General Notes on Drugs for FM & CFS
Drug therapy for pain in FM and CFS is to be avoided if possible, because of side effects and the possibility of addiction. If you decide to use the FDA-approved medications and other medications for pain, it is important to have realisic expectatons. They don’t eliminate pain, but they may reduce it for a period of time in some patients.
Because no medication is consistently helpful for people with FM and CFS, and because pain relievers sometimes lose effectiveness over time, experimentation is usually required. Also, patients are started on dosages that are a small fraction of normal dosage levels.
Many fibromyalgia patients also experience Myofascial Pain Syndrome (MPS), a pain condition localized in trigger points (specific locations in muscles or fascia, not to be confused with tender points used to diagnose FM). MPS may be treated with medication, physical therapies such as massage and myofascial release, and the injection of local anesthetics into the trigger points.
Some people with CFS and FM experience neuropathic or nerve pain, burning or electric shock sensations felt most commonly in the hands and feet. This type of pain is often treated with anti-seizure medications, such as Neurontin.
If you seek pain relief through medications, begin with non-prescription products, such as aspirin and other over-the-counter pain relievers such as Advil (ibuprofen), Aleve (naproxen) and Tylenol (acetaminophen).
A second category is antidepressants, of two kinds. Low doses of tricyclic antidepressants (amitriptyline, desipramine, nortriptyline) can be helpful, but these medications are frequently associated with significant side effects such as dry mouth, blurred vision, and weight gain, and they tend to work less well over time.
More recently, NSRIs (Norepinephrine-Serotonin reuptake Inhibitors) have been shown to be effective for pain, have fewer side effects, tend to be weight neutral, and are durable. That is, they remain effective after months of use. These include Effexor (venlefaxine), Cymbalta (duloxetine), and Savella (milnacipran). Cymbalta and Savella have been FDA approved for treating pain from fibromyalgia.
Third, epilepsy drugs have long been known to reduce atypical or neuropathic pain, and have been useful in both CFS and FM. The first drug of this type was Neurontin (gabapentin). More recently Lyrica (pregabalin) has been FDA approved for the treatment of fibropain.
Fourth is tramadol (aka Ultram, Ultracet, Ryzolt). This drug is in a unique class called “opiate / non-opiate.” Tramadol has the strength of codeine but fewer adverse reactions and is rarely addictive. Therefore, it is very effective and safer for people with CFS and fibromyalgia than narcotic medications.
Finally, there are narcotics. Narcotics are not recommended except via a referral to a pain management specialist.
1) Dr. Lapp's clinic has developed online materials
for physicians. They include information needed to diagnose and manage CFS/ME.
2) For ideas on how to solve five common problems with medications, see the article Managing Your Medications
on the self-help program website.