Unless you live under a rock these days, it would be hard not to know that we are dealing with an opioid epidemic in the US. The opioid epidemic is tied to patients being treated for pain, and for my pharmacy, that happens to be a large percentage of what patients are seeking help with pain relief. The American Academy of Pain Medicine estimates that there are over 100 million chronic pain sufferers. That statistic is mind-boggling.

Unfortunately, the presentation of pain is simply what the patient describes it as, which makes it difficult as everyone’s perception can be different. There is no lab value to run to measure pain, so we rely on the patient to provide information on the current status of their misery.

Fibromyalgia (FM) is one of the most common chronic pain conditions. The disorder affects an estimated 10 million people in the US and an estimated 3-6% of the world population. While it is most prevalent in women (75-90% of the people with FM are women), it also occurs in men and children of all ethnic groups. FM is often seen in families, among siblings or mother and their children. The diagnosis is usually made between the ages of 20 to 50 years. Still, the incidence rises with age so that by age 80, approximately 8% of adults meet the American College of Rheumatology classification of FM.

Like other so-called “invisible disorders,” FM poses a challenge beyond symptom management to those diagnosed with it: the struggle for credibility. It is too easy for those who have not suffered the pain of FM to dismiss it since it offers no visible signs. It is not uncommon for healthcare providers to ignore the symptoms of people with FM for lack of a blood test as a diagnostic criterion.

Although chronic, widespread body pain is the primary symptom of FM, various other symptoms are expected. Symptoms include: moderate to severe fatigue, sleep disorders, problems with cognitive functioning, irritable bowel syndrome, headaches and migraines, anxiety and depression, and environmental sensitivities.

Since there is no known cure for FM, treatment focuses on relieving symptoms and improving function.

Various prescription medications are used to reduce pain levels and improve sleep. The FDA has approved the following prescription medications for FM: Lyrica (pregabalin), Cymbalta (duloxetine HCL), and Savella (milnacipran HCL).

These medications help a percentage of patients with pain, and with Cymbalta and Savella, serotonin and norepinephrine reuptake inhibitors can also help with depression. Unfortunately, these drugs have the potential for side effects that often limit a patient from continuing them. The other issue is cost, Cymbalta and Lyrica are available generically and are moderately priced, but Savella could cost you or your insurance several hundred dollars per month.

Gabapentin is another medication in the same category of drugs as Lyrica, but it is not FDA approved for FM. When a prescription is prescribed for a condition, not FDA approved, it is considered “off-label” use for the medication. Gabapentin has similar side effects to Lyrica, including drowsiness and fatigue. On the bright side, gabapentin is available as a generic, making it a less expensive alternative.

Muscle relaxants like cyclobenzaprine and orphenadrine can provide some benefits for patients. Both are available generically but have similar side effects to the above medications, fatigue, drowsiness, and dizziness.

In many instances where the above options do not control pain, patients and practitioners reach to opioid medications to help ease the chronic pain. Unfortunately, opioids don’t do a great job of addressing the pain, they have side effects like drowsiness, fatigue, constipation, and over time they can cause memory issues. Lastly, they are controlled substances and have the potential for addiction, a severe deterrent for prescribing these medications. Once a patient is placed on an opioid, they have difficulty trying to get off the drug. 

Ultimately, whether it is an opioid or an FDA-approved medication, they are not a fix to end the vicious FM cycle. Simply band-aiding the problem can help relieve the symptoms of FM. The natural cure and treatment is trying to find the root cause and fix the underlying problem, which will ultimately end the cycle of pain. 

In my next article, I will review non-conventional therapies that can help treat and hopefully end FM pain.

My staff and I would like to help you with questions regarding fibromyalgia and finding suitable treatment options to decrease pain, so call or stop to schedule a consultation. Please visit my website at www.irsfeldpharmacy.com to see this and other archived articles in the blog section. Until next time, be vigilant about your health!!