Fibromyalgia Medication – Why It May Not Be the Answer
The EULAR and ACR recommended prescribed medication in fibromyalgia patients tends to be both largely ineffective in reducing symptoms and poorly tolerated. One study found that the average number of allergies listed for fibromyalgia patients was two and a half times greater than that of healthy controls. Also, patients with fibromyalgia were found to be six times more likely to have multiple drug intolerance. 19. Often the adverse side effects of the medication outweigh any benefit and as such, cause more problems than they solve. Having said that, some fibromyalgia patients do find benefit from medication. And you will probably want to try it if you have been struggling with your symptoms. However, it is important that you know the potential side-effects and withdrawal effects. Then you can make an educated decision. So please read on.
Side-Effects of Fibromyalgia Medication Similar to Fibromyalgia Symptoms
Ironically, some of the common side-effects of the medication can be similar to some of the most common fibromyalgia symptoms that they are supposedly treating. For example, the most common side-effects of two of the approved fibromyalgia medications pregabalin and duloxetine include: anxiety; impaired concentration; confusion; dizziness; drowsiness; dry mouth; fall; fatigue; gastrointestinal disorders; joint disorders; memory loss; altered mood; movement disorders; muscle complaints; oedema; pain; abnormal sensation; and sleep disorders.
As a result, doctors will often prescribe other medication to try to resolve the side-effects of the primary medication. However, these medications also have side-effects which may or may not require a different medication to treat those symptoms. And before you know it you have a list of medications that you need to take on a daily basis to try to feel better.
Contra-indications of Medication for Fibromyalgia
Another issue with prescription medications that you should be aware of, is contra-indications of your medications. Some medications can be dangerous if they are taken together, while others can be less effective if taken together. E.g., taking too many serotonergic medications (medication that modifies the effects of serotonin in the body) can result in serotonin syndrome. The following medications are serotonergic: 20.
- Anti-depressants
- SSRIs – such as fluoxetine, citalopram and sertraline
- SNRIs – such as duloxetine and milnacipran;
- Tricyclics – such as amitriptyline and nortriptyline
- MOA Inhibitors – such as phenelzine
- Opioids
- tramadol
- codeine
- oxycodone
- fentanyl
- methadone
- pethidine
- Noradrenaline Dopamine Reuptake Inhibitors (NDRI)
- bupropion
- lithium
- triptans
Mild symptoms of serotonin syndrome include; confusion, agitation, muscle twitching, sweating, shivering, and diarrhoea. Symptoms of severe serotonin syndrome include: a high temperature of 38C or above; seizures (fits); irregular heartbeat (arrhythmia), and loss of consciousness.
Tolerance and Withdrawal
The body develops a tolerance to both opioid and anti-convulsant (pregabalin and gabapentin) medications over time. As a result, the effectiveness of the medication is reduced and the body requires higher doses to get the same initial effect. When the maximum dose is reached, the effectiveness of the medication still reduces but it is not safe to increase the dose any further. Unwanted side-effects also increase as the dose increases. Tolerance is the reason that many people find relief from these medications to start with, and then experience less relief as time goes on. However, reducing the dose of opioids and anti-convulsants too abruptly can lead to withdrawal effects that make you feel much worse. This can make you believe that you need the medication to keep functioning.
Gabapentoid Withdrawal Symptoms
Withdrawal symptoms from gabapentin and pregabalin can include anxiety, restlessness, insomnia, hallucinations, suicidal ideation, palpitations, sweating, excessive tears, headache, shortness of breath, and loss of appetite. 21. Pregabalin and gabapentin withdrawal can occur even with regular doses and short‐term use. Therefore, the dose should be carefully reduced under supervision of a doctor when reducing or discontinuing treatment. It is important to paying close attention to withdrawal symptoms during this time. Withdrawal symptoms can last between one and several weeks even when the medication is tapered down before discontinuing.
Opioid Withdrawal Symptoms
Similarly, withdrawal symptoms from opioids can include aches/pain, muscle spasms/twitching/tension, tremor, abdominal cramps, nausea/vomiting/diarrhoea, anxiety/restlessness, irritability, insomnia, hot flashes/chills, heart pounding, excessive tears, sweating, runny nose, pupillary dilatation, yawning and gooseflesh. 22. Withdrawal symptoms are most severe in the first few days following reduction/withdrawal, and normally last between 5 and 14 days.
Furthermore, one of the most common withdrawal symptoms of opioids is acute, severe pain all over the body, which can be relieved by taking a dose of opioids. So, patients believe that they cannot function without the painkiller. Tapering opioids to low doses before discontinuing under the supervision of your doctor can reduce the severity of the withdrawal symptoms. Fibromyalgia patients who have reached tolerance and can push through these symptoms often find that their pain levels are actually no higher and can in fact be lower than when they were taking the maximum dose of opioids.
WARNING
WARNING **If you are concerned about the prescription medication that you are currently taking, please speak to your doctor or pharmacist. DO NOT abruptly stop taking any prescribed medication or you will risk withdrawal effects and could become seriously ill. The medications prescribed for fibromyalgia have some nasty and prolonged withdrawal effects, so should be tapered down under the supervision of your doctor.**
Next: Alternative Pharmacological Therapies – Private Prescriptions
References
19. Alvarez, A. and Khan, D., 2021. Multiple Drug Intolerance Syndrome in Fibromyalgia. Journal of Allergy and Clinical Immunology, 147(2), p.AB13.
20. Schenk, M. and Wirz, S., 2015. Serotonin syndrome and pain medication: What is relevant for practice?. Schmerz (Berlin, Germany), 29(2), pp.229-251.
21. Ishikawa, H., Takeshima, M., Ishikawa, H., Ayabe, N., Ohta, H. and Mishima, K., 2021. Pregabalin withdrawal in patients without psychiatric disorders taking a regular dose of pregabalin: A case series and literature review. Neuropsychopharmacology Reports.