FIBROMYALGIA/MYOFASCIAL PAIN SYNDROME MEDICATIONS

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http://www.pendulum.org/related/FMS/fm-pain.htm

Fibromyalgia/Myofascial Pain Syndrome Handout

Devin Starlanyl MD

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

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 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 a

problem.

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 neurotrans-

mitter 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):}{\plain tricyclic antidepressant and antihist-

amine. 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 anesthetics.

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

anti-anxiety drugs.

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.

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