
Always consult with your doctor before starting, stopping, or adjusting any medications for fibromyalgia to ensure the best possible outcomes.
Summary
Fibromyalgia medications can play a crucial role in managing the symptoms of this chronic condition, but finding the right treatment often requires trial and error. From pain relievers and antidepressants to anticonvulsants and muscle relaxants, there are a variety of options available, each with its own mechanism of action and evidence supporting its use.
Fibromyalgia is a complex condition that requires a multifaceted treatment approach. In addition to medications, non-pharmacological therapies such as physical therapy, cognitive behavioral therapy (CBT), acupuncture, and tailored movement programs can also help manage fibromyalgia symptoms.
Many patients find that a combination of medication and lifestyle changes is the most effective approach. By working closely with a fibromyalgia specialist like Swing Care, you can develop a comprehensive treatment plan tailored to your specific needs. With the right combination of treatments, it’s possible to improve your quality of life and help manage the challenges of fibromyalgia.
Sources
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