Fibromyalgia Pain Medications

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Pain medications all too frequently play an important role in helping those who suffer from fibromyalgia manage day to day. Breakthrough pain (also referred to as episodic, incidental, or transient pain) refers to exacerbation’s or ‘flare ups’ of pain that occur beyond the more typical, persistent, baseline pain that an individual with chronic pain experiences. Breakthrough pain is also interpreted as pain that transcends or “breaks through” the individuals threshold of being able to cope. Individuals who have conditions that lead to chronic pain – such as osteoarthritis, cancer, diabetic neuropathy, and fibromyalgia – can all experience breakthrough pain. The onset of breakthrough pain is often abrupt, rising to its most severe point within five minutes and then gradually resolving within a half hour – though there is no definitive pattern. Individuals who are accustomed to chronic pain tend to have a higher pain level and longer duration of breakthrough pain than those who do not experience chronic or persistent pain. Furthermore, episodes of breakthrough pain can occur on a daily basis, and may even occur more than once per day. Although nearly half of all breakthrough pain episodes are incident, breakthrough pain is also frequently caused or triggered by the same factors that result in the baseline, persistent pain itself.

A number of medications are used to treat breakthrough pain, and the most appropriate medication is generally chosen after carefully taking into consideration the duration and intensity of the breakthrough pain and consulting with doctors. It is important to make sure that attention is paid to potential side effects and that individuals make efforts to track the effectiveness of any pain medication along with perceived side effects.

Opiate Analgesics

The most powerful type of pain-relieving medication is a class of drugs known as narcotics. Narcotics decrease pain by working on pain receptors found on the nerve cells themselves, and by changing the way in which the brain and central nervous system respond to pain signals generated throughout the body. The term ‘opiate’ refers to a narcotic medication derived from the opium of poppy plants. Opiate analgesics, or painkillers, are the most conventional medications that are used to treat breakthrough pain, and a number of options exist.

Fentanyl is a very powerful opiate analgesic that is available in the form of an oral lozenge, effervescent tablet, skin patch, and injectable preparation. Fentanyl oral lozenges and tables (Actiq, Fentora) are primarily used for breakthrough pain in cancer patients who are already using other opiate analgesics to control their chronic pain, whereas skin patches (Duragesic) are most often used for individuals with chronic pain who require constant pain relief. The injectable versions of fentanyl are usually administered through a vein, into a muscle, or directly into the spine for the purposes of delivering extremely potent pain relief and anesthesia. In fact, Fentanyl is commonly used as anesthesia for individuals undergoing heart surgery.

 Hydrocodone is another narcotic that is often used to treat less severe breakthrough pain. It is frequently combined with the common pain reliever acetaminophen, which is the active ingredient in Tylenol. This hydrocodone/acetaminophen combination is commonly available as Vicodin. Oxycodone is another opiate pain reliever commonly combined with acetaminophen  and available as Endocet or Percocet, among others. Oxycodone by itself is commonly available as Endocodone, Oxycontin, and Percolone.

 Common side effects of opiate analgesics include constipation, dizziness, lightheadedness, feeling faint, drowsiness, nausea, vomiting, dry mouth, and difficulty urinating. Serious liver damage can also result. Some side effects can signal a serious adverse reaction to the medication. These include difficulty breathing, hives, and swelling in the face, lips, or throat. Symptoms of an overdose include cold ‘clammy’ skin, difficulty thinking/confusion, severe restlessness, severe weakness, drowsiness, or dizziness, slowed pace of breathing, and seizures.

 In addition, opiates can be extremely habit-forming and carry a high risk of fatal overdose. Therefore, they should be used with caution by individuals who have a history of illicit drug use or who have ever overused prescription medications. For example, Fentanyl, is 100 times more potent that morphine. It has a history of illegal manufacture for street sale, as well as illicit distribution by both patients and pharmacists because of its heroin-like properties.

Anti-Inflammatory Agents

 Despite the fact that fibromyalgia is neither caused by nor characterized by inflammation, a number of non-steroidal anti-inflammatory drugs (NSAIDs) may help ease the breakthrough pain associated with many of fibromyalgia’s co-morbid conditions, such as headaches, joint pain, and myofascial pain. Examples of NSAIDs include naproxen (Aleve, Naprosyn), ibuprofen (Advil, Motrin), and aspirin. It is important to use caution when using these medications, all of which are available in prescription-strength as well as over-the-counter, as they can cause stomach upset and intestinal damage, as well as interfere with blood thinning medications.

 In additional to synthetic anti-inflammatory medications, certain derivatives of the naturally-occurring turmeric root have demonstrated both anti-inflammatory as well as analgesic properties. Curamin, which contains the active ingredients of turmeric root, is a commercially-available dietary supplement that is marketed as a natural analgesic for individuals with chronic pain. 

Learn about anti-depressants and their use in treating fibromyalgia here.

Other medications often used to treat fibromyalgia include Lyrica, Savella and Gabapentin.

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References

1.        Bennett D, Burton AW, Fishman S, Fortner B, McCarberg B, Miaskowski C, Nash DB, Pappagallo M, Payne R, Ray J, Viscusi ER, Wong W. Consensus panel recommendations for the assessment and management of breakthrough pain. P&T. 2005;30(5):296-301.

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