Prescribed medications are a key component of most fibromyalgia treatment plans. Since there are currently only three FDA approved medications for fibromyalgia, many medications are prescribed off-label. That means the drug is prescribed for a use other than that for which it is approved. Since numerous studies have been published showing that various medications can be beneficial for people with fibromyalgia, physicians are able to prescribe those medications off-label.
Keep in mind that no single medication works for every fibromyalgia patient. Also, FM patients are often more sensitive to medications than the average person, so great care and consideration should be taken when prescribing drugs for fibromyalgia. Sometimes it’s necessary to start with lower doses to prevent adverse reactions. Since it’s frequently a matter of trial and error, it’s important for the patient and the doctor to work together to find the best possible treatment plan.
Following are the seven categories of medications most often used to treat fibromyalgia:
Analgesics are pain killers. They include:
- Over-the-counter medications like aspirin, acetaminophen, ibuprofen and naproxyn. (Ibuprofen and naproxyn are also anti-inflammatories)
- Nonsteroidal anti-inflammatories (NSAIDs) such as etodolac, nabumetone and Cox-II inhibitors (for example, Celebrex).
- Corticosteroid anti-inflammatories like prednisone and dexamethasone.
- Opioids such as codeine, hydrocodone, oxycodone, morphine and fentanyl.
- Tramadol, a narcotic-like opiate agonist.
Since fibromyalgia is not a true inflammation, anti-inflammatories may be less effective in reducing pain. They can, however, be helpful in reducing pain flares brought on by strenuous physical activity, tendonitis or bursitis. Because many of the NSAIDs carry a serious risk of gastrointestinal bleeding and some also have a cardiovascular risk, they should be taken with great caution and care.
Recent studies have indicated that opiate pain medications often do not relieve FM pain. It appears that the mu-opioid receptors in people with fibromyalgia have a reduced ability to bind to the drugs targeting them. There is also emerging evidence that over the long term, the use of high-dose opioids may actually increase an FM patient’s hypersensitivity to pain.