Another promising SNRI currently being studied for the treatment of fibromyalgia is milnaciprin. Although milnaciprin is approved in many countries for depression, it is not currently available in the U.S., and therefore cannot even be prescribed off-label. Late in 2007, Forest Laboratories and Cypress Bioscience filed an application for FDA approval of milnaciprin for the treatment of fibromyalgia and it is expected to be approved by the end of 2008.

3. Anti-convulsants

Two anti-convulsant or anti-seizure medications that have been used to treat fibromyalgia are Lyrica and Neurontin. Lyrica has the distinction of being the first medication ever to receive FDA approval for the treatment of fibromyalgia. It works by affecting chemicals in the brain that send pain signals across the nervous system. In clinical trials, Lyrica reduced pain and improved sleep, fatigue and general health perception in 30 to 40 percent of FM patients. The most common side effects were dizziness and sleepiness.

Neurontin has been found to help neuropathic pain. Fibromyalgia patients who have burning or pain that feels like electric shocks in their hands and feet have reported improvement when treated with Neurontin.

4. Muscle Relaxants

Muscle relaxants like Flexeril, Soma, Skelaxin and Robaxin are sometimes prescribed for fibromyalgia pain. Although they may not actually stop muscle spasms, they appear to have a central neurological mechanism that reduces muscle pain. The most common side effect is drowsiness. If muscle spasms are a particular problem, antispasmotic medications such as Zanaflex and Baclofen can be helpful in reducing the spasms and the pain. Since Zanaflex seems to be effective in improving sleep, blocking pain and reducing headaches, it is sometimes prescribed even if muscle spasms are not the primary problem.

5. Anti-anxiety Medications

Anxiety in fibromyalgia patients can increase pain, muscle tension, irritability and sleep problems. If anxiety is a problem, benzodiazepine medications like Klonopin, Ativan and Xanax can help reduce pain and improve sleep. They work by improving the balance of inhibitory and excitatory receptors in the central nervous system. (Most FM patients have too much activity in their excitatory receptors.) Klonopin taken in the evening can be particularly helpful for patients who have a lot of leg problems, including pain and restless or jerking legs.

6. Sleep Modifiers

The inability to get deep, refreshing sleep is a major problem for most people with fibromyalgia. Although many of the medications already discussed can help improve sleep, sometimes a medication specifically designed to induce sleep is necessary. There are two types of sleep modifiers:

Benzodiazepines like Restoril can be used to treat insomnia. The biggest concern about using benzodiazepines is their habit-forming potential.

Hypnotics such as Ambien, Lunesta and Rozerem cause relaxation that helps patients fall asleep and stay asleep. Ambien is less habit forming than the benzodiazepines but can cause rebound insomnia when it is stopped. The newer hypnotics Lunesta and Rozerem are not habit-forming and do not produce rebound insomnia.

7. Other

The neurologic medication Provigil, originally developed to treat narcolepsy, is sometimes also used to treat the fatigue of fibromyalgia. In a 2006 study, two-thirds of the fibrromyalgia patients taking Provigil experienced a 50 percent reduction in fatigue levels.

Sources:

Pellegrino, M (2005). Fibromyalgia: Up Close & Personal. Anadem Publishing.

Ervin, J.E., Dyer, D., Fox, C. (2007, Sept. - Nov.). Medication Update. Fibromyalgia AWARE, 14, 60-61.

© Karen Lee Richards

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