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Traditional Drug Therapy for Fibromyalgia
Unfortunately the traditional medical treatments for fibromyalgia have not been very effective. The traditional drugs of choice including , NSAIDS, antidepressants, muscle relaxants, tranquilizers, and pain medications may provide short-term relief, yet their results are often fleeting and their side-effects may cause more symptoms than they help. Conventional medical treatments for FMS and CFS is a controversial topic. Consider the following statements from The American College of Rheumatology:
Conventional medical therapies are ineffective and no better than a sugar pill for the treatment of Fibromyalgia.
“On tricyclic medications Amitriptyline (Elavil): Four controlled trials have evaluated the efficacy of Amitriptyline in Fibromyalgia… the longest trial showed NO benefit when compared to placebo. Furthermore, the overall degree of benefit was found to be relatively small in relevant outcomes such as improvement in pain, fatigue, and sleep.”
Of note, 95% of Amitriptyline (Elavil) treated patients experienced side-effects.
“Furthermore, use of anti-anxiety medications Benzodiazepines (Klonopin, Xanax etc.), corticosteroids (medrol dose packs, prednisone, etc.), and nonsteroidal anti-inflammatory agents (Mobic, Celebrex, Vioxx, Bextra, etc.), and pain medications have been shown to be ineffective and should be generally avoided.”
“And our best therapies Amitriptyline (Elavil) and Cyclobenzaprine (Flexeril) could not be distinguished from placebo after three months of therapy. Long-term, follow-up observations indicated that clinical findings for patients with FMS did not change appreciably after 15 years.”
WARNING - Consult your doctor before discontinuing any medications.
Nonsteroidal Anti-inflammatory Drugs (NSAIDs) –Vioxx, Celebrex, Bextra, ETC.
NSAIDs can be helpful, especially when used for inflammation that comes from traumatic injuries (sprains, strains, accidents, etc.). They can be effective in relieving pain and inflammation associated with chronic pain syndromes, including all forms of arthritis and for some who suffer from FMS. However, long term use of these medications can cause a host of unwanted side effects. None of these medications actually correct the cause of pain. In fact, they can accelerate joint destruction and cause intestinal permeability (which leads to more inflammation). Nonsteroidal anti-inflammatories (NSAIDs) such as Bextra, Mobic, Ibuprofen, Daypro, Naprosyn, Celebrex, and Vioxx, can cause intestinal permeability. They cover up the symptoms but do not address the cause, and they can actually cause further joint destruction.
Internal memos show disagreement within the F.D.A. over a study by one of its own scientists, Dr. David Graham, who estimated Vioxx had been associated with more than 27,000 heart attacks or deaths linked to cardiac problems.
NSAIDs causes 10,000-20,000 Deaths a Year. A person taking NSAIDS is seven times more likely to be hospitalized for gastrointestinal adverse effects. The FDA estimates that 200,000 cases of gastric bleeding occur annually and that this leads to 10,000 to 20,000 deaths each year.
High Blood Pressure
NSAIDs can cause high blood pressure. In one study, 41% of those who had recently started on medication to lower their blood pressure were also taking NSAIDs. NSAIDs more than double a person’s risk of developing high blood pressure.
Sleep Medications - Ambien, Elavil, Flexeril, Trazadone, Restoril, Klonopin, Xanax, Ativan, and Sonata
Ambien
(zolpidem) is a short-acting drug that usually lasts for four–six hours. If a patient takes a half dose before bed, then he can take an additional half dose if needed four–six hours later. Even though the literature on Ambien suggests patients don't build up a tolerance, many do. Some patient's do well on Ambien; some build up a tolerance over a period of time needing higher and higher doses until the medicine no longer works. Does promote deep restorative sleep.
Side Effects: Short term memory loss, fuzzy thinking, sedation or next day hang over, mood disorders (anxiety and depression), flu-like symptoms, muscle aches, and in-coordination. This drug, like most drugs, is processed by the liver, so those with sluggish liver function should use this medication with caution. Most common side effects include dizziness and diarrhea. Some patients complain of loss of coordination or concentration. Ambien has caused amnesia (short-term memory loss), but this happens mostly at doses exceeding 10 mg. Patients are cautioned against abruptly stopping the medicine, since withdrawal symptoms commonly occur. Ambien may cause fatigue, headache, anxiety, difficulty sleeping, and memory loss. Long-term use can result in back pain, flu-like symptoms, depression, constipation, upset stomach, joint pain, URI, sore throat, urinary infection, and heart palpitations.
Trazadone
(desyrel) is an antidepressant that increases a person’s ability to hang on to serotonin. It reduces anxiety, and promotes deep sleep. I’ve found this drug to be quite helpful when 5HTP or melatonin doesn’t work. It can cause early morning hangover. Does promote deep restorative sleep.
Side Effects: Common side effects include upset stomach, constipation, bad taste in the mouth, heartburn, diarrhea, rash, rapid heartbeat, mental confusion, hostility, swelling in the arms or legs, dizziness, nightmares, drowsiness, and fatigue.
Elavil
(amitriptyline) is an antidepressant that has become synonymous with treating FMS. It was one of the first drugs to be studied in the treatment of FMS. It can be very helpful in reducing the pain associated with FMS, but it has several potential side effects. It is also prone to lose its effectiveness over time. It does promote deep restorative sleep.
Side Effects: Elavil may cause weight gain, early morning hangover, neurally mediated hypo-tension (low blood pressure), depression, poor sleep, anxiety, and irregular heartbeat.
Flexeril
(cyclobenzaprine) is a muscle relaxant chemically similar to the antidepressant Elavil. It is sometimes used as a sleep aid. Unlike many of the prescription medications for sleep, Flexeril does allow the patient to go into deep stage four (restorative) sleep. It is quite sedating. It does promote deep restorative sleep. Side Effects: Side effects, including gastritis and a feeling of being hung-over or “out of touch,” prevent most patients from remaining on this drug for very long.
Baclofen
(lioresal) is a muscle relaxant similar to the natural neurotransmitter GABA. Side effects include fatigue, drowsiness, low blood pressure, weakness, dizziness, nausea, headache, depression, weight gain, and insomnia. Baclofen does not promote deep, restorative sleep.
Sonata
(zaleplon) is designed to last for only four hours; this helps prevent morning hangover. I’ve not found it to be very effective, though, since most of my patients have trouble sleeping through the night, not just with getting to sleep.
Zanaflex
(tizanidine) is a muscle relaxant that has gained some popularity among physicians treating FMS. It is sedating and, like other muscle relaxers, can help with insomnia. But it doesn’t produce deep, restorative (delta-wave) sleep. It doesn’t help increase serotonin levels; it only tranquilizes the nervous system. For this reason alone it should be avoided. Side Effects: Zanaflex is associated with numerous side-effects, including liver failure (at least three individuals have died from taking this medication), asthenia (weakness), somnolence (prolonged drowsiness or a trance-like condition that may continue for a number of days), dizziness, UTI (urinary tract infection), constipation, liver injury, elevated liver enzymes, vomiting, speech disorder, blurred vision, nervousness, hypo-tension, psychosis/hallucinations, bradycardia (slow heart action), pharyngitis (sore throat), and dykiensia (defect in voluntary movements). This stuff is poison!
Anti-anxiety medication or Benzodiazepines - Xanax, Klonopin, Ativan, Restoril, Busbar, Tranxene, Serax, Librium,Tegretol, Valium, Trileptal, Seraquel, Risperdal, and Symbax. These medications are usually used as anti-anxiety medication. They’re addictive and patients build up a tolerance so that the drug eventually loses it's effectiveness as a sleep aid.
These medications are loaded with side effects that cause further health problems (depression, fatigue, memory loss, "fibro fog" etc.) yet don’t promote deep, restorative sleep. Side effects associated with these medications include sleep disturbances (poor sleep), seizures, neuropsychiatric disturbances (mania, depression, suicide, etc.) tinnitus (ringing in the ears), transient memory loss (amnesia), dizziness, agitation (anxiety), disorientation, hypotension (low blood pressure), nausea, edema (fluid retention), ataxia (muscular in-coordination), tremors, sexual dysfunction (decreased desire and performance), asthenia (weakness), somnolence (prolonged drowsiness or a trance-like condition that may continue for a number of days), and headaches.
Neurontin, Gabitril and Lyrica
GABA inhibitors such as Gabitril (tiagabine) and Neurontin (gabapentin) are anticonvulsant medications originally used to control seizures. They are now being used to block nerve-related pain (neuralgia) including pain caused by herpes zoster. These medications are also being prescribed for chronic headaches (with some success). I’ve not found them to be helpful for the diffuse extremity pains associated with FMS. They don’t promote deep, restorative sleep and can cause many of the same symptoms associated with CFS and FMS, including fatigue, muscle aches, poor mental clarity (“fibro fog”), and mood disorders. Most patients can wean off these medications with no problems.
Side-Effects: There are several side effects associated with their use, including somnolence (prolonged drowsiness or a trance-like condition that may continue for a number of days), dizziness, weakness, fatigue, double vision, edema (fluid retention), ataxia (muscular in-coordination), thought disorder, possible long-term ophthalmic problems (abnormal eyeball movements and disorders), tremors, weight gain, back pain, constipation, muscle aches, memory loss, asthenia (weakness), depression, abnormal thinking, itching, involuntary muscle twitching, serious rash, and runny nose.
Don’t these side-effects sound like some of the symptoms associated with FMS and CFS?
Topamax
(topiramate) is used primarily for adjunctive therapy tonoclonic seizures. It is also used for anxiety disorders. Side Effects: The side effects associated with this drug, especially the fatigue and low blood pressure, prevent patients from having any extra energy. Note: this exert from a letter from the manufacturers of Topamax (Ortho-McNeil Pharmaceutical, Inc.) to doctors: “Topamax: drug used to control epilepsy, off-label drug for anxiety or insomnia—may cause serious eye damage and/or blindness. As of August 17, 2001 there have been 23 reported cases: 22 in adults and one in pediatric patients. It is generally recognized that post-marketing data are subject to substantial under reporting.”
Beta Blockers - Inderal, Lorpressor, Tenormin, Torprol, Etc.
Beta blockers, such as Inderal (propanol), Lorpressor (metoprlol), Tenormin (atenolol), and Torprol (metoprolol) are used for long-term management of angina (chest pain), mitral valve prolapse (MVP), heart arrhythmia (irregular heart beats), and hypertension (high blood pressure). Beta-blockers slow the heart rate, which reduces cardiac output. This leads to low blood pressure and fatigue. The brain and muscles aren’t getting enough blood and oxygen. This can lead to fuzzy thinking, poor memory, depression, anxiety, and physical fatigue.
Side Effects: According to Mark Houston, MD, associate clinical professor of medicine at Vanderbilt School of Medicine, side effects associated with beta-blockers include congestive heart failure (CHF), reduced cardiac output, fatigue, heart block, dizziness, depression, bradycardia (decreased heart beat and function), cold extremities, parathesia (a feeling of “pins and needles”), dyspnea (shortness of breath), drowsiness, lethargy, insomnia, headaches, poor memory, nausea, diarrhea, constipation, colitis, wheezing, bronchospasm, Raynaud’s Syndrome (burning, tingling, pain, numbness, or poor circulation in the hands and feet), claudication, hyperkalemia (muscle cramps), muscle fatigue, lowered libido, impotence, postural hypotension, raised triglycerides, lowered HDL, raised LDL, and hyperglycemia. Dr. Houston recommends Hawthorne berry as a natural beta-blocker alternative. Hawthorne berry is an ACE inhibitor; it works by inhibiting (blocking) the angiotensin-converting enzyme. This enzyme is what causes the constriction of arteries (raises blood pressure and heart contraction/rate). Recommended dose of Hawthorne berry is 160� mg. of standardized extract daily.
Stimulants - Adderall, Concerta, Cylert, Etc
Stimulants such as Adderall (amphetamine), Concerta (methylphenidate), Cylert (pemoline), Dexedrine (dextroamphetamine sulfate), Focalin (dexmethylphenidate HCL), Metadate (methylphenidate), and Ritalin (methylphenidate) are use to increase adrenalin. They can be very helpful in increasing a person’s energy. But you may remember the saying “speed kills.” With the exception of Provigil, these medications are nothing more than various forms of amphetamines (“speed”). These drugs are incredibly hard on the adrenal glands (stress coping glands). Long-term use can cause adrenal fatigue or burnout at least and full blown Addison’s Disease (adrenal failure) at worst. The narcolepsy drug Provigil is being recommend for the fatigue associated with FMS and CFS. This medication is designed to keep a person from going to sleep. Yes, it can help wake you up in the morning and make you more alert. However, the reason you’re tired is because you’re not going into deep restorative sleep each night. However, this medication will interfere with your normal circadian rhythm (sleep wake cycle). The worse thing you can do is take a medication that interferes with your circadian rhythm. Anything that may disrupt your ability to go into deep sleep each night, should be avoided.
Side Effects: Side effects include: insomnia (big problem), Tourette’s syndrome (movement disorder consisting of grimaces, ticks, and involuntary outbursts), nervousness, unstable mood (anxiety, mania, depression, irritability, aggression, etc) tachycardia (rapid heartbeat), hypertension (high blood pressure), tics (abnormal muscle movements), psychosis (abnormal behavior), headaches, seizures, visual disturbances, anorexia (unwanted weight loss), aplastic anemia (arrested development of bone marrow), liver dysfunction, and blood dyscrasias (disease).
Antidepressants Prozac, Zoloft, Celexa, Paxil, Etc.
Selective Serotonin Re-Uptake Inhibitors (SSRIs). SSRIs work by increasing the brain’s use of the neurotransmitter serotonin. Serotonin deficiency is linked to depression, lowered pain tolerance, poor sleep, and mental fatigue. All SSRIs are partially or wholly broken down in the liver. This can create liver dysfunction in some patients, so patients with a sluggish liver should be cautious in taking these medications.
Side Effects: Common side effects include headache, muscle pain, chest pain, anxiety, nervousness, sleeplessness, drowsiness, weakness, changes in sex drive, tremors, dry mouth, irritated stomach, loss of appetite, dizziness, nausea, rash, itching, weight gain, diarrhea, impotence, hair loss, dry skin, chest pain, bronchitis, abnormal heart beat, twitching, anemia, low blood sugar, and low thyroid.
Examples of SSRIs: Zoloft (sertraline), Paxil (paroxetine HCL), Celexa (citalopram), Prozac (fluoxetine), Luvox (fluvoxamine), etc.
Other Side Effects Noted for Antidepressants
Harvard Medical School's Dr. Joseph Glenmullen recently reported on the many dreadful side effects associated with conventional anti-depressant medications. These include neurological disorders, sexual dysfunction (in up to 60% of users), debilitating withdrawal symptoms (including hallucinations, electric shock–like sensations, dizziness, nausea, and anxiety), and decreased effectiveness in about 35% of long-term users.
Tricyclic Antidepressants Elavil, Pamelor, Doxepin, Etc
Tricyclic antidepressants block the hormones serotonin and norepinephrine. This produces a sedative effect. They also reduce the effects of the hormone acetylcholine. Like other antidepressant medications, these drugs are processed by the liver and can cause liver toxicity.
Side Effects: Common side effects include sedation, confusion, blurred vision, muscle spasms or tremors, dry mouth, convulsions, constipation, difficulty in urinating, and sensitivity to light. Examples of tricyclic antidepressants include Pamelor (nortriptyline) and Elavil (amitriptyline). Elavil is an antidepressant now synonymous with treating FMS. It was one of the first drugs to be studied in the treatment of FMS. It can be very helpful in reducing pain, but it has several potential unwanted side effects: weight gain, early morning hangover, neurally mediated hypotension (low blood pressure), and irregular heartbeat.
Prescription Medications Offer Little Hope
A study conducted by the Mayo Foundation for Medical Education and Research demonstrates the need for FMS and CFS treatment beyond drug therapy. Thirty-nine patients with FMS were interviewed about their symptoms. Twenty-nine were interviewed again 10 years later. Of these 29 (mean age 55 at second interview), all had persistence of the same FMS symptoms. Moderate to severe pain or stiffness was reported in 55% of patients, moderate to a great deal of sleep difficulty was noted in 48%, and moderate to extreme fatigue was noted in 59%. These symptoms showed little change from earlier surveys. The surprising finding was that 79% of the patients were still taking medications to control symptoms. We can conclude that the medications weren’t making a significant impact.
I believe that an integrative approach which combines the judicious use of prescription drugs along with nutritional therapy offers the best hope for beating fibromyalgia syndrome.
Back To Fibromyalgia Continued
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