Ask your pharmacistfibromyalgiapart 2

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

This is a continuation of last week’s article. There is no cure for fibromyalgia, however symptoms can be reduced and controlled with appropriate treatment.

Fibromyalgia treatments

Fibromyalgia is a multifaceted problem and must be treated with various treatments such as medication, stretching exercises, and counselling. In this article, I will only discuss medication due to space limits; however there are other aspects of control. Call into Whelehans for a more detailed article on fibromyalgia to get more info on these.

Medications: Antidepressants

Selective serotonin reuptake inhibitors (SSRIs)
Examples of these include fluoxetine and paroxetine. SSRI’s increase the amount of serotonin in the brain. Studies have shown that low serotonin is linked to sleep patterns, mood disorders, pain perception and headaches which are common symptoms of fibromyalgia sufferers.

Tricyclic antidepressants (TCAs)
Examples of these include amitriptyline and dosulepin. It has been shown in clinical trials that the tricyclic antidepressants taken before bed can aid sleep and lessen muscle pain. Amitriptyline is a muscle relaxant which also has antidepressant capabilities. TCAs are started on a low dose then increased slowly. Although improvement is seen in about 30% of patients, TCAs have unwanted side effects such as dry mouth, weight gain, constipation and fluid retention even at low doses and effectiveness can decrease with time.

Dual reuptake inhibitors
Examples include venlafaxine (Efexor®) and duloxetine (Cymbalta®). Their method of action is to increase both serotonin and norepinephrine, two neurotransmitters in the brain. Duloxetine in particular has shown positive results for fibromyalgia sufferers improving fatigue and lessening pain. Common side effects associated with these drugs are nausea and dizziness but there is less chance of this if taken after food and started on lower dose and increased slowly upwards.

Anticonvulsants: Anticonvulsants, which are usually used for the treatment of epilepsy, can be used in fibromyalgia to aid sleep and relieve pain. For example pregabalin (Lyrica®) has been approved for treatment of fibromyalgia in the US. Pregabalin reduces the activity of over stimulated nerve cells thus reducing the communication of pain sensation within the body. Another antiepileptic that has been used in the past with some success was gabapentin (Neurontin®, Gabin®), however side effects may include sedation, dizziness, swelling in the lower legs and weight gain.

Anti-inflammatory drugs

Non steroidal anti-inflammatory drugs (NSAIDS):
Although fibromyalgia doesn’t cause tissue inflammation, when used in combination with other medication such as antidepressants and anticonvulsants they have shown some benefit. Examples of NSAID’s used are ibuprofen and diclofenac but side effects of these include gastric irritation, fluid retention and kidney damage. Diclofenic, Arcoxia® and Celebrex® are best avoided by those with heart problems as they increase risk of heart attack.

Analgesics

Examples of analgesics used are paracetamol, solpadeine, tramadol. While these can help relieve painful symptoms they are not a long term solution and can have negative side effects. For example, tramadol can cause dizziness, diarrhoea and even sleep disturbances in some patients.

Upcoming physiotherapist talk
If you missed our recent Fibromyalgia and Arthritis information evening in the Annebrook, our next event is an upcoming talk with chartered Physiotherapist from Whelehans Pharmacy, Sinead Brogan. The talk starts at 7pm on Tuesday October 28th in Whelehans and Sinead will discuss and demonstrate exercises, stretches and other techniques to help fibromyalgia and arthritis. The talk is free of charge; simply book your place by calling Whelehans at 04493 34591

This article is shortened to fit within Newspaper space limits. More detailed information and leaflets is available in Whelehans