What is Fibromyalgia and The List of Fibromyaldia Medications

What is Fibromyalgia?

Fibromyalgia (fi·bro·my·al·gi·a) is a condition that causes pain all over the body (also referred to as widespread pain), sleep problems, fatigue, and often emotional and mental distress. People with fibromyalgia may be more sensitive to pain than people without fibromyalgia. This is called abnormal pain perception processing. Fibromyalgia affects about 4 million US adults, about 2% of the adult population. The cause of fibromyalgia is not known, but it can be effectively treated and managed.

What Are the Signs and Symptoms of Fibromyalgia?

The most common symptoms of fibromyalgia are

• Pain and stiffness all over the body
• Fatigue and tiredness
• Depression and anxiety
• Sleep problems
• Problems with thinking, memory, and concentration
• Headaches, including migraines

Other symptoms may include:

• Tingling or numbness in hands and feet
• Pain in the face or jaw, including disorders of the jaw known as temporomandibular joint syndrome (also known as TMJ)

Digestive problems, such as abdominal pain, bloating, constipation, and even irritable bowel syndrome (also known as IBS)

What Are the Risk Factors for Fibromyalgia?

Known risk factors include:

• Age. Fibromyalgia can affect people of all ages, including children. However, most people are diagnosed during middle age and you are more likely to have fibromyalgia as you get older.
• Lupus or Rheumatoid Arthritis. If you have lupus or rheumatoid arthritis (RA), you are more likely to develop fibromyalgia.

Some other factors have been weakly associated with the onset of fibromyalgia, but more research is needed to see if they are real. These possible risk factors include:

• Sex. Women are twice as likely to have fibromyalgia as men.  
• Stressful or traumatic events, such as car accidents, post-traumatic stress disorder (PTSD)
• Repetitive injuries. Injury from repetitive stress on a joint, such as frequent knee bending.
• Illness (such as viral infections)
• Family history
• Obesity

How is Fibromyalgia Diagnosed?

Doctors usually diagnose fibromyalgia using the patient’s history, physical examination, X-rays, and blood work.

Diagnosing fibromyalgia can be challenging because there are no specific laboratory tests or imaging studies that can definitively confirm the condition. Instead, healthcare providers rely on a combination of clinical assessments, medical history, and the presence of specific symptoms to make a diagnosis. The diagnostic process typically involves the following steps:

1. Medical History: The healthcare provider will take a detailed medical history, including a discussion of your symptoms, their onset, duration, and any factors that worsen or alleviate them. Be prepared to discuss your overall health, past illnesses, family medical history, and any medications you are currently taking.
2. Physical Examination: The healthcare provider will conduct a thorough physical examination to assess the presence of specific tender points associated with fibromyalgia. There are 18 designated tender points on the body, and a diagnosis often involves the identification of pain or tenderness in at least 11 of these points.
3. Symptom Assessment: Fibromyalgia is characterized by widespread pain and tenderness, fatigue, sleep disturbances, and cognitive issues (often referred to as “fibro fog”). The healthcare provider will assess the presence and severity of these symptoms.
4. Exclusion of Other Conditions: Since fibromyalgia shares symptoms with other medical conditions, the healthcare provider will rule out other potential causes of the symptoms through various tests. These may include blood tests to check for inflammatory markers, thyroid function, and other potential underlying conditions.
5. Diagnostic Criteria: The diagnosis of fibromyalgia is often based on established criteria, such as those set by the American College of Rheumatology (ACR). The ACR criteria include the widespread pain index (WPI) and the symptom severity (SS) scale. Meeting these criteria helps confirm the diagnosis.

How is Fibromyalgia Treated?

Fibromyalgia can be effectively treated and managed with medication and self-management strategies. You can learn about self-management strategies in the section below titled How can I improve my quality of life?

Fibromyalgia should be treated by a doctor or team of healthcare professionals who specialize in the treatment of fibromyalgia and other types of arthritis, called rheumatologists. Doctors usually treat fibromyalgia with a combination of treatments, which may include:

• Medications, including prescription drugs and over-the-counter pain relievers
• Aerobic exercise and muscle strengthening exercise
• Patient education classes, usually in primary care or community settings
• Stress management techniques such as meditation, yoga, and massage
• Good sleep habits to improve the quality of sleep
• Cognitive behavioral therapy (CBT) to treat underlying depression. CBT is a type of talk therapy meant to change the way people act or think

Fibromyalgia Treatment

There is no cure for fibromyalgia, but the condition can be managed using a variety of measures.  A holistic approach should be taken as not all symptoms can or should be treated with medications. Learning about the condition and modifying your attitude and behavior towards the condition also helps.

Nonpharmacological treatments include:

• Acupuncture
• Dietary changes
• Education
• Homeopathy
• Meditation
• Mindfulness
• Regular exercise
• Stress management
• Yoga.

Many different types of medications have also been used in the treatment of fibromyalgia. Treatments usually involve trial and error, as what works for one person may not work for another. Examples of medications that may benefit some symptoms of fibromyalgia include:

• Acetaminophen
• Antidepressants (eg, tricyclic antidepressants, SNRIs, SSRIs)
• Capsaicin
• Cyclobenzaprine
• Duloxetine
• Gabapentin
• Ibuprofen
• Pramipexole
• Pregabalin
• Tramadol.

What are the Complications of Fibromyalgia?

Fibromyalgia can cause pain, disability, and a lower quality of life. US adults with fibromyalgia may have complications such as:

• More hospitalizations. If you have fibromyalgia you are twice as likely to be hospitalized as someone without fibromyalgia.
• Lower quality of life. Women with fibromyalgia may experience a lower quality of life.
• Higher rates of major depression. Adults with fibromyalgia are more than 3 times more likely to have major depression than adults without fibromyalgia. Screening and treatment for depression are extremely important.
• Higher death rates from suicide and injuries. Death rates from suicide and injuries are higher among fibromyalgia patients, but overall mortality among adults with fibromyalgia is similar to the general population.
• Higher rates of other rheumatic conditions. Fibromyalgia often co-occurs with other types of arthritis such as osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis.

How can I improve my Quality of Life?

• Get physically active. Experts recommend that adults be moderately physically active for 150 minutes per week. Walk, swim, or bike 30 minutes a day for five days a week. These 30 minutes can be broken into three separate ten-minute sessions during the day. Regular physical activity can also reduce the risk of developing other chronic diseases such as heart disease and diabetes. Learn more about physical activity for arthritis. You can exercise on your own or participate in a CDC-recommended physical activity program.
• Go to recommended physical activity programs. Those concerned about how to safely exercise can participate in physical activity programs that are proven effective for reducing pain and disability related to arthritis and improving mood and the ability to move. Classes take place at local Ys, parks, and community centers. These classes can help you feel better. Learn more about CDC-recommended physical activity programs.
• Join a self-management education class, which helps people with arthritis or other conditions—including fibromyalgia—be more confident in how to control their symptoms, how to live well and understand how the condition affects their lives. Learn more about the CDC-recommended self-management education programs.

Approved Drugs for Fibromyalgia

People with fibromyalgia are typically treated with pain medicines, antidepressants, muscle relaxants, and sleep medicines. In June 2007, Lyrica (pregabalin) became the first FDA-approved drug for specifically treating fibromyalgia; a year later, in June 2008, Cymbalta (duloxetine hydrochloride) became the second; and in January 2009, Savella (milnacipran HCI) became the third.

Lyrica, Cymbalta and Savella reduce pain and improve function in some people with fibromyalgia. While those with fibromyalgia have been shown to experience pain differently from other people, the mechanism by which these drugs produce their effects is unknown. There is data suggesting that these drugs affect the release of neurotransmitters in the brain. Neurotransmitters are chemicals that transmit signals from one neuron to another. Treatment with Lyrica,  Cymbalta, and Savella may reduce the level of pain experienced by some people with fibromyalgia.

Lyrica, marketed by Pfizer Inc., was previously approved to treat seizures, as well as pain from damaged nerves that can happen in people with diabetes (diabetic peripheral neuropathy) and in those who develop pain following the rash of shingles. Side effects of Lyrica including sleepiness, dizziness, blurry vision, weight gain, trouble concentrating, swelling of the hands and feet, and dry mouth. Allergic reactions, although rare, can occur.

Cymbalta, marketed by Eli Lilly and Co., was previously approved to treat depression, anxiety, and diabetic peripheral neuropathy. Cymbalta’s side effects include nausea, dry mouth, sleepiness, constipation, decreased appetite, and increased sweating. Like some other antidepressants, Cymbalta may increase the risk of suicidal thinking and behavior in people who take the drug for depression. Some people with fibromyalgia also experience depression.

Savella, marketed by Forest Pharmaceuticals, Inc., is the first drug introduced primarily for treating fibromyalgia. Savella is not used to treat depression in the United States, but acts like medicines that are used to treat depression (antidepressants) and other mental disorders. Antidepressants may increase suicidal thoughts or actions in some people. Side effects include nausea, constipation, dizziness, insomnia, excessive sweating, vomiting, palpitations or increased heart rate, dry mouth and high blood pressure.

Studies of both drugs showed that a substantial number of people with fibromyalgia received good pain relief, but there were others who didn’t benefit.

Lyrica and Cymbalta are approved for use in adults 18 years and older. The drug manufacturers have agreed to study their drugs in children with fibromyalgia and in breastfeeding women.