Tramadol is a synthetic opioid. Although it is described as “opiate-like” and is considered an opiate agonist, it differs from other opioids in the way it acts on the central nervous system. Unlike other opioids, it is not considered a controlled substance in the U.S. and many other countries. Thus far studies on the effectiveness of tramadol in relieving FM pain have had quite positive results.
2. Antidepressants
Antidepressants are often among the first treatment options tried for fibromyalgia patients because they can improve sleep, reduce pain and help mood disturbances. There are three categories of antidepressants:
- Tricyclics like amitriptyline, nortriptyline and trazodone can be effective and were the favored FM treatment for many years. However, because of frequent side effects such as dry mouth and the “morning hangover” effect, newer types of antidepressants may be preferable.
- Selective serotonin reuptake inhibitors (SSRIs) like Lexapro, Paxil, Zoloft, Prozac and Celexa increase the serotonin concentration in the body (which is low in FM patients) by blocking the breakdown of serotonin. Because SSRIs can be particularly effective in treating depression, they may be a good choice for fibromyalgia patients who also suffer from depression. On the downside, SSRIs can cause sexual dysfunction and weight gain.
- Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as Cymbalta, Effexor and Savella are the newest and perhaps most promising class of antidepressants to be used in the treatment of fibromyalgia. They increase both serotonin and norepinephrine concentrations in the body by blocking their breakdown. Cymbalta received FDA approval for the treatment of fibromyalgia in June 2008. Studies have found that it can reduce pain, improve energy, decrease anxiety, improve depression, and help alertness and concentration with only minimal side effects. It has also been found to be beneficial for FM patients who are not clinically depressed. Savella was approved by the FDA to treat FM in January 2009 and is expected to be in pharmacies by mid-2009. Clinical trials showed that many of the patients taking Savella reported improvements in pain, physical function, and patient global assessment. Remeron is another SNRI that is being used by pain specialists for its ability to promote sleep and it’s suspected ability to reduce pain and headache symptoms.
