Drugs to Treat Fibromyalgia Just as Likely to Harm as Help
Release Date: January 31, 2013 |
- Two medications prescribed to reduce fibromyalgia pain help and harm patients in nearly equal numbers.
- Treatment for fibromyalgia with drugs alone should be discouraged.
- Combining medication, exercise and counseling may be the most helpful approach to fibromyalgia.
Among fibromyalgia patients taking either of two commonly prescribed drugs to reduce pain, 22 percent report substantial improvement while 21 percent had to quit the regimen due to unpleasant side effects, according to a new review in The Cochrane Library.
People with fibromyalgia suffer from chronic widespread pain, sleep problems and fatigue. The illness affects more than 5 million Americans, 80 percent of whom are women. The cause of fibromyalgia is unknown and currently there is no cure. Using a Quality of Life (QOL) scale for fibromyalgia, the studies reviewed reported QOL ratings lower than 15 on a scale of 0 to 100 even among patients on medications. The two medications often prescribed to treat fibromalgia are duloxetine, known by the brand name Cymbalta or milnacipran, commonly known as Savella.
“A frank discussion between the physician and patient about the potential benefits and harms of both drugs should occur,” noted the reviewers, led by Winfried Häuser, M.D. of Technische Universität München.
The authors reviewed 10 high-quality studies comprising more than 6,000 adults who received either duloxetine, milnacipran, or a placebo for up to six months. A substantial majority of study participants were middle-aged, white women.
“This is a very important study,” says Fred Wolfe, M.D. of the National Data Bank for Rheumatic Diseases. “There’s an enormous amount of advertising suggesting that these drugs really help, whereas the research data show that the improvement is really minimal.”
Treatment with drugs alone “should be discouraged,” the reviewers added. Instead, the review authors recommend a multi-faceted treatment approach including medications for those who find them helpful, exercises to improve mobility and psychological counseling to improve coping skills.
“The medical field does poorly with the treatment of fibromyalgia in general,” says Brian Walitt, M.D., M.P.H., a co-author of the review and an expert in pain syndromes at Washington Hospital Center in Washington, D.C. “Chasing [a cure] with medicine doesn’t seem to work.The people who seem to me to do best sort of figure it out on their own by thinking about things, getting to know themselves, and making changes in their lives to accommodate who they’ve become,” concludes Walitt.
The only other medication approved for fibromyalgia treatment in the U.S. is the anti-convulsant pregabalin, known by the brand name Lyrica. The Cochrane Library plans to publish a review of its effectiveness later this year.
Intensive neuroscientific research is needed to reveal the underlying causes of fibromyalgia and other pain syndromes, say the researchers. In the meantime, combinations of various medications as well as combinations of drug and non-drug treatments may offer better symptom control for sufferers.
For More Information:
The Cochrane Library (http://www.thecochranelibrary.com) contains high quality health care information, including systematic reviews from The Cochrane Collaboration. These reviews bring together research on the effects of health care and are considered the gold standard for determining the relative effectiveness of different interventions.
HäuserW, Urrútia G, Tort S, ÜçeylerN,Walitt B. Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia syndrome. Cochrane Database of Systematic Reviews 2013, Issue 1. Art. No.: CD010292. DOI: 10.1002/14651858.CD010292.
Comments on this article
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|Amy Marie Perkins says|
January 31, 2013 at 10:26 AM
I tried Savella and the side effects were HORRIBLE. I thought I was dying. That is the only way I know how to describe it. Cymbalta's side effects outweighed any benefit at all. As a matter of fact, there were not ANY benefits of Cymbalta either. As for Lyrica, unfortunately, was not much better. My fibromyalgia is very stubborn. Good luck with the studies~
|Sonia L. says|
January 31, 2013 at 10:36 AM
I completely agree with Amy, if you missed a dose of Savella it was like you had a fibro flair up but also couldn't even move! Cymbalta made me bananas and Lyrica is just uhmn... when talking about good affects or bad. There doesn't seem to be much of a difference except if you take too much you're going to sleep. Fibromyalgia is so hard to deal with that doctors don't want to give us false hope. I however, vastly approve of the use of medical marijuana in this instance. It's very helpful but, not everyone will want or can go that way!
|Alisa Moran says|
January 31, 2013 at 10:38 AM
I've tried all three and each was bad in their own way. Cymbalta was the worst though, it gave me pains I didn't have before and zombied me out. Glad I'm off all of them. Now I take some nortriptylin and that helps the best. Still have lots of pain, but the nortriptylin and some viccoprofin and I can move better with less pain.
January 31, 2013 at 10:40 AM
I have been taking cymbalta for years and it seems to make things bearable not perfect but I can function or maybe it is a combination of all the meds I take there are too many of them if you ask me.. If I don't take my meds I can't move or function so I take them and am thankful I can function. Guess I am not really sure which ones do it or what combination just thank full it works and I don't mess with the combination as long as it works.
January 31, 2013 at 10:46 AM
I took Lyrica and their side effects were terrible. I am on low dose of Cymbalta and the pain is just barely tolerable. My doc will not change or upgrade it.
|Robin Milliken says|
January 31, 2013 at 10:47 AM
I have taken Svella in which it was helpful for about 2 weeks. The Cymbalta I have not taken eventhough it has been stressed to try because of medical familial history, so I am truly not a candidtate for it. As far as Lyrica goes I took that for a period of time.It seemed to help more with mobility for me than pain,but it messed my eyes up to the point I had to replace my glasses. This is a very difficult physical issue and I was able to stay ahead of it for 15 ish years,but it has gotten so I can not work any longer. What I do not understand is why it is believed that excercise is such a good thing for keeping us mobile.I do believe that anyone with this condition needs to do the best they can doing whatever they can on any given day. That is all I can do each day and my personality is to not one to give up, but there seemed to come a time that I had to be sensible for myself. Meds Just don't do much,or arm harmful in my case
January 31, 2013 at 10:48 AM
I agree that Cymbalta and Savella are the worst drugs out there! I never felt as sick as when I took just one of those, at the lowest dose also!. I have been taking Lyrica since before it was "Lyrica", it helps but not like I would like it to. When I don't take it, I feel AWFUL! Probably the best thing that helps my Fibro is not laying around the house and doing nothing. If I do that I get major stiffness and sore all over. Must do all lots of stretching and massage too!
January 31, 2013 at 11:01 AM
I have both Lupus and Fibromyalgia and for the past year took Lyrica to help with the everyday pains, along with several others. I wasn't completely satisfied with the results but it did help. Recently I was took off Lyrica and put on Sulfasalazine (azulfidine) and the side effects of this is absolutely horrible. I have a constant headache, I feel nauseated constantly, have completely lost my appetite and my vision is blurry even with my glasses. Not to mention, it has not helped the pain at all. I have never tried cymbalta or savella but sounds like something to be avoided.
January 31, 2013 at 11:03 AM
I have been taking cymbalta for four months, I am pain free but I am still stiff and sore. The first few months the side effects were horrible but not as bad as the pain without it. The Dr. kept telling me the side effects would go away he was right. I take xanax at night I sleep better than I have in many years. Before cymbalta I had tried everything it would help somewhat with side effects but I still had pain. I hope this keeps working.
January 31, 2013 at 11:04 AM
I take Savella, at this point and time I am not sure it is helping. But then if I skip a dose its awful. I have tried cymbalta but it makes my migraines so much worse..I can't take Lyrica, it causes my A-Fib to act up. I did try physical therapy and it was worse. Its like a double edge sword..What do we do!!!!!
January 31, 2013 at 11:09 AM
I took Savella for two weeks and I really believe if I had taken it any longer it would have killed me. That stuff has to be poison. I've been off of it for 4 days and I'm still sick. There is nothing out there I can take. It is so upsetting to know I have to live in all this pain and no one can find something for me to take without it "killing" me.
January 31, 2013 at 11:11 AM
I have another appointment with my doctor today and he has talked about putting me on Cymbalta. NOT! Earlier he put me on Lyrica and I turned into a zombie but it did nothing for two of my friends. My doctor is a D.O. and usually gives me a treatment and that helps some. I do try to stay active as much as possible but some days it is all I can do to take the dog out for his duty.
January 31, 2013 at 11:15 AM
I agree that Cymbalta is the worse I could not take that at all! I agree with Lucinda to many Meds... I do take a high dose of Lyrica, I have been on it for about 3 years and with a combination of all my medications my life can be bearable some times I just want to crawl under my desk and dye! But I just take everyday as it is and some how we make it though it.
I wish the goverment would try more reserch to help find a cure.
|Debra Gibbs says|
January 31, 2013 at 11:16 AM
I was on Lyrica. It took my eyesight to an all time low. I have since stopped the medication and I had surgery to correct my eyes. The other two meds that you mention I can not have because I have had Cancer and it is suggested that if you ever had Cancer do not take. So I am at a loss when it comes to these medications. Right now my Doctor has me on the morphine patch. It does help CURB the pain, but I am to the point that I feel nothing will take it away except for the Medicinal Marijuana. Yes I have tried it over the years to ease the pain and it works.. It relaxes you to a point where the pain dulls like a very soothing song. NO I do not get HIGH. I actually have only take a few puffs off of a pipe that is all that I needed to calm it all down. So since New Jersey has the legal medicinal Marijuana available we are now checking into that. I personally would rather that then using the morphine patch that we all know is very addicting. Thankfully I only use the patch when it hurts to no end. So it will stay off the addicting part.
If you are going to give clear thoughts to studies, I would like to see you include the Medicinal Marijuana under controlled usage and compare the results to the other drugs mentioned.
January 31, 2013 at 11:45 AM
I have tried cymbalta and neurontin in the past with no relief. I have been on opiate regimen with flexeril and amitriptyline at night. I have constant pain still but it is generally tolerable and I am functional. I have been on this for almost 3 yrs now after many different trials of various medications.
January 31, 2013 at 11:50 AM
My dr has me taking lyrica, savella, cymbalta, and tizanadine. He wanted me to take them both morning and and night but I have stop taking all of them in the morning due to the side effects. I am 28 with 2 children and cannot function all doped up. I also stopped taking the savella and lowered the dosages myself to my tolerance. I have a very aggressive dr who doesn't really listen just likes to up the meds.
January 31, 2013 at 12:06 PM
Currently on Neurontin day and night and Nortryptinol at bedtime, along with Mobic daily for arthritis. As long as I don't miss a dose, my pain is managed.
January 31, 2013 at 3:24 PM
All of the comments, just show how different we all are, and why treating Fibromyalgia is so hard. I have been on everything under the sun, Neurontin, Nortryptinol, Amitriptyline, Lyrica, and some I don't remember the name ... all effected me something terrible, with being zombied out, gave me major migraines, non stop throwing up, you name it as a side effect, I had it. Cymbalta (60mg), combined with Flexeril, is the first treatment that has given me any relief at all. I am almost back to a normal function person, with flareups, only if I super duper over do it. I am able to exercise four times a week, with no flare ups, and foods are bothering me less than they used to.
January 31, 2013 at 3:58 PM
I am on Cymbalta 60 mg one time a day, the pain and stiffness never goes away, even with the other meds i take. I'm on CeleBREX 200mg one time a day, but I still hurt just like I have the flu..I have to take Tramadol several times a day to be able to cope with the pain. A Problem i have found with all these Medications, they cause weight gain. i have tried taking Flexeril, it makes me so sleepy i can't hold my head up, even taking 5mg..
|Robin Isle says|
February 11, 2013 at 5:38 PM
I have Fibromyalgia. Daily I take a regimen of Cymbalta; Lyrica; Topiramate;Valium. I use Percocet PRN; Morphine Cream PRN for body pain from head to toe.I also take Prenatal Vitamins, B-Complex w/Folic Acid and Vitamin C; and Fish Oil. Some days are better than others, but I am in constant pain. I never wake up refreshed. I have "foggy hazy days". Days when I cannot operate a vehicle. i admit that I fall down occasionally. "clumsy". My fingertips and my toes tingle from the Lyrica. A numb feeling. That's my take on the medical scene. Without medication I fear what my life would be like. Worse than this? I cannot imagine it being any more painful than this. It is miserable! Others don't understand; when your intentions were good. When you suddenly can't make events because you are taken ill with flu like symptoms that you cannot shake. I cannot begin to tell you how many events I have missed due to chronic nagging pain. It makes you hate your life.
February 15, 2013 at 12:53 AM
I had complete issues with Cymbalta, I know I wasnt supposed to but I stopped it cold turkey about a month ago, and while i have more pain generally my quality of life has triplicated since I stopped taking it. I didn't realize just how seriously the drug was effecting my life. I mean for the first time in 2 years I have nails that actually are strong and grow, I didn't realize it but my depression was so bad I couldnt do much but cry and hide to get away from my anxieties. I put on weight and even a few times got close to harmful thoughts. I was very anti medication to treat fibro in the first place, i really dont think i will go back on another any time soon.
|Jo-Anne W - SA Australia says|
February 17, 2013 at 4:07 AM
I have fibromyalgia i have been on no longer take tramadol couldn't even get off of the couch when my then dr say how bad i was took me off Lyrica made me put on heaps of weight Cymbalta did nothing but gave really bad side effects interferring with weeing pooing Cymbalta was so horrible refused to take it numbness something with S made my turn black blue as well as other side effects tried methadone went back to the way i was before i went on Norspan patches although the pain in my feet legs thighs & some pain over neck down back relieve i'm allergic to the patch it's so itchy leaves me looking like patchwork quilt begin last year pain in all over back worsened and pain in other areas returning more each day went up 25mcg to 30mcg needs to be upped more and changed drs as the one last year wouldn't even give me a script for Panadeine Forte had to beg my specialist this year when i saw him wrote it in letter so he'd prescribe it also told seeing another dr i've know since 17 yrs made me take blood tests taking under 2yrs Vit B12 inj every 3 months helps taken of Lipitor as affecting med so the only meds i'm taking are Panadeine Forte up to 6 a day & Norspan Patches 30mcg but need to be increased again as nothing else works.
|Jo-Anne W - SA Australia says|
February 17, 2013 at 4:17 AM
Forgot to mention that i'm 50 yrs 51 late in the year sorry for some of the errors also left out heaps of other sides effect and meds like mobic cheers!
February 17, 2013 at 11:27 AM
I have used both cymbalta and am currently on Savella. I am doing well for me. The key is exercise, even if you hurt. Any exercise produces natural pain relief, endorphins. I always feel better when I am done my walk. Walk, not run. Walking uses every major muscle in the body. Start slow and increase gradually. The fm person never gets to phase 4 sleep where the body produces hormones that mend the tears in the muscles from the daily activity. For this reason everything must be done slowly and slightly increase depending on how your doing. A sleep med that simulates phase 4 does not help create hormones but you do get the rest you would not get without it. The latest research I have read said it is a malfunction of the brain. That is why so many systems are affected. I think they are getting close to a cure. I have had it since childhood.
March 3, 2013 at 5:47 PM
The first medication I was put on was Cymbalta and even at the lowest dose I felt, looked and acted drunk. The worst feeling ever. Switched to Savella 50 mg morning and night and it has been very good for me. Yes I still have pain but it is bearable. I walk for 45 minutes every day and even though I hurt when I start, I have no pain when I finish. I also do aerobic pool therapy once a week. The single most beneficial thing I do though is get an hour long massage with reflexology every other week. The massage gives me as much relief as anything else that has been tried. I have to change doctors soon as the doctor I was seeing has moved out of state. I may be starting the medicine trial period all over again as I know different doctors have varying opinions on how to treat fibro.
March 18, 2013 at 7:10 PM
I'v tried Cymbalta, Savella & Lyrica. Nothing worked. I am now on Gabapentin at a high dose. It doesn't take flares away but makes them mentally manageable to where I don't scream * cry through them. Everyone needs to keep trying. Healthy diet, keep moving even if stretching. Staying laying down or sitting will stiffen you up. It may hurt to walk around the house but try.. I hope everyone finds something that will help them. It's hit and miss. Especially the right dr. Do your research on them before you waste your time with an appointment that is going to leave you in tears..
|Sophie in SW Washington State -- damp climate most says|
April 22, 2013 at 11:36 PM
Hello. Diagnosed in 1993 w/sister and father same time. 59 now, sister 62, father 87. Due to life-threatening allergic reactions to morphine/opiate meds can't use patches or pills.Deal with pain by electronic TENS unit, gentle exercise and stretching, strength resistence practice 3 x week, and hot cold compress or ice and warm showers, daily coated aspirin, 40 mg generic -fluoxetine at night, vitamin D3, Potassium and magnesiun, rest of nutrients through food. Doulble the suggested amount of omega 3 fatty acids through fish, walnuts, flax, chia, green veg with omega 3's so balance of efa"s good. i actually have less pain with this increase of efas. Still have overwhelming fatigue. That gets very annoying-- fall asleep at any moment in the afternoon. Sometimes go to bed at 5 :30 pm sleep until 12 noon next day. Drink lots of water. Enjoy laughter and hearing children play. Good patient and understanding company is hard to find.
Bless you all. The struggle continues.
May 20, 2013 at 3:28 PM
I was just recently diagnosed with FM (which was very difficult to determine because I also have a bad back; spinal fusion at L5/S1, herniated disc at L4/L5, severe pain in middle back I suspect may be more disc degeneration, and pain that has spread up to the shoulders, neck, and jaw with frequent headaches and add to that I am without health insurance!) and have tried Cymbalta and Lyrica in the past, which I did not notice any improvement whatsoever. The doctor put me back on 75mg of Lyrica twice a day even though I told him it didn't do anything for me the first time. He said I didn't take it long enough for it to "build up" in my system for it to work. I understand the theory, but as someone who knows how it feels to be in pain 24/7, WHY and HOW am I supposed to wait around for a med to start working?!? It's aggravating because if I find that a med is not working how I expect it to, I just forget to take it because it wasn't helping in the first place! I wouldn't forget to take a med that actually works because I am also on 350mg of Soma 4x a day, 10mg of Vicodin also 4x a day. My pain management doctor had me on the Fentanyl patches (have been on all doses, up to 100mcg at varying times before and after my back surgery), but had to go off of them ONLY because I could not afford them without health insurance (which I had been on my parent's until 26 and I am now 28, will be 29 in January). My last visit to him was 4/25 and I asked him if he would prescribe them again because they helped SO MUCH and my parents were willing to pay for the Rx as long as it was going to help me be able to live a more normal life, but he refused, which ended up making me cry because I have known what works for me, but he doesn't want to put me back on it and both my parents are on the patch for their severe back pain (my dad has had 9 different back surgeries (he's kinda like the bionic man now) and two total knee replacements in the same knee because he got MRSA after the first replacement). Thankfully both of my parents have been nice enough to share a few with me every month just so I don't have to suffer, but I REALLY want to get an Rx for myself since I have been on them in the past and the only reason I had to stop was because I knew my parents couldn't afford them for me with no health insurance. Should I just keep asking him every time I see him (every 3 months) since the Lyrica does not help me? I just feel done with trying the antidepressants and nerve pain meds because THEY DON'T WORK! I cannot even hold a part time job because I'm either in too much pain, too tired, or too sick (nausea) on most days, especially in high stress jobs. I wish I could afford some kind of counseling or therapy where I could talk to someone because I have a lot of unwarranted stress/anxiety/depression. I am not good at talking about my feelings with people I know because I don't need their criticisms or advice, I just want someone to listen and not dismiss or invalidate my feelings. I understand my feelings about some things may not be right, but I just want someone to tell me it's ok to feel how I feel because I just can't change those feelings.
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