Suggest treatment for fibromyalgia

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Posted on Thu, 4 Dec 2014 in Pain Management
Question: Hi,

Here is a brief history of my illness: I was diagnosed with fibromyalgia and chronic fatigue syndrome in 2001. I generally feel like i have a flu with my most bothersome symptom widespread pain that moves around in no particular pattern. When I became ill, I had to leave my full-time job and was not able to work for over seven years.

In 2004, I was referred to a doctor who specializes in lyme disease and was diagnosed with lyme and a couple viruses, epstein barr and HHV6. The lyme specialist believed that my chronic infection was the primary culprit causing the symptoms. I have taken many oral antibiotics and had IV abx three times via PICC line. After the IV abx, my health improved significantly, although the improvements were not permanent.

Some other health problems I have had are migraines, depression, anxiety, and polycistic ovarian syndrome.I also have a neck injury that causes moderate pain.

Since 2002, I have been on and off of opiate pain medication three times. First it was prescribed by my GP and then two different pain specialists. The primary medications use were duragesic 75mg and oxycodone 5 and 7.5 mg prn (up to 3 or 4 times day). Also tried a few other opiates and combination therapy, including gabapentin and cymbalta, spinal injections, physical therapy, acupuncture, hypnosis, yoga, swimming, and many alternave treatments. I have also been prescribed methadone (for chronic pain) and suboxone (for pain with tolerance).

The reason I have been "on and off" opiate pain medication is because my symptoms have improved after treatment and I no longer needed the meds.

My question: after I signed up for new insurance under the affordable care act, I found I needed to find a new pain management doctor. After a series of problems (mostly my fault) I found myself in the position of having no doctor to prescribe my pain meds. The last year has been very challenging and I have not felt well. I have a huge about of pressure and responsibilities at work.

While I was waiting for an appointment with a new pain doc, I was close to running out of meds and started cutting back. I did run out though and became horribly sick with withdrawals. Feeling sick, desperate and depressed, I began using heroin (my husband has siblings who are addicts). I didn't think this though very well and certainly didn't plan for it to go on long, but it's been five months.

I'm sure you can imagine the new problems I created for myself in getting into a pain specialist. In fact I can not find a single doctor in the salt lake city or surrounding areas that treats patients for pain who have a history of substance abuse or addiction. I did go to a methadone clinic, the type you have to visit once a day for your dose. Unfortunately, it seemed the once daily dose was not very effective in managing the pain. I stopped going after about three weeks.

I am very desperate and need to find a prescriber. I'm wondering what advise you can provide or even a posdible referral. I want to mention that I never abused my pain medication, never failed a urinalysis, and in fact do not experience euphoria from pain meds or heroin (however my tolerance is high so I may at increased doses). I am just someone who has suffered a lot and made some really dumb choices.
doctor
Answered by Dr. Shruti Rijhwani 3 hours later
Brief Answer:
Follows.

Detailed Answer:
Dear Madam,

Thank you for posting your query on HCM.

Well going through the entire history you have provided I can understand the pain you are suffering .

We cannot give you a prescription or referral here but possibly suggest you the best medicine in our opinion for your situation . I think most of your symptoms are due to Fibromyalgia , the factors contributing to fibromyalgia can be many .

Amitryptyline starting with 25 mg or duloxetine with 20 mg dose will be the best ones for you . Whether you have heroin addiction or not needs to be seen . You need to reduce the amount of heroin you take gradually to wean your self and it needs to be done on priority . Plus I will also recommend taking a multivitamin tablet daily , along with supplements for calcium and Vitamin D . Follow good sleep hygiene , a sound sleep is very important for your body to recover .You will need to be strong willed to come out of this vicious circle.

Take care.

Dr. Shruti
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Answered by
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Dr. Shruti Rijhwani

Rheumatologist

Practicing since :2008

Answered : 2366 Questions

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