Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Suggest Treatment For Fibromyalgia
Question: I am a 54 yr old female. In my history there is severe abuse (I am clinically depressed and on XXXXXXX Disability for my mental health issues), I recovered from a case of E coli o157 h7/HUS; I currently have 38% usage of my kidneys. I have a pacemaker due to sick sinus syndrome/A fib. I have IBD; I had a Roux-en-Y gastric bypass and have pretty bad issue with diarrhea. My doctor feels that I have fibromyalgia; I see a rheumatologist in 2/2016, but I am having pain level of 8+ every day (1-10 scale)! I had bad reactions to Cmybalta and Gabapenten - Is there anything out there I can take to help besides narcotics?
Brief Answer:
well.... if fibromyalgia
Detailed Answer:
then by definition narcotics are ineffective.
XXXX
best research review and the wide consensus of the majority of researchers in the field is not to use narcotics in fibromyalgia. Furthermore, they feel that fibromyalgia has to do with an inability of the opiate receptor to work; therefore narcotics wouldn't work anyway.
Depression certainly changes pain perception. and If someone says they are depressed personally I haven't found anyone to be incorrect on that.
Antidepressants work in pain especially if there is not a physical cause for pain.
Then further discussion would depend on what is / where is the pain. Obviously if someone had IBD and had pain associated with defecation many medications to change gut motility would be helpful for pain. Anti-inflammatories likely would also have a role.
38% of kidney function of a 30 yr old when one is mid-fifties is slightly abnormal and unlikely to change anything other than a slight increased risk of fluid retention if there are other reasons for the fluid retention including hypertension. Unlikely to cause pain.
Likewise atrial fibrillation, sick sinus, or pacemakers are not painful. Previous surgery is not necessarily painful but can have consequences that are. sometimes this can be corrected depending on the reasons why it is painful.
well.... if fibromyalgia
Detailed Answer:
then by definition narcotics are ineffective.
XXXX
best research review and the wide consensus of the majority of researchers in the field is not to use narcotics in fibromyalgia. Furthermore, they feel that fibromyalgia has to do with an inability of the opiate receptor to work; therefore narcotics wouldn't work anyway.
Depression certainly changes pain perception. and If someone says they are depressed personally I haven't found anyone to be incorrect on that.
Antidepressants work in pain especially if there is not a physical cause for pain.
Then further discussion would depend on what is / where is the pain. Obviously if someone had IBD and had pain associated with defecation many medications to change gut motility would be helpful for pain. Anti-inflammatories likely would also have a role.
38% of kidney function of a 30 yr old when one is mid-fifties is slightly abnormal and unlikely to change anything other than a slight increased risk of fluid retention if there are other reasons for the fluid retention including hypertension. Unlikely to cause pain.
Likewise atrial fibrillation, sick sinus, or pacemakers are not painful. Previous surgery is not necessarily painful but can have consequences that are. sometimes this can be corrected depending on the reasons why it is painful.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I only reported IBD, pacemaker and depression to give you a full view of who I am. None of those reports are pain related.
At first I thought I had a type of flu because it seemed like everything hurt, including my skin (to touch) it is a burning and stabbing pain.
Areas affected are: base of skull, neck, and halfway to shoulders; lower back; hips; inside part of my knees; shin area and feet. All are both sides (one side might hurt a little more; or one area a little more - but it ALL hurts) I have only started to read up on Fibromyalgia so I don't much. I am being treated, at this time, with hydrocodone/tylenol 5/325 (it is worthless as far as my pain goes). I am concerned about two things: ability of my Kidneys to waste without toxicity, and possible medicinal interactions (bad).
I also forgot to note that the inside area of my elbows hurt and my hands/wrists, too. Lastly, both sides of my chest area above the breasts/below the collar bone.
At first I thought I had a type of flu because it seemed like everything hurt, including my skin (to touch) it is a burning and stabbing pain.
Areas affected are: base of skull, neck, and halfway to shoulders; lower back; hips; inside part of my knees; shin area and feet. All are both sides (one side might hurt a little more; or one area a little more - but it ALL hurts) I have only started to read up on Fibromyalgia so I don't much. I am being treated, at this time, with hydrocodone/tylenol 5/325 (it is worthless as far as my pain goes). I am concerned about two things: ability of my Kidneys to waste without toxicity, and possible medicinal interactions (bad).
I also forgot to note that the inside area of my elbows hurt and my hands/wrists, too. Lastly, both sides of my chest area above the breasts/below the collar bone.
Brief Answer:
These are not one area.
Detailed Answer:
With a nerve problem, one would expect pain in the direction/pathway of a nerve. If the nerves are sick then all the nerves in a symetric pattern. While MS, heavy metal, b12, lyme, metastatic cancer, and vasculitis/lupus, MIGHT affect multiple individual nerves, All of these disorders all follow the paths of nerves; it wouldn't be one spot here or there but an entire pattern in one or multiple locations.
There are syndromes of overall increased susceptibility of pain. THis has characteristics that areas that become painful had some mild trauma done to them and the pain is more and longer lasting than expected. Also there is hyperalgesia (things are more painful than expected), allodynia (something is painful that you wouldn't expect to be). The most common cause is use of narcotics which usually modifies pain perception.
This is not meant to be specific for any particular patient but is a compilation of all of the relevant information on a particular topic (pain that is not in a particular clearly defined pattern).
These are not one area.
Detailed Answer:
With a nerve problem, one would expect pain in the direction/pathway of a nerve. If the nerves are sick then all the nerves in a symetric pattern. While MS, heavy metal, b12, lyme, metastatic cancer, and vasculitis/lupus, MIGHT affect multiple individual nerves, All of these disorders all follow the paths of nerves; it wouldn't be one spot here or there but an entire pattern in one or multiple locations.
There are syndromes of overall increased susceptibility of pain. THis has characteristics that areas that become painful had some mild trauma done to them and the pain is more and longer lasting than expected. Also there is hyperalgesia (things are more painful than expected), allodynia (something is painful that you wouldn't expect to be). The most common cause is use of narcotics which usually modifies pain perception.
This is not meant to be specific for any particular patient but is a compilation of all of the relevant information on a particular topic (pain that is not in a particular clearly defined pattern).
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Okay, here is my final attempt at a QUESTIONl I am not a medical student; I don't go to college; therefore your answers, thus far, fail to give me the information I am actually seeking. To be honest, reading your answers is like reading a magazine column about medicinal side effects, and descriptors.
My question is: what are the best and most effective medications for fibromyalgia? I am not really in need of a diagnosis - as my doctor thinks it is FM and I already have an appt. with a rheumatologist. I am specifically seeking a few names of effective pain treatments for FM to ask my doctor about prescribing BEFORE seeing the specialist (which is over 2 months away). I am in pain now.
By-the-way, why is a drug addiction specialist doing answering my questions when I specifically asked for (and thought I paid for) a Rheumatologist? I have no drug addiction problems... I would prefer an internist/with speciality in rheumatiod medicine.
My question is: what are the best and most effective medications for fibromyalgia? I am not really in need of a diagnosis - as my doctor thinks it is FM and I already have an appt. with a rheumatologist. I am specifically seeking a few names of effective pain treatments for FM to ask my doctor about prescribing BEFORE seeing the specialist (which is over 2 months away). I am in pain now.
By-the-way, why is a drug addiction specialist doing answering my questions when I specifically asked for (and thought I paid for) a Rheumatologist? I have no drug addiction problems... I would prefer an internist/with speciality in rheumatiod medicine.
Brief Answer:
sorry,
Detailed Answer:
There is absolutely no reason why this should go for addiction. Even if you have complications from narcotics doesn't mean you have addiction. Everything you are saying goes against addiction I would say (focus is on disease, health, care, and on non-narcotic medications; zero focus on narcotics).
.
The title under my photo is misleading. I am board certified in Internal medicine. My secondary board certifications are in Clinical Pharmacology and Addiction. I am on the panels for pain management, smoking, alcohol, and drugs, but most questions I see are in the area of pain.
As a PhD clinical pharmacologist I'm pretty well versed on pain management and answer questions for that specialty. Although my residence was AT the best rheumatology center in XXXXXXX it was in internal medicine not rheumatology per se. Reasonably if the question were categorized as a pain issue, they would alert me and I would answer it.
And your original question was "what drugs can I take"? If not on a blood thinner (and frankly if you ARE in afib, you SHOULD be on a blood thinner to prevent stroke), aspirin like drugs are possible to be helpful. Narcotics are probably not a good idea at all, and if depressed an antidepressant would be the first drug type to add.
Other more specific advise would depend upon the particular condition. While in fibromyalgia, amitryptiline, trying different muscle relaxers, but predominantly exercise are helpful other disorders of increased pain susceptibility are handled differently. Most common is one that occurs commonly after getting narcotics. It is treated mainly by being off narcotics.
sorry,
Detailed Answer:
There is absolutely no reason why this should go for addiction. Even if you have complications from narcotics doesn't mean you have addiction. Everything you are saying goes against addiction I would say (focus is on disease, health, care, and on non-narcotic medications; zero focus on narcotics).
.
The title under my photo is misleading. I am board certified in Internal medicine. My secondary board certifications are in Clinical Pharmacology and Addiction. I am on the panels for pain management, smoking, alcohol, and drugs, but most questions I see are in the area of pain.
As a PhD clinical pharmacologist I'm pretty well versed on pain management and answer questions for that specialty. Although my residence was AT the best rheumatology center in XXXXXXX it was in internal medicine not rheumatology per se. Reasonably if the question were categorized as a pain issue, they would alert me and I would answer it.
And your original question was "what drugs can I take"? If not on a blood thinner (and frankly if you ARE in afib, you SHOULD be on a blood thinner to prevent stroke), aspirin like drugs are possible to be helpful. Narcotics are probably not a good idea at all, and if depressed an antidepressant would be the first drug type to add.
Other more specific advise would depend upon the particular condition. While in fibromyalgia, amitryptiline, trying different muscle relaxers, but predominantly exercise are helpful other disorders of increased pain susceptibility are handled differently. Most common is one that occurs commonly after getting narcotics. It is treated mainly by being off narcotics.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I take aspirin daily for the A fib, I am on a muscle relaxer and have moved from 2 to 3 pills a day, I've only been on the hydrocodone for a week. Though exercise would bring blood to the affected areas - I hurt so bad I could cry and it's hard enough getting out of bed!
I read that marijuana is a preferred treatment for FM by as much as 62% of those afflicted. Do you know anything about that? If so, what method and dosage would be recommended?
I have asthmas and have no interest in smoking or ingesting cookies... Just a pure form of THC in a pill or tincture maybe...
I read that marijuana is a preferred treatment for FM by as much as 62% of those afflicted. Do you know anything about that? If so, what method and dosage would be recommended?
I have asthmas and have no interest in smoking or ingesting cookies... Just a pure form of THC in a pill or tincture maybe...
Brief Answer:
Really good question.
Detailed Answer:
The depression issue is still there. Marijuana just doesn't have huge effects on depression one way or another.
The nature of the pain is still there as an unresolved issue.
Furthermore, clearly the pain isn't the issue. Fundamentally there is the main problem of the not being able to get out of bed. A contingency management approach to increase behaviors of coping/participating would be recommended as the overall context for whatever therapy you are in.
Then, there is some soft data that I would not believe that the impure smoked/injested full plant has several other compounds than THC that are relevant. There is an inherent contradiction: if you don't have purified stuff that you know what you have, then conclusions are not going to be very precise.
Review of THC and pain.
Questionable benefit on pain in multiple sclerosis
failed in pancreatitis
XXXX
Might work a little in cancer pain
XXXX
pretty good indication it worked in diabetic pain, other neuropathic pain
XXXX
XXXX
XXXX
specifically on fibromyalgia here
XXXX
XXXX 30 to 50% pain reduction in fibromyalgia use of 5 to 15 mg a day (mostly 10-15 mg a day)
XXXX but failed in fibromyalgia here
BUT the effect of marijuana on pain is MILD, marijuana has other toxicities, AND it is less effective on conditions where we have other specific treatments.
"cannabinoids should be employed as analgesics only when safer and more effective medication trials have failed, or as part of a multimodal treatment regimen"
XXXX
Really good question.
Detailed Answer:
The depression issue is still there. Marijuana just doesn't have huge effects on depression one way or another.
The nature of the pain is still there as an unresolved issue.
Furthermore, clearly the pain isn't the issue. Fundamentally there is the main problem of the not being able to get out of bed. A contingency management approach to increase behaviors of coping/participating would be recommended as the overall context for whatever therapy you are in.
Then, there is some soft data that I would not believe that the impure smoked/injested full plant has several other compounds than THC that are relevant. There is an inherent contradiction: if you don't have purified stuff that you know what you have, then conclusions are not going to be very precise.
Review of THC and pain.
Questionable benefit on pain in multiple sclerosis
failed in pancreatitis
XXXX
Might work a little in cancer pain
XXXX
pretty good indication it worked in diabetic pain, other neuropathic pain
XXXX
XXXX
XXXX
specifically on fibromyalgia here
XXXX
XXXX 30 to 50% pain reduction in fibromyalgia use of 5 to 15 mg a day (mostly 10-15 mg a day)
XXXX but failed in fibromyalgia here
BUT the effect of marijuana on pain is MILD, marijuana has other toxicities, AND it is less effective on conditions where we have other specific treatments.
"cannabinoids should be employed as analgesics only when safer and more effective medication trials have failed, or as part of a multimodal treatment regimen"
XXXX
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I want to make sure I'm understanding you correctly. Are you saying my depression IS the cause of my pain. Are you saying my does soon IS THE NATURE of pain itself?
I need to understand something - if the above IS what you were stating. I have been treated with psych meds since 2010; I reported this "all over" pain last month. In 2010 I had no pain like I am experiencing now, what changed?
Are you saying your treatment would focus on the depression issue and the pain is what? Swept under the rug?
I have not read the people who suffer from FM, are all clinically depressed, too... I need more clarification. please help me and finish this sentence or thought for me to help me see better. Cause of FM pain?_______ if treat your FM with ____________ because that medicine speaks to FM through _________.
I need to understand something - if the above IS what you were stating. I have been treated with psych meds since 2010; I reported this "all over" pain last month. In 2010 I had no pain like I am experiencing now, what changed?
Are you saying your treatment would focus on the depression issue and the pain is what? Swept under the rug?
I have not read the people who suffer from FM, are all clinically depressed, too... I need more clarification. please help me and finish this sentence or thought for me to help me see better. Cause of FM pain?_______ if treat your FM with ____________ because that medicine speaks to FM through _________.
Brief Answer:
Nothing quite that complicated.
Detailed Answer:
Obviously, I would never presume to diagnose, treat, or prescribe to someone, however charming and eloquent, that I have not actually met. Questions of what "my treatment" would be or "what changed" in you or what IS causing your particular pain are outside of what legitimately this context should answer. General information on what occurs in pain, and giving the best information about a particular condition, translating the latest scientific papers relevant to a particular context can be done in this context and are quite worth it.
You have said that you are depressed and my experience is that people really do know that when they say they have it. Sometimes they are depressed and do not realize how much depression they have. Furthermore if someone were to say they cannot get out of bed, then that would be the main issue at hand ahead of all other considerations/conditions. If that person were depressed and said that, wouldn't consideration of depression as a cause of that be relevant?
On your latest question. Exercise. Maybe amitryptiline
[underlined] participation and exercise [end underlined] is the cornerstone of every reputable treatment regimen for fibromyalgia because it speaks to FM through
[underline] it's effect on muscle [end underlined]
XXXX
specifically muscle mitochondria
[underline] through exercise effect on how fibromyalgia sufferers organize their world-view [end underlined]
"Physical exercise and cognitive-behavioural therapy are first-line treatments, showing high level of evidence. Amitriptyline, used for short periods of time for pain control, is the pharmacologic treatment with the most solid evidence. "
XXXX
[underline] through "Sense of Well-Being in Patients with Fibromyalgia: Aerobic Exercise Program in a Mature Forest-A Pilot Study"[end underlined]....the title had that one.
XXXX
Amitryptiline acts on pain in multiple ways:
It is an antidepressant, but this is largely irrelevant.
It increases stress hormones in the spine that act as blockers of pain as the less effective drug cymbalta also does.
It has lidocaine like effects on pain through blocking sodium channels.
It's mild sedative effects might have effects.
Depression accentuates pain. If my kid stepped on my foot intentionally it would hurt more than if it were accidental. Particular attitudes and orientations to the world certainly affect ability to hear, understand, and participate in courses of treatment and these are changed by depression. Certainly if depression changes personality to be irredeemably irascible to the point where the person does not accept any outside information/input/ideas/treatment options then they cannot possibly have their pain treated. For this reason, issues of depression have to be primary to have other other treatments/modalities even be possible. Suppose theoretically, someone couldn't get out of bed due to depression, they couldn't even go to the doctor, so any other treatment would be contingent upon getting depression treated.
Obviously, I would never presume to diagnose, treat, or prescribe if I am not actually there. These comments are therefore, not to your particular situation/condition, but are general medical information well researched and documented.
Nothing quite that complicated.
Detailed Answer:
Obviously, I would never presume to diagnose, treat, or prescribe to someone, however charming and eloquent, that I have not actually met. Questions of what "my treatment" would be or "what changed" in you or what IS causing your particular pain are outside of what legitimately this context should answer. General information on what occurs in pain, and giving the best information about a particular condition, translating the latest scientific papers relevant to a particular context can be done in this context and are quite worth it.
You have said that you are depressed and my experience is that people really do know that when they say they have it. Sometimes they are depressed and do not realize how much depression they have. Furthermore if someone were to say they cannot get out of bed, then that would be the main issue at hand ahead of all other considerations/conditions. If that person were depressed and said that, wouldn't consideration of depression as a cause of that be relevant?
On your latest question. Exercise. Maybe amitryptiline
[underlined] participation and exercise [end underlined] is the cornerstone of every reputable treatment regimen for fibromyalgia because it speaks to FM through
[underline] it's effect on muscle [end underlined]
XXXX
specifically muscle mitochondria
[underline] through exercise effect on how fibromyalgia sufferers organize their world-view [end underlined]
"Physical exercise and cognitive-behavioural therapy are first-line treatments, showing high level of evidence. Amitriptyline, used for short periods of time for pain control, is the pharmacologic treatment with the most solid evidence. "
XXXX
[underline] through "Sense of Well-Being in Patients with Fibromyalgia: Aerobic Exercise Program in a Mature Forest-A Pilot Study"[end underlined]....the title had that one.
XXXX
Amitryptiline acts on pain in multiple ways:
It is an antidepressant, but this is largely irrelevant.
It increases stress hormones in the spine that act as blockers of pain as the less effective drug cymbalta also does.
It has lidocaine like effects on pain through blocking sodium channels.
It's mild sedative effects might have effects.
Depression accentuates pain. If my kid stepped on my foot intentionally it would hurt more than if it were accidental. Particular attitudes and orientations to the world certainly affect ability to hear, understand, and participate in courses of treatment and these are changed by depression. Certainly if depression changes personality to be irredeemably irascible to the point where the person does not accept any outside information/input/ideas/treatment options then they cannot possibly have their pain treated. For this reason, issues of depression have to be primary to have other other treatments/modalities even be possible. Suppose theoretically, someone couldn't get out of bed due to depression, they couldn't even go to the doctor, so any other treatment would be contingent upon getting depression treated.
Obviously, I would never presume to diagnose, treat, or prescribe if I am not actually there. These comments are therefore, not to your particular situation/condition, but are general medical information well researched and documented.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I am (somewhat) following your line of thinking. I would like to, if you would, have you understand my line of thinking.
Since being diagnosed with Depression, being hospitalized for a mental break, having spent a few times in an ER "special" crisis room - I can tell you what it is like from my perspective.
Before diagnosed with depression - if I had pain the pain was treated based on the location of the pain, possible cause (like injury), etc.
NOW - it feels like every single medical treatment I am looking at cannot be treated until the "special" Depression Glasses are on. If I have headaches - it is caused by depression, if I have a backache - it is caused by depression. If I ask for pain medication, my depression gets in the way. No matter where I turn - depression is the cause of or the block to getting any help.
If I tell someone at my office "I'm having a tough day." I get told something stupid (even though I know they are only trying to help) like "Just make a list of your blessings and read it."
If I say I have pain and the doctor says "Depression causes and even increases pain." - I think to myself ...this person thinks I'm lying!
Before Depression, my doctor visits were fairly simple - or at least, explaining was fairly simple.
After Depression all things medical have become blurred. I would like (just once) to wear those "special glasses" so I could understand what the big difference is!
Is a backache pain or is depression pain? Is a headache pain or is depression pain? Before depression they were a backache and a headache; now they are expressions of my depression.
To be honest, I constantly feel like I have to justify my depression to individuals who have no clue that it's not my "fault" and think I'm just in an unending pitty party. As well, I constantly feel like I have to justify my pain to doctors who put every problem in the depression category that leaves me thinking they don't really believe me at all!!
Probably - all this comes from not having a thorough "medical" understanding of the definition of depression. No matter how much I read, I seem to get even more confused than I already am. I may never get a grip on this.
I will read through your links hoping to find insight. I have a hard time communicating about my depression.
Your medical understanding of depression, my counselor's understanding of depression, my communities understanding of depression and the world's understanding of depression are all very different from one another. It's exhausting trying to figure it out in order to be understood.
Thank you for the links - I'm sure they have a better slant than when I type something in Google search...
Since being diagnosed with Depression, being hospitalized for a mental break, having spent a few times in an ER "special" crisis room - I can tell you what it is like from my perspective.
Before diagnosed with depression - if I had pain the pain was treated based on the location of the pain, possible cause (like injury), etc.
NOW - it feels like every single medical treatment I am looking at cannot be treated until the "special" Depression Glasses are on. If I have headaches - it is caused by depression, if I have a backache - it is caused by depression. If I ask for pain medication, my depression gets in the way. No matter where I turn - depression is the cause of or the block to getting any help.
If I tell someone at my office "I'm having a tough day." I get told something stupid (even though I know they are only trying to help) like "Just make a list of your blessings and read it."
If I say I have pain and the doctor says "Depression causes and even increases pain." - I think to myself ...this person thinks I'm lying!
Before Depression, my doctor visits were fairly simple - or at least, explaining was fairly simple.
After Depression all things medical have become blurred. I would like (just once) to wear those "special glasses" so I could understand what the big difference is!
Is a backache pain or is depression pain? Is a headache pain or is depression pain? Before depression they were a backache and a headache; now they are expressions of my depression.
To be honest, I constantly feel like I have to justify my depression to individuals who have no clue that it's not my "fault" and think I'm just in an unending pitty party. As well, I constantly feel like I have to justify my pain to doctors who put every problem in the depression category that leaves me thinking they don't really believe me at all!!
Probably - all this comes from not having a thorough "medical" understanding of the definition of depression. No matter how much I read, I seem to get even more confused than I already am. I may never get a grip on this.
I will read through your links hoping to find insight. I have a hard time communicating about my depression.
Your medical understanding of depression, my counselor's understanding of depression, my communities understanding of depression and the world's understanding of depression are all very different from one another. It's exhausting trying to figure it out in order to be understood.
Thank you for the links - I'm sure they have a better slant than when I type something in Google search...
Brief Answer:
Very good then.
Detailed Answer:
The links are the best reviews on the current treatment of fibromyalgia and other links for the complicated risk/benefit relationship between fibromyalgia and marijuana treatment. There is a lot of material there, but it is pretty reasonably well written and accessible.
The fibromyalgia articles stress the need for participation/getting around/maximizing function/exercise.
Very good then.
Detailed Answer:
The links are the best reviews on the current treatment of fibromyalgia and other links for the complicated risk/benefit relationship between fibromyalgia and marijuana treatment. There is a lot of material there, but it is pretty reasonably well written and accessible.
The fibromyalgia articles stress the need for participation/getting around/maximizing function/exercise.
Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
