Fibromyalgia/Myofascial Pain Syndrome Medications
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 or MPS. 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. Medications
which affect the central nervous system are appropriate for FMS/MPS.
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 patients often react oddly
to medications. It is the rule rather than the exception that
a FMS/MPS patient will save strong pain meds from surgery or injury
for when they REALLY need it--for an FMS/MPS "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 McCaffery 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 in its facts, and so well documented, I
suggested that my local library buy it. They did. I wanted everyone
in the area to have access to the information within. 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
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 may 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. Narcotic analgesics are sometimes more easily tolerated
than NSAIDs, the Non-Steroidal Anti-Inflammatory Drugs. Neither
FMS nor MPS is inflammatory. Prolonged use of these narcotics
may result in physiological changes of tolerance or physical dependence
(withdrawal), 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". This meds list is only a partial list.
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. 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 (Trazadone): a tricyclic 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 pain-reliever may be useful when itching is
Elavil (amitriptyline): this tricyclic antidepressant (TCA) is
cheap and useful. It generates a deep stage four sleep. Most patients
will adapt to this med after a few weeks. It can cause photosensitivity,
water retention 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 in place of Elavil. It can promote seizures.
Ambien (zolpidem tartate): hypnotic--sleeping pill, for short-term
use for insomnia. There have been reports of serious depression.
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.
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): tricyclic 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.
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. It has a "low-abuse
potential", so doctors may prescribe it more liberally than
other strong pain-killers. It is not a controlled substance. Reports
say it doesn"t work well on an "as needed" basis--you
have to take it regularly for best benefits. Many people said
it brought more alertness for longer times, and less "fibrofumble"
of the fingers. It can lower the seizure threshold. It is having
good success with migraines.
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
Pamelor (nortriptyline): this is used to help sleep. but some
people find it stimulating, and must take it in the morning. Some
reports of depression with use.
Klonopin (klonazepam): 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
Zoloft (sertraline): this is an SSRI and antidepressant, and is
commonly used to help sleep.
Tagamet, Zantac, Prilosec, Axid: often used to counter esophageal
reflux. Tagamet may increase stage 4 sleep, and enhance Elavil.
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) mornings--may cause insomnia.
Effexor (venlafaxine HCl): 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.
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.
Hismanol(astemizole): this is a potent antihistamine often given
for allergies. Do not take at the same time as ketaconazole.
Librax: for Irritable Bowel Syndrome. It is a combination of antispasmotic
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.
Potaba (aminobenzoate potassium): used to diminish fibrotic tissue.
Travell and Simons recommend it for stubborn cases of myofascial
pain syndrome. Do not use with sulfa. The suggested dosage 500
mg tid for 5 months. It will counteract guaifenesin.
Guaifenesin: see handout "Guaifenesin"
Quotane: this topical prescription ointment is helpful for TrP
relief in close-to-the-surface areas not reachable by stretching.
TrPs that refer burning, prickling or lightning-like jabs of pain
are likely to be found in cutaneous scars.
Imitrex (sumatriptan): this is an injectable solution that will
not prevent migraines, but it is effective for migraine pain in
most cases. Works on serotonin release instead of blood vessel
spasm, and may provide relief in less than 20 minutes. It works
very fast, but 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". A pill form of this may be approved soon.
***A FMS/MPS Reading List ***
"Sick & Tired of Feeling Sick & Tired: Living With
Chronic Invisible Illness" by Paul J Donoghue & Mary
"Stretching" by Bob Anderson;
"Office Hours Day and Night" by Janet Travell, M.D.;
"Myofascial Pain and Disfunction: Trigger Point Manual Volumes
I & II" by Janet G. Travell, M.D. and David G. Simons,
M.D. (medical texts)
"Prescription for Anger", by Gary Hankins, Ph.D. and
"When Muscle Pain Won"t Go Away" by Gayle Backstrom
and Bernard R.Rubin, D.O.;
"Job's Body" by Deane Juhan;
"Nasty People: How to Stop Being Hurt by Them Without Becoming
One of Them", by Jay Carter;
"Fibromyalgia: Fighting Back" by Bev Spencer
"Coping with Fibromyalgia" by Beth Ediger. LRH publications
Box 8 Station Q
Toronto, ON Canada
"The Fibromyalgia Syndrome" by Mary Anne Saathoff RN,
Columbus, Ohio 43221-0988
"Fibromyalgia: Managing the Pain" by Mark J. Pelligrino
3620 N. High Street
Columbus Ohio 43214
"Advances in Research", "Getting the Most Out of
Your Medicines", "FMS/CFS in Young People" and
"Fibromyalgia Network Newsletter"
Tucson AZ 85751-1750
Coming Spring 1996: "Fibromyalgia and Chronic Myofascial
Pain Syndrome: A Survival Manual" by Devin Starlanyl M.D.
and Mary Ellen Copeland M.A., M.S. New Harbinger
"The Best Revenge: Living Well with Fibromyalgia and Chronic
Pain", by Miryam Williamson, Walker and Co.
Modified Jnauary 9, 2003