2265 North Clybourn Avenue    Chicago, IL 60614    P: 773.296.6700     F: 773.296.1131

Fibromyalgia: Conventional Treatment

Patients and physicians unfamiliar with fibromyalgia are rightfully a bit shocked when they learn the average fibro patient uses five prescription drugs to make it through her day. Not one of these is “for fibro,” in the sense of a cure, the way penicillin cures a strep throat. The medications don’t even actually treat fibro, the way insulin treats diabetes. At their best, the drugs (sometimes) reduce symptoms.

Doctors face a real challenge when treating fibro:
• First, fibro patients are extremely chemically sensitive, probably related to low levels of stress-buffering serotonin. If anyone is going to experience a side effect from medications, it will be a fibro patient.

• Second, fibro drugs actually have more side effects than most other prescription medicines. I’ve personally sampled them all, and I don’t regard myself as particularly chemically sensitive, but all things considered I would have preferred sampling a selection of Cote du Rhone wines. The thought of taking five of these drugs simultaneously (which I did not attempt) curls my toes.

There are three FDA-approved drugs for fibromyalgia. Two of them, Savella and Cymbalta, were originally developed as antidepressants, but were later found to have fibro pain-relieving benefits. Physiologically, they do “correct” the basic defect occurring in fibromyalgia–low levels of the brain chemicals serotonin and norepinephrine–and work for about half the women who try them. The other half are stymied by nausea, headaches, palpitations, and sweating.

The third FDA-approved med–the one you see in TV ads–is Lyrica, one of several in a class of anti-epilepsy drugs that some years ago was found to have pain-reducing qualities. Lyrica works for about a third of my patients who try it, the other two-thirds abandoning it for side effects of dizziness, brain fog, double vision, and weight gain.

Everything else prescribed for fibromyalgia falls under the heading “FDA off-label” which translates to “Let’s try this one and see what happens.”

• Painkillers The acetaminophen family (Tylenol, etc.): useless. The NSAID family (ibuprofen): useless. The tramadol family (Ultram): can be helpful. The opioid family (Vicodin, OxyContin): helpful, but see my comments at the end of this article.

• Muscle relaxants (Flexeril, Skelaxin, Soma): marginally helpful, but cause drowsiness, dry mouth, and other side effects.

• Sleeping pills (Ambien, Lunesta, etc.): helpful because deeper sleep reduces fibro pain.

• Antidepressants (Elavil, Trazodone, Prozac, Effexor, etc): sometimes helpful, but inconsistent and may have unpleasant side effects (dry mouth, drowsiness, brain fog, flat emotions, weight gain).

• Energizers (Provigil, Nuvigil): sometimes helpful in boosting daytime energy and alertness. Side effect is very straightforward: think “too much Starbucks.”

As you may have guessed, when you take five meds the side effects are additive, meaning the drowsiness from medication A is added to the dry mouth of B and the weight gain of C. In the parlance of physicians, the current approach to fibro is called “shotgun therapy with a load of dirty (i.e., side effect-laden) drugs.”

What this really means is that the pharmaceutical industry may not be the best place to look for fibro treatment. Most physicians work with a single toolbox–their prescription pads. Maybe it’s time to look for a different one.

I’m going to close with a topic that is really–and I mean truly–controversial among physicians.

Because fibromyalgia is basically a physiological chronic pain syndrome and not an actual disease, the ideal treatment should be the best available pain medication. And the best available pain medications are the opioid family (Vicodin, Percocet, and the drug that Rush Limbaugh bought in a Denny’s parking lot, OxyContin).

US physicians are extremely reluctant to write prescriptions for opioid medications, fearing addiction (though the addiction rate among chronic pain patients is less than 1%), street re-selling, and so forth. They also fear a variety of government agencies that monitor physicians and their opioid prescription-writing habits.

There’s a gender bias here as well. An orthopedic surgeon might readily prescribe Vicodin to a guy with chronic back pain, but a rheumatologist will virtually never give OxyContin to a woman with fibromyalgia. Dentists, on the other hand, are quite generous with Vicodin, and many patients have told me that their fibro “melted away” after taking a few Vicodin after dental surgery.

Opioid side effects include constipation, which is so universal that variations of opioid drugs are used for chronic diarrhea (Lomotil, paregoric), and brain fog or nausea.

But the opioid issue is heatedly argued among doctors. A few weeks ago, after a fibro meeting, when the topic was the chronic pelvic pain of fibromyalgia, one physician said “I’d rather schedule a hysterectomy on her than write a Vicodin prescription.” If I were one of his patients, I’d keep a watchful eye on my uterus.

You can read more about the opioid controversy here.

Next week: alternative therapies for fibromyalgia, the last article in this lengthy series I promise.

Click here for Part 6.

Leave a Comment


  1. Thank you so much for writing such amazing and enlightening articles. I work with many patients who have fibro as an energy healer, and I was recently diagnosed myself after 15 years of searching for answers. My life has literally been turned around since the publication of your insightful articles and in addition to visiting your office, I plan to forward your articles to everyone that I know in the healing community and in my life. Thanks again for validating the nightmare of fibromyalgia, as so many western medical dotors have failed to do.

  2. Joann Burnham says:

    Here is one of several articles. If you go to all the F topics, you find a series.

Join our Newsletter

Get health recommendations, delicious and time-saving recipes, medical news, supplement reviews, birthday discounts, and more!

BIRTHDAY

Health Tips

Dr. Edelberg’s Health Tips contain concise bits of advice, medical news, nutritional supplement and pharmaceutical updates, and stress relief ideas. With every Health Tip, you’ll also receive an easy, delicious, and healthful recipe.

When you sign up to receive Health Tips, you can look forward to Dr. Edelberg’s smart and very current observations arriving in your in-box weekly. They’re packed with helpful information and are often slightly irreverent. One of the most common responses to the tips is “I wish my doctor talked to me like this!”

Quick Connect

Get One Click Access to our

patient-portal

The Knowledge Base

Patient education is an integral part of our practice. Here you will find a comprehensive collection of staff articles, descriptions of therapies and nutritional supplements, information addressing your health concerns, and the latest research on nutritional supplements and alternative therapies.

Join our Newsletter

Get health recommendations, recipes, medical news, supplement reviews, birthday discounts, and more!

Upcoming Workshops

**Pain Relief with Myofascial Balls
Tuesday, October 29, 6-8pm
With Renee Zambo, C-IAYT Yoga Therapist

Course Fee: $65.00
(includes WholeHealth Chicago Myofascial Release Kit, $40 value)

Does that same spot in your neck, shoulders, back or hips seem to bother you every day? Do you have joint aches and pains in the hands and feet? Would you like to learn ways to alleviate that pain and tension?

Join WholeHealth Chicago’s Yoga and Movement Therapist Renee Zambo for an evening of muscle tension release with myofascial therapy balls.

Space is limited and registration is required.
Please register online.
Call the Center for additional information at (773) 296-6700
More>>

Recent Health Tips

  • Dandruff, Fungi, and Cancer of the Pancreas

    It’s an eye-catching title, I’ll admit. But the links are quite real and further research may guide medicine in new directions of cancer prevention and treatment. It all starts in your gut microbiome, the totality of microorganisms–bacteria, viruses, protozoa, and fungi–present in your gastrointestinal (GI) tract, mouth to anus. Until recently, researchers and clinical physicians alike paid virtually no attention to the microbiome and the Read More

  • New Hope For Sinus Sufferers

    When osteopath Dr. Rob Ivker moved to Colorado in the 1980s to set up his family practice, he had no idea that when he stepped off the plane he’d succumb to symptoms of chronic sinusitis that just wouldn’t go away: stuffy nose, thick mucus, pressure behind his cheekbones and above his eyebrows, dull aching headache, and thick goopy drainage in the back of his throat. Read More

  • Director of IV Therapies Katie McManigal, BSN, ANP

    Most people at some point in their lives have had an intravenous (IV) line. An adept nurse warned you about the tiny pinch of the needle as it was smoothly inserted and taped in place.  Then the  fluid dangling above your head slowly started making its way through a tube and into your body. IVs are all over the place in hospitals. They’re seen in Read More

October Sale – Save 20% off UltraMeal Rice

UltraMeal RICE is a tasty, non-dairy, nutritionally fortified, powdered meal replacement for those who want to support healthy body composition but may be sensitive to soy.

Click here to take advantage of this month’s promotion!