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Suggest ways to manage pain due to fibromyalgia

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Posted on Sat, 29 Apr 2017
Question: my wife is suffering from fibromyalgia.She has allergy to nsaids except paracetamol.She was put on duloxatine but she had ecg changes and pain chest with the same after 2mths of starting the same.
Other drugs of differant grps like milanacipran are also known to cause strain on the heart .wHAT SHOULD I DO TO ALLIEVIATE HER PAIN
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Answered by Dr. Naval Mendiratta (57 minutes later)
Brief Answer:
Fibromyalgia management

Detailed Answer:
good evening

thank you for writing on health care magic

Well, it is a tough condition to manage and I understand it can be very stressful for the patient and their family.

firstly amitryptilline and nortryptilline are both of the same group. So I am not sure if using both the drugs will provide additional benefit. we can double the dose of nortryptilline if it is suting her and go off amitryptilline.

2. the next line of drugs which we can try is pregabalin or gabapentin. As such they don't effect the heart but yes can cause a bit of fluid retention

3. I hope your wife is trying non drug therapy as well like yoga, meditation, exercises cause all these medicines have a saturation point beyond which they are ineffective ...

I. hope the information was useful

Do let me know for more queries

regards
Dr naval
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Naval Mendiratta (3 days later)
Dear Dr Naval
I had already written in the additional column for allergies that she was allergic to
pregabalin and gabapentin .She had tingling sensation on the face and body and diffuse swelling on forehead and face on being administered the same.As i was going through the possibility of other drugs.Tab Granisetron1MG available as GrandemMD would be a safer option as what i perceive it to be a anti vommiting drug with beneficial role in fibro myalgia.Could you plz elaborate on this from your experience or suggest anything else which may not be available in XXXXXXX but one could get it from abroad


doctor
Answered by Dr. Naval Mendiratta (4 days later)
Brief Answer:
Late Response

Detailed Answer:
Good evening

My sincere apologies for the late reply. Was out of town and somehow the notification went missing , so I missed the reply...Really sorry for the delay

Sorry, the allergy column didnt show about pregalin and gabapentin, So I had suggested the 2 drugs.

As for the Grandisteron, We havnt used it in Fibromyalgia management. It is a 5 HT3 blocker, but not sure about the effect it will have on her. But with Fibromyalgia, at times the placebo also does have a good effect. So never the less, you can try it for a couple of weeks and see how it helps her. Either ways, there are no major side effects of it...

But we can try increasing the dose of nortryptilline to 25 mg twice daily. Other possibility is Milnacepram. I understand your concerns about it, but we can start it at a low dose of 25 mg and monitor for the side effects if any...And slowly step up the dose if there are no side effects..

Sadly, there are not many drugs recommended for Fibromyalgia. These are the few ones which are around and we keep changing shifts back and forth with dose adjustment. But saying all that, we have to keep her motivated for non pharmacological therapy as well as mentioned

Hope the information was useful

do let me know for more queries

REgards
Dr Naval


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Naval Mendiratta

Rheumatologist

Practicing since :2007

Answered : 754 Questions

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Suggest ways to manage pain due to fibromyalgia

Brief Answer: Fibromyalgia management Detailed Answer: good evening thank you for writing on health care magic Well, it is a tough condition to manage and I understand it can be very stressful for the patient and their family. firstly amitryptilline and nortryptilline are both of the same group. So I am not sure if using both the drugs will provide additional benefit. we can double the dose of nortryptilline if it is suting her and go off amitryptilline. 2. the next line of drugs which we can try is pregabalin or gabapentin. As such they don't effect the heart but yes can cause a bit of fluid retention 3. I hope your wife is trying non drug therapy as well like yoga, meditation, exercises cause all these medicines have a saturation point beyond which they are ineffective ... I. hope the information was useful Do let me know for more queries regards Dr naval