Medications for Fibromyalgia

Leon Chaitow, N.D., D.O., M.R.O.
The most widespread treatment approach to Fibromyalgia involves Medications (the use of various pharmacological agents) and it is useful to evaluate the results of studies as to their efficacy.  Tricyclic antidepressant fibromyalgia medications increases the amount of serotonin in the central nervous system and increases the delta-wave sleep stage and is found to consistently improve the symptoms of fibromyalgia, though not by acting as an anti-depressant and not in all patients treated.

Studies involving various forms of antidepressant medications for fibromyalgia tend to support use of Amitripyline (25 to 50mg daily) with pain scores, stiffness, sleep and fatigue all improving on average but by no means in all patients.

In one study 77% of Fibromyalgia patients receiving medications of Amitripyline reported general improvement after 5 weeks as against only 43% of those receiving placebo medication. Side effects from the antidepressant were however measurable with a selection of drowsiness, confusion, seizure, agitation, nightmares, blurred vision, hallucinations, uneven heartbeat, gastrointestinal upsets, low blood pressure, constipation, urinary retention, impotence and mouth dryness all being observed or reported.

When combined with osteopathic manipulative methods (mainly soft tissue techniques – see below) anti-depressant medication offered greater relief.  A study involving the use of systemic corticosteroids (prednisone 15mg daily) showed that there were no measurable improvements, and since side effects with such medication is usual this approach is clearly not desirable. Indeed if it were to produce an improvement it would be sensible to question whether fibromyalgia was indeed the correct diagnosis. Some other rheumatic condition is a more likely to improve symptomatically with its use.

When muscle relaxant medications were tested in Fibromyalgia patients most were found to be useless but cyclobenzaprine was found to improve pain levels, sleep and tender point count (10 to 40 mg daily given at night to prevent daytime drowsiness) and this is thought to be because it has a chemical similarity to Amitripyline.

Many other drugs are currently being researched and tried in treatment of Fibromyalgia ranging from antiviral agents to substances which modulate the immune system. Various cocktails of antidepressant and sedative medications are being tried out as well. Even aspirin has been tried and is said to be mildly useful!

References:
1. Goldenberg D et al Randomized, controlled trial of Amitripyline anproxine in treatment of patients with fibromyalgia Arthritis/Rheum 1986;29: pp 1371-1377
2. Clark S et al Double blind crossover trial of prednisone in treatment of fibrositis J Rheumatol 1985; 12(5) pp 980-983
3. Campbell S et al A double blind study of cyclobenzaprine in patients with primary fibromyalgia Arthritis Rhem 1985; 28: S40
4. Carette S et al Evaluation of Amitripyline in primary fibrositis Arthritis Rhem 1986: 29 pp 655-659
Dr. Chaitow is a practicing naturopath, osteopath, and acupuncturist in the UK, with over forty years clinical experience.  He regularly lectures in the USA and  Europe, and has written over 60 books on natural health and alternative medicine.