Fibromyalgia occurs predominantly in women of child-bearing age, and is seen commonly in the offices of most rheumatologists in the United States. Afflicted patients usually complain of diffuse musculoskeletal pain, poor sleep, and fatigue. Often, the amount of pain is related to the amount of sleep—the less sleep, the more pain. Many patients feel their pain is worsened by stress, cold weather, or overexertion. Conversely, patients will feel better in warm weather, while on vacation and away from the usual worries of day to day living, and with improved sleep hygiene. Patients will often suffer from chronic headaches and an irritable bowel.
On physical examination of fibromyalgia patients, the only abnormal finding is the presence of numerous tender points, or in many cases, diffuse pain wherever the doctor touches the patient. There are no laboratory findings characteristic of fibromyalgia. And therefore fibromyalgia should be considered a diagnosis of exclusion. I have seen more than one patient with unexplained pain and fatigue who ended up with a thyroid disorder, or even a malignancy. A complete physical examination is in order for any patient who has “unexplained” pain. And a good doctor will not explain the pain away as being due to fibromyalgia until there are no other obvious explanations.
Over the years, the treatment of fibromyalgia has included graded exercise programs, physical therapy/massage therapy, and the use of muscle relaxants and anti-depressant drugs to help with the chronic pain and the chronic sleep problems. There have been no drugs specifically approved by the FDA for the treatment of fibromyalgia.
But many drugs have been studied, including Lyrica. It is chemically and structurally similar to Neurontin (gabapentin), with anti-seizure, pain-relieving, and anxiety-relieving properties. Lyrica has been studied for the treatment of refractory partial seizures, diabetic neuropathy, post-herpetic neuralgia, social anxiety disorders, and also fibromyalgia. It is FDA-approved for the treatment of post-herpetic neuralgia and painful diabetic neuropathy.
In a blinded, placebo-controlled study, Lyrica was examined for its ability to reduce the severity of pain in fibromyalgia patients. The patients studied were women in their 40s, who had suffered from fibromyalgia for many years. The study found a significant number of patients had a significant (at least 30%) improvement in pain compared to placebo. And when the data focused only on the higher dose of Lyrica, that number went to a 50% or greater improvement in pain. In addition, the patients also reported improvement in sleep and a reduction in fatigue. Slight dizziness and sleepiness were the main side effects.