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Advances in Fibromyalgia

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As readers of my book The Triple Whammy Cure know, fibromyalgia is essentially a response by your body to unchecked stress, generally occurring (or returning) when your stress level exceeds the protective effect of your serotonin. You suffer that stress and your muscles tighten up and stay that way, hurting more and more. That’s fibromyalgia

Serotonin is the brain chemical that acts as your factory-installed stress buffer. That women make up 90% of those with fibro is due to their gender-specific low levels of serotonin–just one quarter the levels men have.

Conventional physicians have historically been dismissive of fibro patients, mainly because their tests always come back normal. Having ruled out any “serious disease,” like rheumatoid arthritis, they don’t much like dealing with a patient who complains of feeling chronically unwell but looks fine and shows nothing wrong on tests.

For years, the Rheumatology Department of Northwestern University (not far from my office) provided me with a steady stream of patients after telling women who had obvious fibro that there was no such thing–that it was a catch-all “fad” diagnosis and they needed to see a psychiatrist.

Fortunately, times are changing (even at Northwestern), though not as rapidly as I’d like. Today we’ll discuss prescription medicines for fibro pain and next time I’ll summarize the new nutritional supplement protocols used by integrative physicians like myself. In the third installment, we’ll talk about what you can do on your own.

Lyrica
Lyrica, with a cheery sounding name, was the first medication to receive FDA approval for fibromyalgia pain. Its chemical name is pregabalin and it’s a cousin of a medicine used for epilepsy and chronic pain, called gabapentin (Neurontin).

I never thought much of Neurontin’s effectiveness, so I was skeptical about Lyrica’s claims. However, clinical trials did show effectiveness, and in my own practice I’ve prescribed Lyrica for some patients. The results have been iffy. The reason everyone’s not on Lyrica is because of side effects (mainly drowsiness and mental fuzziness), which increase as you increase the dose.

Some women–many of you are already drug-sensitive–need high doses of Lyrica to feel any effect. Side effects can be avoided by slowly increasing the dose over several weeks, so for those patients with intractable pain, Lyrica might be worth a try.

Cymbalta (and Lexapro)
The antidepressant Cymbalta is about to be FDA-approved for fibromyalgia. Unlike most antidepressants, which boost brain levels of the neurotransmitter serotonin, Cymbalta raises levels of both serotonin and norepinephrine. By raising this second neurotransmitter, patients report increased energy and some diminishment of pain. The major side effect is, unfortunately, nausea, and it can be so severe that patients abandon Cymbalta after a few days.

However, nausea can be reduced by taking the drug with food, and it doesn’t occur with everyone. What’s puzzling is that new research is showing that Lexapro, a serotonin-only antidepressant, seems to work just as well as Cymbalta but without the nausea. My own experience with patients confirms this and I’ve been told that Lexapro has filed for fibro-approval with the FDA as well.

Most fibro patients are familiar with the old standards like Flexeril, Skelaxin, Ultram, Ultracet, Ambien, Elavil (amitriptyline), Doxepin, Trazodone, Vicodin, and OxyContin, so I won’t go in to those.

Let me say, however, I’m not thrilled with any of the prescription drugs available for fibromyalgia. Although none is dangerous in terms of life-threatening side effects, patients are often unhappy with nausea, mental fuzziness, dry mouth, constipation, etc. To avoid side effects, very small doses are the order of the day. Dosages that a pharmacist might define as “This dose is too small to do anything,” can, in fact, work wonders for a fibro patient.

So basically, don’t say “no” to prescription medication. A cautious “yes” may work wonders.


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