How it works: The first drug approved to treat fibromyalgia, Lyrica (pregabalin) is an anticonvulsant that the U.S. Food and Drug Administration (FDA) previously approved in late 2004 to treat pain associated with diabetic neuropathy and shingles. The medicine is believed to calm overactive neurons as well as possibly influence the release of neurotransmitters.
How it works: Approved in 2008 for use in fibromyalgia (and previously approved for diabetic retinopathy and depression), Cymbalta (duloxetine) is a serotonin and norepinephrine reuptake inhibitor (SNRI)a type of antidepressant that raises the levels of the neurotransmitters serotonin and norepinephrine in the brain and body. These highly sensitive brain chemicals seem to play a role in the perception of pain and keeping them at consistent levels appears to help alleviate it.
How it works: Approved in January 2009, Savella (milnacipran) is also an SNRI.
Off-label: Other antidepressants
Doctors often prescribe drugs off-label to treat medical conditions; this means they prescribe a drug to treat a condition for which it has not been approved by the FDA but has shown promise in practice. For fibromyalgia, the most common medications prescribed off-label are tricyclic antidepressants such as amitriptyline, or a chemically similar muscle relaxant, cyclobenzaprine (Flexeril).
In early 2009, a Stanford University study found that low doses of the drug naltrexone helped reduce pain and fatigue in women with fibromyalgia. Naltrexone is relatively inexpensive and has been used for years to treat drug addiction, but it has only been used off-label to ease fibromyalgia symptoms. Researchers say the study was too small for them to make any new recommendations, but that the results were promising.
Since medication is not universally successful and because the causes of fibromyalgia are so poorly understood, Dr. Argoff cautions that “medication alone is not the solution” and recommends that it be combined with lifestyle changes such as good sleep hygiene and moderate aerobic exercise as well as complementary therapies, such as cognitive behavioral training, to manage pain.