• Pregabalin (known by its brand name, Lyrica) is designed to ease pain and anxiety and help with certain sleep problems. It was originally designed to treat seizures, and limits the body’s release of chemicals that relay pain. Side effects such as weight gain, dry mouth, and dizziness may be experienced.
• Duloxetine (brand name Cymbalta), an anti-depressant, eases pain and improves functioning. Itching, nausea, and agitation are some of the potential side effects.
• Milnacipran HCI (brand name Savella) works like an anti-depressant, helping the body reduce feelings of pain and fatigue. Among possible side effects are nausea, constipation, and dizziness.
Side effects of anti-depressants may also include a greater incidence of depression, suicidal thinking or actions, and heart palpitations. The doctor should be contacted about any side effects.
Doctors may recommend medications other than (or in addition to) the three FDA-approved drugs approved to treat fibromyalgia. This practice is called “off-label” use, and is common in treating fibromyalgia. Medications that ease pain can encourage individuals to move more throughout the day, which in turn can improve lung capacity and muscle tone. Medications may also be helpful in dealing with sleep problems, depression, and anxiety.
A prescription for anti-depressants does not mean the doctor thinks the patient is depressed; these medications are chosen because they may reduce an individual’s symptoms.
Off-label medications often prescribed include:
• Some older antidepressants such as amitriptyline (Elavil), nortriptyline (Pamelor), and doxepin (Sinequan) ease pain and promote quality sleep. This group of medications, however, has potential side effects already common with fibromyalgia, including morning sleepiness, confusion, and urinary retention.
• Cyclobenzaprine (often known by the brand name, Flexeril) helps with pain and sleep issues, but its antidepressant effects are minimal. It is used only as a short-term muscle relaxant.
• Gabapentin (brand names Neurontin, Gralise), developed for epilepsy, relieves pain in certain situations.
Research on another medication, low-dose naltrexone, has been encouraging for treating fibromyalgia. Used for years to help people break drug addictions, research suggests low-dose naltrexone may help improve mood and outlook among people with fibromyalgia.
Acetaminophen used alone or in combination with Tramadol (brand name Ultram), is sometimes useful in treating pain. Tramadol is sometimes described as “narcotic-like,” and is used for fibromyalgia pain when other options have not worked.
Research has not been definitive on two treatments—local injections at tender points and transcutaneous nerve stimulation (TENS)—but these may be helpful in some cases.
Some medications used effectively for other conditions do not have the same effect in fibromyalgia treatment:
• Non-steroidal anti-inflammatory medications are typically not helpful in treating fibromyalgia, except as an ingredient in drug combinations.
• Narcotic pain medications, also called opioids, are strong pain medications but are generally avoided because they do not usually relieve fibromyalgia pain. In addition, opioids have many serious potential side effects and can be addictive for some people.