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More on Lyrica, the Fibromyalgia Drug

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Several readers sent me a link to this New York Times article about fibromyalgia and the newly approved drug Lyrica.

The article addresses a continuing (and unnecessary) controversy about fibromyalgia. Namely, whether fibro is a “real” disease that deserves its own medication and, alternatively, if it’s not a disease then why should doctors treat it like one.

One of my favorite comments came in a follow-up letter. Broadly, that writer noted that just because Western medicine doesn’t understand fibromyalgia doesn’t make it less real for the sufferer.

Back to the article. The most interesting statement comes from Dr Frederick Wolfe, a rheumatologist who wrote the clinical description of fibromyalgia in 1990, when he believed it was a disease. Now, years later, he’s become cynical about fibromyalgia, doubting its existence since there has yet to be any evidence of positive lab tests, which would allow fibro to be classified as a disease. His conclusion? Fibro seems to be a response of the body to stress and depression.

For one brief moment, I fantasized Dr. Wolfe had read my book, which states exactly that.

I’ve been hearing about this so-called problem for years. In order for your symptoms to merit being taken seriously by physicians, they need to coalesce into a “real” disease according to the gold standard of disease existence, those positive lab tests. This is the limited way in which many doctors think. Without the lab results, Dr. Wolfe has become cynical. Odd emotion for a doctor, isn’t it? Not concerned or troubled. Just, well, cynical. Yikes.

The Lyrica argument then becomes: should doctors give patients a medicine for the “non-disease”? The FDA is willing to call fibromyalgia a disease, even though it fulfills none of the usual requirements. Primary care doctors seem delighted with this stance. Sales of Lyrica are booming.

Does anyone sense a problem here? Is anyone else uneasy about where this is going?

Why are we bothering with a discussion about whether or not fibromyalgia is a disease? We take aspirin for a headache, and no one argues that aspirin helps many a headache. There are no positive lab tests for a typical tension headache, but nobody argues about headaches or aspirin. So, if Lyrica helps fibromyalgia pain, it’s a pain medicine, pure and simple.

If Dr. Wolfe is cynical about fibromyalgia because it’s “just” a response to stress and depression, why does this cause him to apparently reverse his original ideas and lose interest in fibro? Maybe he and other doctors should explore the effects of stress more deeply. Maybe the answer to fibro is an analysis of the stressors that triggered it, and then helping patients reduce stress, perhaps through counseling, yoga, and meditation–steps that we already know work for fibro.

Probably most important is the problem with Lyrica itself. The first time Lyrica was presented to the FDA for nerve pain, it was rejected because of excessive side effects. Read that sentence again. It was rejected. Stubbornly, Pfizer persisted and finally the FDA relented. But the side effects haven’t gone away. Patients taking Lyrica get dizzy, disoriented, and drowsy, retain fluid, and gain weight. These are significant side effects for a drug that appears iffy at best, especially for a condition triggered by stress.

Because I treat so many fibro patients, Pfizer contacted me to be a spokesperson to physicians for Lyrica. The professional fee, I assure you, was generous.

I then did what I often do with new medications before I prescribe them: I took it myself. By the time I’d reached half the recommended dose for fibromyalgia, I had to call it quits. I wasn’t thinking clearly and was vaguely nauseated too. As a result, I turned down Pfizer’s offer. I do prescribe Lyrica, mostly when patients ask for it, but not before I explain the side effects.

What’s the take-away from this New York Times article?
• Fibromyalgia exists. It’s a chronic pain syndrome but not, in doctor-speak, a disease.
• I agree that fibro is a problem with how the body responds to stress.
• If you have fibro and want to try Lyrica, know that it’s essentially a pain pill with significant side effects. Most of my patients discontinue it after a few weeks.
• Always be suspicious of TV commercials for drugs.

There are a lot of non-drug ways to improve your fibro, and I describe them in The Triple Whammy Cure.

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