Lyrica (pregabalin), when used on its own for fibromyalgia, is superior to opioids in reducing pain and improving pain interference in daily life, finds a study sponsored by Pfizer.
The analysis, which included 1,421 fibromyalgia patients, showed that those using Lyrica doses recommended for fibromyalgia treatment had the best outcomes, suggesting that many patients should increase their doses to reach recommended levels.
Pfizer and ProCare Systems conducted the study, “Interpreting the Effectiveness of Opioids and Pregabalin for Pain Severity, Pain Interference, and Fatigue in Fibromyalgia Patients,” which took aim at the notion that — despite little evidence of their effectivity — opioids are the most commonly prescribed drugs for fibromyalgia. To examine how different treatments affect pain and related outcomes in fibromyalgia patients, the research team turned to information from the ProCare Systems network of chronic pain clinics in Michigan.
All patients received Lyrica or opioids alone or in combination, and had been through several pain health assessments, including pain characteristics, physical function, and psychosocial function.
The team divided the patients into different groups based on their average morphine equivalent dose or average Lyrica dose. Patients were followed between 56 and 365 days. Nearly 78 percent of them were women — typical of fibromyalgia in the real world.
Findings, published in the journal Pain Practice, showed that only 3.4 percent of patients took the recommended Lyrica dose of 300-450 mg. Most patients took less than 150 mg of Lyrica, either alone or combined with high-dose opioids.
The team assessed the number of patients in the different medication groups and noted that more of those who took Lyrica without opioids achieved at least 30 percent improvement across all pain measurements.
Lyrica treatment was also superior to opioids or opioid-Lyrica combinations in improving pain-related aspects, such as “ability to enjoy life, activity in general, mood and sleep.” The only pain-related aspect that was better in the group combining Lyrica and moderate doses of opioids was “relationships with others.”
When increasing the threshold to at least 50 percent improvement in pain and pain-related aspects of daily living, Lyrica was again superior to opioids or combinations.
While Lyrica did score low on how well it affected fatigue, it did better when combined with moderate opioid doses.
“Pregabalin without opioids provided the most favorable outcomes overall based on ≥30% and ≥50% improvement thresholds … with support for moderate … opioids+pregabalin in patients suffering from fatigue” researchers wrote.
Researchers also noted that patients taking higher Lyrica doses, reaching the recommended dose range, had better outcomes than those taking low doses.
After two hourlong sessions focused first on body awareness and then on movement retraining at the Feldenkrais Institute of New York, I understood what it meant to experience an incredible lightness of being. Having, temporarily at least, released the muscle tension that aggravates my back and hip pain, I felt like I was walking on air.
I had long refrained from writing about this method of countering pain because I thought it was some sort of New Age gobbledygook with no scientific basis. Boy, was I wrong!
The Feldenkrais method is one of several increasingly popular movement techniques, similar to the Alexander technique, that attempt to better integrate the connections between mind and body. By becoming aware of how one’s body interacts with its surroundings and learning how to behave in less stressful ways, it becomes possible to relinquish habitual movement patterns that cause or contribute to chronic pain.
The method was developed by Moshe Feldenkrais, an Israeli physicist, mechanical engineer, and expert in martial arts after a knee injury threatened to leave him unable to walk. Relying on his expert knowledge of gravity and the mechanics of motion, he developed exercises to help teach the body easier, more efficient ways to move.
I went to the institute at the urging of Cathryn Jakobson Ramin, author of the recently published book “Crooked” which details the nature and results of virtually every current approach to treating back pain, a problem that has plagued me on and off (now mostly on) for decades. Having benefited from Feldenkrais lessons herself, Ms. Ramin had good reason to believe they would help me.
In her book, she recounts the experience of Courtney King, who first experienced crippling back spasms in her late 20s. Ms. King was taking several dance classes a week and practicing yoga, and she thought the stress of these activities might be causing the pain in her tight, inflexible back. But after a number of Feldenkrais sessions, she told Ms. Ramin, “I realized that the pain had more to do with the way I carried myself every day.”
Even after just one session, I understood what she meant. When I make a point of walking upright and fluid, sitting straight, even cooking relaxed and unhurried, I have no pain. The slow, gentle, repetitive movements I practiced in a Feldenkrais group class helped foster an awareness of how I use my body in relation to my environment, and awareness is the first step to changing one’s behavior.
One common problem of which I’m often guilty is using small muscles to accomplish tasks meant for large, heavy-duty ones, resulting in undue fatigue and pain.
The group class, called Awareness Through Movement, was followed by an individual session called Functional Integration with a therapist that helped to free tight muscles and joints that were limiting my motion and increasing my discomfort. Using gentle manipulation and passive movements, the therapist individualized his approach to my particular needs.
The ultimate goal of both sessions is, in effect, to retrain the brain – to establish new neural pathways that result in easy, simple movements that are physiologically effective and comfortable. Although the Feldenkrais method was developed in the mid-20th century, neurophysiologists have since demonstrated the plasticity of the brain, its ability to form new cells, reorganize itself, and, in effect, learn new ways to do things.
The beauty of Feldenkrais lessons is that they are both relatively low-cost (group classes average $15 to $25, individual sessions $100 to $200) and potentially accessible to nearly everyone. There are more than 7,000 teachers and practitioners working in 18 countries, including large numbers in the United States. You can be any age, strength, fitness level, and state of well-being to participate. The exercises are slow, gentle, and adjustable to whatever might ail you. Their calming effect counters the stress that results in contracted muscles, tightness, and pain.
Many Feldenkrais practitioners, like Marek Wyszynski, director of the New York center, start professional life as physical therapists, although many other practitioners begin with no medical background. They then undergo three and a half years of training to become certified in the Feldenkrais Method.
Mr. Wyszynski explained that he starts by observing how patients are using their skeletons – how they sit, stand, and walk-in ways that may cause or contribute to their pathology, be it spinal disc disease, arthritis, shoulder pain, or damaged knee joints. In accordance with Dr. Feldenkrais’s astute observation, “If you don’t know what you are doing, you can’t do what you want,” patients are then given a clear sensory experience of how their posture and behavior contribute to their pain and physical limitations.
For example, some people may use excessive force, clench their teeth, hold their breath, or rush, causing undue muscle tension and skeletal stress. Years ago, I realized that my frequent headaches resulted from an unconscious habit of clenching my jaw when I concentrated intently on a task like sewing or cooking. Feldenkrais teachers do not give formulas for a proper way of behaving; rather, they rely on their patients’ ability to self-discover and self-correct.
Once aware of their counterproductive habits, students are given the opportunity to experience alternative movements, postures, and behaviors and, through practice, create new habits that are less likely to cause pain.
Mr. Wyszynski told me that there are more than 1,000 distinct Feldenkrais lessons currently available, most of which involve everyday actions like reaching, getting up from a chair, turning, bending, and walking.
As a mechanical engineer and physicist, Dr. Feldenkrais understood that the job of the human skeleton was to accommodate the effects of gravity in order to remain upright. And he wanted people to achieve this in the most efficient way possible.
Using two tall foam cylinders, one perched on top of the other, Mr. Wyszynski demonstrated a guiding principle of the Feldenkrais Method. When the top cylinder was centered on the bottom one, it stood in place without assistance. But when it was off-center, perched near the edge of the bottom cylinder, it tipped over. If instead of cylinders these were someone’s skeletal parts that were askew, tightened muscles would have to keep the patient from falling over.
As Mr. Wyszynski explained, “Good posture allows the skeleton to hold up and support the body without expending unnecessary energy despite the pull of gravity. However, with poor posture, the muscles are doing part of the job of the bones, and with poor skeletal support, the muscles have to remain contracted to prevent the body from falling.”
Throughout the history of Fibromyalgia, this disease has been strangely hard to identify and analyze on the grounds that it shows up, at first look, to be something else. Perhaps its symptoms including musculoskeletal pain, fatigue, mood swings, and memory loss, are genuinely common. To give some point of view 1 in 70 people, almost ladies, in the US really have fibromyalgia.
However, there is stunning news for all of us. For those who have this horrible condition, hyperbaric oxygen treatment has made some diversion changing ground in medicine. Women who attempted hyperbaric oxygen treatments were able to reduce or completely wipe out their requirements for pain medication, found by the Researchers from Tel Aviv University.
As per beliefs of Researchers, the primary cause of fibromyalgia is a disturbance of brain mechanisms that are responsible for processing pain.
“For me, as a physician, the most important finding is that 70 percent of the patients could recuperate from their fibromyalgia symptoms. For the world of research, the most amazing finding, however, is that we were able to map the malfunctioning brain regions responsible for the syndrome… The intake of [the pain medication they were taking] facilitated the pain but did not reverse the condition. But hyperbaric oxygen treatments actually reverse the condition…
Hyperbaric oxygen treatments are designed to address the actual reason for fibromyalgia – the brain pathology in charge of the syndrome.
Thyme is an herb from the mint family. This is a truly ancient herb, used by the Egyptians, Greeks, and Romans for ceremonial and ritualistic purposes. Through the Middle Ages where it was also used for religious and medicinal reasons. It is an incredibly potent yet simple herb affecting multiple systems in the body and capable of treating dozens of diseases. It contains one of the strongest antioxidants known and is proven to kill 98% of breast cancer cells.
Thyme contains thymol which is a natural antiseptic, antibacterial, and an expectorant, making this tea with honey and lemon a delicious remedy for all of you suffering from sore throats and coughs.
Wild thyme tea is recommended for cough, hangover, flu, and sore throat. Thyme has primarily been used for respiratory ailments for its infection-fighting and cough suppressive qualities. Thyme honey is ideal for sweetening herb teas. Blend thyme with nettle for allergies and mints for colds and congestion. It is also help’s if you have fibromyalgia, rheumatoid arthritis, lupus & multiple sclerosis.
-1c Boiling Water -1tbs dry or 1T fresh Thyme -1tbs dry or 1T fresh sage -1-1 Ginger slices -Honey to taste
Directions: -Warm your teacup with hot water. -Pour away the water. -Put herbs in the cup. Add fresh boiling water and cover. -Leave to steep 3 to 5 minutes. Add more herbs for a stronger flavor. -Steeping too long will make the tea bitter. Use Honey or a natural herbal sweetener like Stevia. -Add ginger slices and/or lemon slices if desired.
Many fibromyalgia sufferers have been told that the pain is “all in their head.” New research indicates there may be some truth to that, and that overactive brain networks could play a role in the hypersensitivity of fibromyalgia patients.
Fibromyalgia is a poorly understood disorder characterized by deep tissue pain, fatigue, headaches, mood swings, and insomnia. There is no known cause and successful treatments have been elusive.
In a lengthy study published in the journal Scientific Reports, an international team of researchers at the University of Michigan and in South Korea report that patients with fibromyalgia have brain networks primed for rapid responses to minor changes. This abnormal hypersensitivity is known as called explosive synchronization (ES).
“For the first time, this research shows that the hypersensitivity experienced by chronic pain patients may result from hypersensitive brain networks,” says co-senior author Richard Harris, Ph.D., an associate professor of anesthesiology at Michigan Medicine’s Chronic Pain and Fatigue Research Center.
In ES, a small stimulus can lead to a dramatic synchronized reaction throughout the network, as can happen when a power outage triggers a major grid failure or blackout. Until recently, this phenomenon was studied in physics rather than medicine. Researchers say it’s a promising avenue to explore in the quest to determine how a person develops fibromyalgia.
“As opposed to the normal process of gradually linking up different centers in the brain after a stimulus, chronic pain patients have conditions that predispose them to link up in an abrupt, explosive manner,” says first author UnCheol Lee, PhD., a physicist and assistant professor of anesthesiology at Michigan Medicine.
The researchers tested their theory by conducting electroencephalogram (EEG) tests on the brains of 10 female patients with fibromyalgia. Baseline EEG results showed the patients had hypersensitive brain networks, and that there was a strong correlation between the degree of ES conditions and the self-reported intensity of their pain during EEG testing.
Lee’s research team and collaborators in South Korea then used computer models of brain activity to compare the stimulus responses of the fibromyalgia patients to those of healthy ones. As expected, the fibromyalgia model was more sensitive to electrical stimulation.
“We again see the chronic pain brain is electrically unstable and sensitive,” Harris says.
Harris says this type of modeling could help guide future treatments for fibromyalgia. Since ES can be modeled outside of the brain in computers, researchers can test for influential regions that transform a hypersensitive network into a more stable one. These regions could then be targeted in living humans using noninvasive brain modulation therapies such as transcranial magnetic stimulation, which is currently used to treat fibromyalgia and depression.
“We expect that our study may ultimately suggest new approaches for analgesic treatments. ES provides a theoretical framework and quantitative approach to test interventions that shift a hypersensitive brain network to a more normal brain network,” researchers reported.
“It may be possible to convert an ES network to a non-ES network just by modulating one or two hub nodes. Indeed, transcranial magnetic stimulation and/or transcranial direct current stimulation may be improved by ‘targeting’ these sensitive hub nodes. The application of deep brain stimulation to critical nodes that could modify ES conditions is another therapeutic possibility that could be explored.”
Let’s be perfectly honest. Most doctors have a difficult time with chronic pain patients. One physician described it to us many years ago: “When I see a patient suffering severe chronic pain come in the front door I want to go out the back door.” That’s because there are few good options. Drugs like hydrocodone or oxycodone used to be prescribed in huge quantities. Now gabapentin (Neurontin) and pregabalin (Lyrica) are on the ascendency and opioids are shunned. The Opioid Epidemic: Doctors are dismayed by the opioid epidemic sweeping the nation. Over the last year, the drumbeat of headlines about opioid overdoses and deaths has scared a lot of physicians into cutting back on prescribing drugs like hydrocodone or oxycodone.
Many of the overdose deaths are caused by illicit fentanyl. People OD because they have no idea how potent the narcotics are that they are snorting, swallowing, or injecting. According to the CDC (Nov. 3, 2017):
“Preliminary estimates of U.S. drug overdose deaths exceeded 60,000 in 2016 and were partially driven by a fivefold increase in overdose deaths involving synthetic opioids (excluding methadone), from 3,105 in 2013 to approximately 20,000 in 2016. Illicitly manufactured fentanyl, a synthetic opioid 50–100 times more potent than morphine, is primarily responsible for this rapid increase. In addition, fentanyl analogs such as acetylfentanyl, furanylfentanyl, and carfentanil are being detected increasingly in overdose deaths and the illicit opioid drug supply.”
Fentanyl powder does not come from your local pharmacy. Most of it is illicit and is coming from foreign countries (CBS News; New York Times, Aug. 10, 2017). China and Mexico are major suppliers. It is being added to heroin or even counterfeit opioid pills that look like Percocet (CNN June 8, 2017) or Oxycontin. The government does not seem to know how to stem the flow of illicit fentanyl that is flooding the country. Doctors and Opioids: It is hardly any wonder that doctors have cut back on prescriptions for hydrocodone and oxycodone. Like the rest of us, they read horrifying reports about opioid deaths. The evening news often leads with graphic accounts of accidental overdoses. Federal guidelines and restrictions have made it harder for physicians to prescribe opioids. Gabapentinoids: What Are They?
As a result of the negative publicity and constraints about opioids, many people who are in severe pain have been left without relief. Consequently, physicians are searching for other drugs they can prescribe instead of narcotics. They may turn to gabapentinoids (gabapentin and pregabalin).
Gabapentin (Neurontin) and pregabalin (Lyrica) are both used to treat nerve pain. Doctors prescribed these medications three times more often in 2015 than they did in 2002, despite no radical change in the number of patients with neuropathic pain (JAMA Internal Medicine, online Jan. 2, 2018). The author advises his colleagues to use these drugs cautiously:
“The combination of a dearth of long-term safety data, small effect sizes, concern for increased risk of overdose in combination with opioid use, and high rates of off-label prescribing, which are associated with high rates of adverse effects, raises concern about the levels of gabapentinoid use. While individual clinical scenarios can be challenging, caution should be advised in the use of gabapentinoids, particularly for those individuals who are longterm opioid users, given the lack of proven long-term efficacy and the known and unknown risks of gabapentinoid use.”
A perspective published in the New England Journal of Medicine goes even further (Aug. 3, 2017).
The authors note that guidelines from the CDC recommend acetaminophen and NSAIDs as first-line options for osteoarthritis and low back pain. The physicians point out that “acetaminophen is often ineffective, and NSAIDs are associated with adverse effects that limit their use…” They go on to say:
“The CDC guidelines also recommend gabapentinoids (gabapentin or pregabalin) as first-line agents for neuropathic pain. We believe, however, that gabapentinoids are being prescribed excessively — partly in response to the opioid epidemic”
They conclude:
“Patients who are in pain deserve empathy, understanding, time, and attention. We believe some of them may benefit from a therapeutic trial of gabapentin or pregabalin for off-label indications, and we support robust efforts to limit opioid prescribing. Nevertheless, clinicians shouldn’t assume that gabapentinoids are an effective approach for most pain syndromes or a routinely appropriate substitute for opioids.”
Gabapentin Side Effects: The history of gabapentin (Neurontin) is fascinating. It was originally approved by the FDA for treating epilepsy in 1993. There is a tale of woe and intrigue about how the company that marketed Neurontin got into trouble with the FDA for illegal off-label marketing practices. We won’t go into that here, but you can read all about it in this article: Surprising Gabapentin Side Effects Gabapentin has become a go-to drug for doctors who are trying to control chronic pain problems. At last count, dispensed prescriptions have gone from 39 million in 2012 to 51 million in 2014 to 64 million in 2016 (Quintiles IMS, May 2017, now IQVIA Institute).
Gabapentin can cause depression, dizziness, fatigue, drowsiness, digestive tract upset, trouble with balance, cognitive difficulties, and visual problems. The official prescribing information warns:
“Antiepileptic drugs (AEDs), including gabapentin, increase the risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Patients treated with any AED for any indication should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior.”
Fibromyalgia (FMS) is not just about chronic pain and fatigue, although if you spoke to the majority of general practitioners, you would think those were the only symptoms people get. FMS is a complex, multifactorial condition and is a condition of exclusion. In other words, many, many conditions have to be excluded before a diagnosis can be made. It can, and in my case, it has, affected almost every system of my body from my skin and gastrointestinal tract to joints and muscles and not forgetting my brain. It has had a catastrophic effect on my career, which I loved. It has devastated my social life and family life will never be the same again.
This may all sound defeatist but the best thing I have done is to accept and adapt to the changes in my life. With this in mind, I have come up with a list of rules for myself. I haven’t just made them up from thin air, they have really just evolved organically over the years.
Living with FMS is tricky because it is such a complex condition. As well as living with this condition, I have researched it a lot! It’s difficult to understand, it’s difficult to explain and it’s difficult to describe.
There’s a famous saying, “If you can’t explain it to a 6-year-old, you don’t understand it yourself.”
If I can’t explain it, describe it and much less understand it, how can I expect other people to? Be patient with people — they will say things that hurt, they will expect more from you than you can achieve. They may think you are lazy and you will have to keep explaining yourself, but most of all, chances are they just want you to get better. They don’t understand it, because you don’t fully understand it yourself. I find the best way is to just be honest. Tell them if you can’t do something but also what you can do. Tell them when you are having a bad day or a flare-up, but also when your day is “good.” Tell them your symptoms, even on a good day, but don’t expect them to understand until you do!
You have a chronic illness, it is not going to get better or go away. You may be lucky enough to have a recession, but the majority of us don’t. Learn to live with it, learn to manage it. Become self-aware and understand your symptoms. You may not fully understand the condition, but get to know the symptoms you have before a flare–up, for instance. I know if I get swollen glands, a fever, and a loss of appetite, there will be a flare-up in the next 48 hours. Most importantly, plan your day around your symptoms. I tend to have more energy after a shower in the morning. I generally need a nap in the middle of the day and my pain is at its worst in the evenings. This is my pattern generally, but I have to accept changes as they come and new symptoms as they arise. This is normal for me now. It’s all part of living with a chronic illness.
Not only do I have fibromyalgia, I also have migraines, cluster headaches, and vertigo. I try not to keep them separate from each other. Treat yourself as a whole and not as a list of conditions. Your symptoms are part of you whether they come from one condition or another.
Adjust your measuring stick. If you can’t do something like you used to, make what you can do your new standard and be proud of it. I know, if I tried to do a five-mile hike with the dog, not only would I be wiped out, the dog probably would, too. But, if we go for our 20-minute stroll in the park and we both feel good, even on a bad day. It may sound trivial to some, but every day, I am proud of myself for getting up and doing that walk. Don’t beat yourself up if you can no longer do the things you once used to.
Think about the boom and bust theory. We all do this, without realizing or without intention. On a good day, you do everything you can because you don’t know when your next good day will be. Then, the next day you are in pain and severely fatigued, so you do nothing in order to recover and hope for another good day soon. The theory is, do less on good days and more on bad days. The idea is to become time-focused instead of task-focused. In other words, set a time for activity instead of just your normal full task.
Life is not perfect. Sometimes you can plan and pace yourself meticulously but there will always be something that disrupts your life. Don’t let it faze you. Crap happens to everyone. We just have to accept what happens and expect that there will be bad days and flare-ups, it’s just part of having the condition. Make sure you have a well-equipped flare-up box. This should always be part of the plan.
You can’t do it alone, you have to ask for help. This is one of the hardest lessons I’ve learned. You may think it’s a sign of weakness in asking for help, and that it has always been quicker and easier to just do it yourself. Unfortunately, this may no longer be the case. Asking is now obligatory. Accepting help can be equally difficult but it’s time for someone else to take the strain. Life with FMS is not easy. It isn’t often that people will ask you if you need help, so when they do, be gracious. Your loved ones will not want to see you struggling, they will want to help, so let them and show gratitude with a smile and a thank you. That’s all they want in return.
I don’t mean go to bed and let it take over your life. I just think we shouldn’t be afraid to let people know we have a condition that impacts our life. Life is difficult enough without making it harder by ignoring issues that can bite. You should be able to tell others that there are things you can and cannot do because of the symptoms you have.
Over the years, various medications have undergone evaluation for use in the treatment of fibromyalgia. Those medications include muscle relaxants, corticosteroids, non-steroidal anti-inflammatory medications (NSAIDs), sedatives, and tricylic antidepressants.
Tricylic antidepressants actually have some history in the treatment of fibromyalgia. In fact, several of these antidepressants are used in the treatment of the condition. Nortriptyline, doxepin, and amitriptyline are all used in the treatment of fibromyalgia. When used for fibromyalgia, in particular, it has been demonstrated in studies to be the most efficient antidepressant for treating the condition.
Amitriptyline is, as mentioned, a type of tricyclic antidepressant (TCA) used for treating clinical depression. As a result, it’s considered the most common TCA used around the world.
The antidepressant was originally developed by Merck and was first synthesized in 1960. It was later approved by the Food and Drug Administration in April 1961.
This medication works as an inhibitor of the brain chemicals serotonin and norepinephrine. The medication’s mechanism of action acts strongly on the serotonin transporter, while it causes a moderate effect on the norepinephrine transporter. It doesn’t do anything to affect the dopamine transporter, however.
Amitriptyline is used for several medical conditions, including its FDA-approved use for major depressive disorder. That doesn’t stop other medical resources from claiming it plays a role in assisting recovery from other similar conditions.
Amitriptyline is even said to act more efficiently than other antidepressants when treating disorders. Interestingly enough, it is actually passed over for other newer antidepressants, since it is known to cause side effects and can get very toxic if consumed to overdose.
Various medications are used to treat symptoms of fibromyalgia. The most common medications include painkillers, sleeping pills, and various antidepressants. Antidepressants are said to help treat fibromyalgia symptoms originating from the dysfunction of the brain’s regular functions.
Antidepressants, especially tricylic antidepressants, have been used in the treatment of fibromyalgia for years. Tricylic antidepressants are actually some of the oldest antidepressants on the market and have been utilized in fibromyalgia treatments for years.
Tricylic antidepressants like amitriptyline work by boosting the levels of the brain’s chemicals or neurotransmitters. When the levels of neurotransmitters are boosted, it prevents the brain from succumbing to impairment in its natural function. These antidepressants mainly boost the neurochemicals serotonin and norepinephrine. After taking these antidepressants, people with chronic pain typically feel much better, since they are known to have lower levels of those aforementioned neurotransmitters present in their brain.
Tricylic antidepressants also play a role in helping relax pain-ridden muscles. It also boosts the body’s natural painkiller, also known as endorphins. Even though these medications have positive results for conditions like fibromyalgia, they have various side effects that might make them hard to take on a regular basis.
Interestingly enough, the tricylic antidepressants that are prescribed for fibromyalgia include duloxetine, milnacipran and venlafaxine. Both duloxetine and milnacipran are already approved by the Food and Drug Administration for fibromyalgia treatment.
Venlafaxine has less research and, therefore, evidence supporting it as an effective treatment. Other antidepressants that have been studied and proposed as potential fibromyalgia treatments include citalopram, paroxetine, and fluoxetine.
Amitriptyline falls in the category of relative untested tricylic antidepressants without further support as a fibromyalgia treatment. Though, it hasn’t stopped researchers from studying it and its potential as an effective treatment for fibromyalgia.
Studies on Amitriptyline
Antidepressants have been used to treat chronic pain disorders for years. Even though that’s true, only a limited amount of studies exist covering how tricylic antidepressants help people treat their fibromyalgia symptoms.
According to information collected about fibromyalgia and antidepressants, antidepressants like tricyclic antidepressants ‘produced mild to moderate improvements in [fibromyalgia] symptoms.’ In controlled studies, it was found that as much as ‘one-third to half of the monitored patients responded to medication-based treatment.
There was one study that had tested the effects of amitriptyline and fluoxetine on patients with fibromyalgia. Patients in that study were given 25 mg of amitriptyline, while others were given 20 mg of fluoxetine.
As a result, the patients found that either medication helped reduce their fibromyalgia symptoms. Patients who took both medications found that the combination was actually ‘twice as effective than just taking one medication alone.
The dosages used for amitriptyline for fibromyalgia are much lower than the usual doses for treating depression. In most cases, the dosage can be started at as low as 10 mg each day, taken 2 to 3 hours before going to sleep. This allows the patient to take advantage of the medication’s sedative effects without experiencing those same effects when awake.
Another study of amitriptyline followed 70 different patients with the condition with fibromyalgia. The study’s main purpose evaluated the effectiveness of a regular 50 mg dose for fibromyalgia.
The results of the study revealed some interesting data. The patients who had received the regular 50 mg dose for fibromyalgia saw a ‘significant improvement in their sleep quality, morning stiffness, and pain thresholds.’ The ‘tender point score’ taken at the time didn’t improve.
Newer studies concerning the drug for fibromyalgia patients follow the newest iteration of fibromyalgia criteria. A complication of data from other studies about the medication found that ‘amitriptyline for fibromyalgia can continue to be used for [neuropathic pain] treatment, but most patients won’t achieve enough pain relief.’
Various studies collected in the complication lasted as long as 6 weeks (on average). They also tested anywhere from 15 to as many as 100 participants, with four of the studies hosting over 100 participants. Each study administered doses between 15 mg to 125 mg.
Some studies gradually increased the dose during selected intervals of the study trial. Overall, no concrete evidence was found to support amitriptyline as an effective treatment for fibromyalgia. Some studies did find that it may play a role in reducing some neuropathic pain, such as the pain associated with fibromyalgia.
Cannabis, also known by many other names, is a derivative of the Cannabis plant that is popularly used as a psychoactive drug and medication. This controversial drug, which many would know it as weed or marijuana, has taken a bad rap due to it being exploited for recreational purposes. However, apart from being the star of a party, Cannabis has many medical purposes including treating fibromyalgia.
This refers to cannabis in the form of medication, rather than for recreational purposes. It is said to be useful in treating several diseases and medical problems, ranging from nausea resulting from chemotherapy to glaucoma’s high ocular pressure. Cannabis contains a wide variety of chemicals that has many applications. Fibromyalgia is one medical condition that it has proved to be highly effective in.
The Cannabis plant contains a wide variety of compounds that can affect both the brain and the rest of the body. The body is affected by a category of compounds termed cannabinoids that bind and interact with the brain’s cannabinoid receptors. Of them, the most well-known cannabinoid is THC, which is responsible for cannabis’ classic effects, among the 85 other cannabinoids in this plant.
Where fibromyalgia is concerned, however, THC is the most important cannabinoid as it binds with the brain’s cannabinoid receptors that help to relieve the pain associated with fibromyalgia. THC also helps the patient relax and get over their feeling of exhaustion.
Patients use a vaporizer in order to heat cannabis to the point of vaporization of the active ingredients of the plant. This provides the same effect and relief as smoking cannabis but eliminates the risks of smoking. Hence, medical cannabis is a more controlled and low-risk treatment as compared to its recreational form.
Cannabis helps fibromyalgia patients by helping ease muscle stiffness and pain. For this, a strong variant of cannabis is recommended. However, it should be used with care and in controlled dosage as prescribed by a doctor as it could cause side effects like heavy drowsiness. Researchers on patients with fibromyalgia found that those who took cannabis were significantly better in mind and body than those who did not take it. They also found that it relieved fibromyalgia patients of pain to the extent of 50%.
Looking at the map above, it is obvious that not all of us are fortunate to live in a medical marijuana legalized state. However, the good news for those who reside in places that do not legalize the use of medical marijuana is, a synthetic medical marijuana pill, Nabilone, was found to work successfully in reducing the pain and anxiety of fibromyalgia comparably. Well, the bad news is, in areas where medical marijuana is legal, many find that it is more economical and effective than Nabilone.
Every so often he grabs his left shoulder and winces. It hurts when he walks when he sits still when he rises from his couch, and when he missteps in a damp meadow. More than hurts. It seems a kind of agony, though he never mentions it. There are times when he cannot help but show this, the fallout from a car accident four years ago, in which the car he was driving flipped and rolled, leaving Freeman and a friend to be pulled from the car using the Jaws of Life.
Despite surgery to repair nerve damage, he was stuck with a useless left hand. It is stiffly gripped by a compression glove most of the time to ensure that blood doesn’t pool there. It is a clamp, his pain, an icy shot up a relatively useless limb. He doesn’t like to show it, but there are times when he cannot help but lose himself to a world-ending grimace. It’s such a large gesture, so outside the general demeanor of the man, that it feels as if he’s acting.
This means Morgan Freeman can’t pilot jets the way he used to, a hobby he took up at sixty-five. He can no longer sail as well. There was a time when he would sail by himself to the Caribbean and hide out for two, three weeks at a time. “It was complete isolation,” he says. “It was the best way for me to find quiet, how I found time to read.” No more. He can’t trust himself on one arm. He can’t drive, not a stick anyway, not the way he used to — which is to say fast, wide open, dedicated to what the car can do.
And he can’t ride horses as much, though once he rode every day. He never mentions any of it as a loss, though how could it be anything else? He never hints around about the unfairness of it. “There is a point to changes like these. I have to move on to other things, to other conceptions of myself. I play golf. I still work. And I can be pretty happy just walking the land.”
Wait. How can he play golf with a clipped wing like that? How can you swing a club when you can’t lift one of your arms?
“I play one-handed,” he tells me. “I swing with my right arm.” How does that work out for you? “See for yourself,” he says. “I’m playing at 3:00 today.”
Freeman’s revelation that he has fibromyalgia spread like wildfire through the FM community. Finally, here was an A-list celebrity acknowledging he had been diagnosed with FM. A handful of other celebrities have had the courage to speak up about their FM, for which we are extremely grateful, but as yet none have had the super-star power of Morgan Freeman.
Almost immediately FM patients and advocates began calling on Freeman to speak out on behalf of others with fibromyalgia. It’s even been rumored that a large national FM organization has approached him about being their spokesperson. While most in the FM community seem to strongly support that idea, a few have questioned the wisdom of Freeman being an FM spokesman.
From what I have read, those who are hesitant about Freeman representing the FM community appear to have three concerns:
Does he really have fibromyalgia since he only mentioned pain in his left shoulder and arm? He is still very active and therefore would present an inaccurate picture of how debilitating FM can be. Since most people with FM are women, as a man he would not be representative of the majority of patients. Let’s take a closer look at each of these concerns.
Does he really have fibromyalgia? – I have to admit the first time I read the article I, too, wondered whether he had been diagnosed correctly. But when I reread it, I noticed that he said, “Up and down the arm. That’s where it gets so bad. Excruciating.” His statement, “That’s where it gets so bad” sounds like he probably has other pain but it’s the pain in his arm that is the worst. For many years, I could have made a similar statement about my left hip. Although I had body-wide pain almost all the time, it was the pain in my hip that was usually the worst.
We also have to remember that the purpose of this interview was not to discuss Freeman’sfibromyalgia. The author simply noticed Freeman grimacing several times and asked him about it. It’s logical that Freeman would only mention the pain he was experiencing at the time. Or perhaps he did go into more detail but when composing the article, Chiarella chose to include only what he felt was most important.
So is whether or not Freeman really has fibromyalgia a valid concern? Absolutely. When we’re talking about someone being a spokesperson for a disease, it’s legitimate to want to be sure they actually have the disease. We just shouldn’t jump to any conclusions based on one isolated statement.
Morgan Freeman opens up his ‘struggle’ about fibromyalgia
His activity level doesn’t paint an accurate picture of FM.– People with FM fall into a wide range of functioning abilities. Freeman appears to be fairly high-functioning since he continues to work and play golf. The article did note, however, that he has had to give up several activities that he loved. On the other hand, some people with FM are completely disabled, unable to handle even basic self-care tasks. The rest of us fall somewhere in between. While Freeman’s activity level should not preclude him from representing people with FM, I would hope that part of his message would be to describe just how debilitating FMcan be and to explain that different patients have different levels of disability.
As a man, he is not representative of the average FM patient.– Frankly, I think the fact that he is a man with FM is a positive thing. Whether we like it or not, when it comes to health issues, men are still given more credibility than women. Studies have shown that health care professionals are more likely to take a man’s symptoms seriously, but attribute a woman’s symptoms to emotional causes. Although the acceptance of FM has come a long way in recent years, there are still some people, including some medical professionals, who don’t believe it is real. Therefore, having a well-known and highly respected man like Morgan Freeman speak out about FM might help improve our credibility among the doubters.
Given the repeated urgings to step up and be a spokesperson for fibromyalgia, I sometimes wonder if Freeman wishes he had never mentioned it. He probably never dreamed uttering that one word in the middle of a multi-hour interview would ever garner so much attention.
In our enthusiasm to have a prominent celebrity like Morgan Freeman speak out on our behalf, I think we need to keep in mind how doing so could impact his life. Years ago celebrities did everything in their power to keep any health problems secret because revealing an illness could ruin their careers.
Although Hollywood seems to be a little more accepting these days, I suspect there is still some hesitation about casting an actor who has a known health issue. And even if his career is not a major concern, Freeman strikes me as the kind of man who prefers not to dwell on his pain and what he can’t do but rather to push ahead and focus on what he can do.
Yes, it would be wonderful if Morgan Freeman would decide to become an advocate for fibromyalgia. The entire FM community would welcome him with open arms. His support could do wonders for increasing awareness and raising money for research. But ultimately it’s a personal decision – each of us has to decide what is best for our lives at any given point in time. While I hope he’ll choose to use his celebrity to help others with FM, I’ll respect his decision either way.
