Fibromyalgia - Medications

Anti-Seizure Agents (Anti-Convulsants)

Anti-seizure drugs, also called anti-epileptics or anticonvulsants, affect the neurotransmitter gamma aminobutyric acid (GABA), which helps prevent nerve cells from over-firing. Studies have shown that gabapentin (Neurontin), an anti-seizure medication also approved for postherpetic neuralgia, affects pain transmission pathways and may relieve the pain associated with fibromyalgia. Phase II and III clinical trials are underway.

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Pregabalin (Lyrica) is an anti-epileptic drug closely related to gabapentin. The FDA approved pregabalin in 2004 for treatment of nerve pain and diabetic peripheral neuropathy. It is currently in late-stage trials for treatment of fibromyalgia. A 2005 study of 529 patients with fibromyalgia reported that 450 mg/day of pregabalin reduced pain and improved sleep quality and fatigue symptoms. Dizziness and drowsiness were the most common side effects.

Other Investigative Drugs

Tropisetron. Tropisetron (Navoban) is a 5-HT3 receptor blocker used to reduce vomiting during chemotherapy. European studies are suggesting it may also help patients with fibromyalgia by reducing pain, dizziness, and depression and improving sleep. Fatigue and dizziness are the most common side effects.

Targeting Pressure Points and Stretching Techniques

Much of the pain experienced by patients occurs where muscles join tendons or bones, particularly when the muscles are stretched. Stretching or flexibility exercises are part of the warm-up and cool-down routines of any regular program. Stretching techniques may also employ injections or cooling agents to inactivate the pressure points so that muscles can be more effectively stretched. These techniques must be performed by a person other than the patient, usually a family member or close friend. With use of either injections or the spray, the benefits may last from a few days to weeks. Neither the spray nor the injection is useful without muscle stretching.

Spray and Stretch. One such technique is known as "spray and stretch." This method uses the following approach:

The patient must be in a comfortable position.
The partner presses on suspected tender points and the patient reports any pain.
The points, when targeted, are sprayed with either ethyl chloride (Chloroethane) or Fluori-Methane. (These chemicals are not anesthetics. They cool the blood vessels in the skin to inactivate the tender points. Anesthetic skin creams do not appear to be effective for this treatment.)
The spray bottle is held upside-down about 12 to 18 inches from the targeted area. (The patient's face should be covered if the spray is being used near the head.)
The patient's partner then slowly stretches the affected muscle.