Combining Drugs May Work Better in Fibromyalgia

Cort

Founder of Health Rising and Phoenix Rising
Staff member
So far as pain disorders go, fibromyalgia (FM) ranks right up there in nastiness. Estimates vary, but the highest estimates puts rates of disability in FM at about 25%; far higher than in most other pain disorders (@10%).

[fright]
Pain-state.jpg
[/fright]There are no solutions for fibromyalgia yet. Recommended treatment protocols generally call for a multi-dimensional approach that includes drugs, physical therapy, behavioral interventions to calm a twitchy nervous system down and get better sleep, and exercise to induce an analgesic response.

Fibromyalgia may be amongst the poorest funded diseases, but it does have three FDA approved drugs. Lyrica was the first to be approved in 2007, followed by Cymbalta and Savella in 2009. Many other drugs - Drugs.com lists over 30 - are used in FM, and over time a substantial database of their effectiveness is being formed.

Now comes an intriguing study that suggests that some people may have given up on the FDA approved drugs too soon.

Combination Drug Therapy for Fibromyalgia

Healthcare Costs and Medication Adherence Among Patients with Fibromyalgia: Combination Medication vs. Duloxetine, Milnacipran, Venlafaxine, and Pregabalin. Nicole M. Marlow, PhD, MSPH,a Kit N. Simpson, DrPH,b Ivana A. Vaughn, MPH,a Ara Jo, MS,a James S. Zoller, PhD, MHA,b E. Baron Short, MD, MSCRc Pain Practice April 18th, 2017. 10.1111/papr.12585

These results suggest that patients in the combination therapy cohort were better able to achieve a therapeutic effect given the complementary pharmacologic activities of this treatment regimen, specifically a SNRI with pregabalin. The authors

The researchers - none of whom were allied with the pharmaceutical industry - looked at FM drug use and adherence over a three year period in South Carolina. They included a long, long list of medications (opioids. anticonvulsants, SSRI's, SNRI's, anti-inflammatories, anti-migraine drugs, benzodiazepines, ADHD drugs, sedatives/hypnotics, muscle relaxants) in their study.

Their goal - to determine if FM patients who combined one of the big three FDA approved drugs (Lyrica, Cymbalta, Savella) with other drugs stayed on them longer than patients who were just taking the FDA approved drugs. Staying on the combo treatment longer presumably indicated that the drug combo was working. Dropping one of the drugs more quickly, on the other hand, presumably indicated that the drug combo didn’t work.

They also determined if medical costs went down. (Successful drug use often causes the numbers of doctor's visits and medical issues to go down.)

The study found that FM patients taking Lyrica, Cymbalta or Savella who also took another drug tended to remain on the drug combo longer than if they were just taking Lyrica, Cymbalta or Cymbalta. That suggested to the authors that combining drugs was probably generally helpful in FM.

Increased adherence rates could be important because drug adherence rates in FM because of side effects, lack of effect, and probably cost, to put it bluntly, suck. Adherence rates for Lyrica by itself bombed out at about 22% in this study. Savella adherence rates were better but still poor (31%) and Cymbalta's were a relatively decent 45%. Combining each of those drugs with another one increased adherence rates by about 60% in Cymbalta (34%) and 30% in Savella (43%) and rates in Cymbalta remained about the same (45%). Other studies have found similar adherence rates (Savella - 20%, Lyrica - 24%, Cymbalta - 45%.).

[fright]
pharrmaceutical.gif
[/fright](The best dose to take? The highest adherence rates (@40%) for Cymbalta occurred at its highest dose of >60 mgs. Another study suggested that FM patients taking 60 mgs of Cymbalta had the best chance of having a good response. Lyrica (300 mgs) was next, followed by Savella (200 mgs) and then Lyrica again (150 mgs.).

Instead of going down overall, costs to the medical system went up for combination drug protocols. This was caused not by increased doctor's or ER visits or hospitalizations, but simply because the FM patients on combination therapies were taking more drugs and were staying on them longer.

Unfortunately, because the study was unable to assess pain levels or functioning, it was impossible to tell if some FM patients went on or stayed on the drug combos longer or simply because they were more desperate. In general, though, the authors noted that longer drug adherence is usually associated with better treatment outcomes.

This isn't the first study to suggest that it might be better to combine drugs than to fly solo in FM. A 2012 Spanish FM study found that the least effective course of action was to stay on one drug, and the most effective was to combine an antidepressant and an anti-convulsant. (For some reason pain drugs were not included in the study.) Some sort of synchronicity appeared to be occurring; using these drugs together increased the effectiveness of the antidepressant drug by about 50% and the effectiveness of the anticonvulsant drug by 100%.

Adding Savella (milnacipran) to Lyrica more than doubled the rate of those responding to it (from 21-46%) in a 2013 open-label study. Another study found that pain relief was significantly greater for FM patients on both Lyrica and Cymbalta than for those using just one drug. The jump in the percentage of patients stating they'd attained at least moderate pain relief was startling. Sixty-seven percent of patients on the drug combo reported attaining at least moderate pain relief compared to 38.5% on Lyrica alone and 42% on Cymbalta alone. One potential downside of the drug combination, however, was increased drowsiness.

Another study suggested that if you're adding antidepressants to your drug mix, Paxil (paroxetine) might be the best option. FM patients on Paxil plus Lyrica had significantly lower symptom scores, tolerated their medications better, and reported more improved life satisfaction, mood, and sleep quality (P < 0.05) than FM patients taking Lyrica and either amytriptyline or Effexor (venlaxafine). Effexor, in particular, was poorly tolerated by the FM group.

Cymbalta First?

If you're going to focus on one FDA approved drug, which should you try? One rather massive study had some sobering news. None of the FDA approved drugs for FM by themselves reduced the number of doctor visits or hospitalizations or emergency room visits significantly. We've just seen, though, that adherence rates for Cymbalta top the big three FDA approved drugs for FM.

FM patients using Cymbalta also use the medical system less than those taking Lyrica. A 2014 study came to a similar conclusion: FM patients on Cymbalta saw the doctor less and spent less money on medical costs and took their medication more consistently than those on Lyrica. The possible flaw in that scenario? Doctors may be funneling their more severely ill patients to Lyrica.

Cymbalta demonstrates how easily drugs can transcend categorization. First approved for both depression and anxiety, Cymbalta has now been approved to treat neuropathic pain in diabetes, pain in fibromyalgia and osteoarthritis pain.

Taking the Older Drug Route

"All of these medications have been on the market for 15 years or more and have been widely used. They are all available as inexpensive generics and are at least as effective and safe as the other fibromyalgia medications." Consumer Reports
Or you might try older drugs. In 2014 Consumer Reports recommended that FM patients focus on effectiveness, safety and price and try these three older drugs first.: generic amitriptyline (Elavil), generic gabapentin (Neurontin), Generic paroxetine-IR (immediate release Paxil). (Lyrica is an updated version of gabapentin.)

Other Possibilities

Medical Marijuana and low dose naltrexone are two less mainstream medications that fare very well in patient surveys.
Low Dose Naltrexone
Medical Marijuana


Conclusion

The current batch of FM drugs is hardly the cat's meow. This and other studies suggest, though, that if you're going to go the drug route that combining them - perhaps in lower doses - may be better. This study found that fibromyalgia patients who used FDA approved drugs in combination with other drugs stayed on them longer than patients on mono-therapy.
 

Issie

Well-Known Member
I'm going to "rain on the parade" here. Cymbalta can and does help pain. BUT........it can cause strokes. I lost 2 family members (that we feel is medicine related) with this as a consequence. Both wouldn't stop the meds because of the pain relief. And both had bad strokes that eventually took their lives. It can also potentially cause all the symptoms of POTS. Here is a drug symptom list.
www.drugs.com/sfx/cymbalta-side-effects.html
Issie
 

Remy

Administrator
Cymbalta kicked off the crash that has taken me out for nearly a decade.

It did help pain but also made me unable to do anything but stare at the wall. I felt dead inside. And when the dose started to wear off, it felt like someone had dipped me in gasoline and lit a match.

It also has severe sexual side effects, even at low doses.

I would not wish this drug on my worst enemy. Well, maybe. :)
 

jsuzor

Member
I find that at least 1,000 mg of magnesium divided up in 2 doses throughout the day, and 5,000 IU of vit D has given me better results than antidepressants's and gabapentin.
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
Cymbalta adherence was actually substantially better than the two other FM drugs so I imagine the list of possible side effects for those drugs is longer.

According to Drugs.com orthostatic problems can occur but they occur rarely and usually when the drug is first used
Orthostatic hypotension and syncope tend to occur within the first week of therapy; however, they may occur at any time during treatment, particularly after dose increases. The risk of blood pressure decreases may be greater when duloxetine (the active ingredient contained in Cymbalta) is given concomitantly with drugs that may induce orthostatic hypotension, such as antihypertensives, with potent CYP450 1A2 inhibitors, or with duloxetine doses above 60 mg per day.[Ref]

Common (1% to 10%): Flushing, hot flush, hypertension, increased blood pressure, palpitations
Uncommon (0.1% to 1%): Chest pain, myocardial infarction, orthostatic hypotension, peripheral coldness, tachycardia
Rare (less than 0.1%): Hypertensive crisis, supraventricular arrhythmia (mainly atrial fibrillation)

Postmarketing reports: Hematomas, ventricular arrhythmias[
It can increase bleeding events and should not be used cautiously with aspirin or other blood thinners

Abnormal Bleeding: CYMBALTA may increase the risk of bleeding events. Patients should be cautioned about the risk of bleeding associated with the concomitant use of CYMBALTA and NSAIDs, aspirin, or other drugs that affect coagulation (5.5, 7.4)
Ref]

I'm going to "rain on the parade" here. Cymbalta can and does help pain. BUT........it can cause strokes. I lost 2 family members (that we feel is medicine related) with this as a consequence. Both wouldn't stop the meds because of the pain relief. And both had bad strokes that eventually took their lives. It can also potentially cause all the symptoms of POTS. Here is a drug symptom list.
www.drugs.com/sfx/cymbalta-side-effects.html
Issie
[/SIZE][/SIZE]
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
I find that at least 1,000 mg of magnesium divided up in 2 doses throughout the day, and 5,000 IU of vit D has given me better results than antidepressants's and gabapentin.
Good to hear :). Always good to have non-drug alternatives. Anyone else doing better on them?
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
Cymbalta kicked off the crash that has taken me out for nearly a decade.

It did help pain but also made me unable to do anything but stare at the wall. I felt dead inside. And when the dose started to wear off, it felt like someone had dipped me in gasoline and lit a match.

It also has severe sexual side effects, even at low doses.

I would not wish this drug on my worst enemy. Well, maybe. :)
Wow...:hurting::hurting::hurting::hurting:

So far Cymbalta's not doing so good!
 

Kat

Member
[Cymbalta] made me unable to do anything but stare at the wall. I felt dead inside.
Pretty much what it did to me, plus some disembodiement. I felt like I was sitting beside myself, watching myself stare at the wall. I didn't last three days on it before I was back at the doctor, who told me it takes three weeks to get over the side effects. So I stopped taking it and felt amazing the next day. It's become a pattern: try an antidepressent, it makes me feel worse so i stop taking it, then get this amazing rebound towards feeling great that lasts a day, two if I'm lucky.
 
Cymbalta's high level of adherence is because going back off it is pure hell. There was even a huge lawsuit about it, and if you look into it, there are tons of people who have had huge problems stopping it. There can be a lot of problems with discontinuing any of the drugs mentioned, but Cymbalta is particularly bad. Also, I suspect that part of the reason for the increased adherence for combos of drugs is similar. It is much harder to go back off those drugs when you are on more than one.
 

Steve

Well-Known Member
I'm reading this on one of the worst pain days of life and thinking if you run enough studies on manure, you will probably find it cures cancer. Cymbalta got me confused as I drove out my driveway and then I ran a red light with my wife in the car watching in disbelief. I won't go through the other adverse events with the others you posted. These are toxic, often repurposed meds. Crapola. We need real studies with real meds.
 

marcie myers

New Member
So far as pain disorders go, fibromyalgia (FM) ranks right up there in nastiness. Estimates vary, but the highest estimates puts rates of disability in FM at about 25%; far higher than in most other pain disorders (@10%).

[fright]View attachment 2502 [/fright]There are no solutions for fibromyalgia yet. Recommended treatment protocols generally call for a multi-dimensional approach that includes drugs, physical therapy, behavioral interventions to calm a twitchy nervous system down and get better sleep, and exercise to induce an analgesic response.

Fibromyalgia may be amongst the poorest funded diseases, but it does have three FDA approved drugs. Lyrica was the first to be approved in 2007, followed by Cymbalta and Savella in 2009. Many other drugs - Drugs.com lists over 30 - are used in FM, and over time a substantial database of their effectiveness is being formed.

Now comes an intriguing study that suggests that some people may have given up on the FDA approved drugs too soon.

Combination Drug Therapy for Fibromyalgia

Healthcare Costs and Medication Adherence Among Patients with Fibromyalgia: Combination Medication vs. Duloxetine, Milnacipran, Venlafaxine, and Pregabalin. Nicole M. Marlow, PhD, MSPH,a Kit N. Simpson, DrPH,b Ivana A. Vaughn, MPH,a Ara Jo, MS,a James S. Zoller, PhD, MHA,b E. Baron Short, MD, MSCRc Pain Practice April 18th, 2017. 10.1111/papr.12585

These results suggest that patients in the combination therapy cohort were better able to achieve a therapeutic effect given the complementary pharmacologic activities of this treatment regimen, specifically a SNRI with pregabalin. The authors

The researchers - none of whom were allied with the pharmaceutical industry - looked at FM drug use and adherence over a three year period in South Carolina. They included a long, long list of medications (opioids. anticonvulsants, SSRI's, SNRI's, anti-inflammatories, anti-migraine drugs, benzodiazepines, ADHD drugs, sedatives/hypnotics, muscle relaxants) in their study.

Their goal - to determine if FM patients who combined one of the big three FDA approved drugs (Lyrica, Cymbalta, Savella) with other drugs stayed on them longer than patients who were just taking the FDA approved drugs. Staying on the combo treatment longer presumably indicated that the drug combo was working. Dropping one of the drugs more quickly, on the other hand, presumably indicated that the drug combo didn’t work.

They also determined if medical costs went down. (Successful drug use often causes the numbers of doctor's visits and medical issues to go down.)

The study found that FM patients taking Lyrica, Cymbalta or Savella who also took another drug tended to remain on the drug combo longer than if they were just taking Lyrica, Cymbalta or Cymbalta. That suggested to the authors that combining drugs was probably generally helpful in FM.

Increased adherence rates could be important because drug adherence rates in FM because of side effects, lack of effect, and probably cost, to put it bluntly, suck. Adherence rates for Lyrica by itself bombed out at about 22% in this study. Savella adherence rates were better but still poor (31%) and Cymbalta's were a relatively decent 45%. Combining each of those drugs with another one increased adherence rates by about 60% in Cymbalta (34%) and 30% in Savella (43%) and rates in Cymbalta remained about the same (45%). Other studies have found similar adherence rates (Savella - 20%, Lyrica - 24%, Cymbalta - 45%.).

[fright]View attachment 2503 [/fright](The best dose to take? The highest adherence rates (@40%) for Cymbalta occurred at its highest dose of >60 mgs. Another study suggested that FM patients taking 60 mgs of Cymbalta had the best chance of having a good response. Lyrica (300 mgs) was next, followed by Savella (200 mgs) and then Lyrica again (150 mgs.).

Instead of going down overall, costs to the medical system went up for combination drug protocols. This was caused not by increased doctor's or ER visits or hospitalizations, but simply because the FM patients on combination therapies were taking more drugs and were staying on them longer.

Unfortunately, because the study was unable to assess pain levels or functioning, it was impossible to tell if some FM patients went on or stayed on the drug combos longer or simply because they were more desperate. In general, though, the authors noted that longer drug adherence is usually associated with better treatment outcomes.

This isn't the first study to suggest that it might be better to combine drugs than to fly solo in FM. A 2012 Spanish FM study found that the least effective course of action was to stay on one drug, and the most effective was to combine an antidepressant and an anti-convulsant. (For some reason pain drugs were not included in the study.) Some sort of synchronicity appeared to be occurring; using these drugs together increased the effectiveness of the antidepressant drug by about 50% and the effectiveness of the anticonvulsant drug by 100%.

Adding Savella (milnacipran) to Lyrica more than doubled the rate of those responding to it (from 21-46%) in a 2013 open-label study. Another study found that pain relief was significantly greater for FM patients on both Lyrica and Cymbalta than for those using just one drug. The jump in the percentage of patients stating they'd attained at least moderate pain relief was startling. Sixty-seven percent of patients on the drug combo reported attaining at least moderate pain relief compared to 38.5% on Lyrica alone and 42% on Cymbalta alone. One potential downside of the drug combination, however, was increased drowsiness.

Another study suggested that if you're adding antidepressants to your drug mix, Paxil (paroxetine) might be the best option. FM patients on Paxil plus Lyrica had significantly lower symptom scores, tolerated their medications better, and reported more improved life satisfaction, mood, and sleep quality (P < 0.05) than FM patients taking Lyrica and either amytriptyline or Effexor (venlaxafine). Effexor, in particular, was poorly tolerated by the FM group.

Cymbalta First?

If you're going to focus on one FDA approved drug, which should you try? One rather massive study had some sobering news. None of the FDA approved drugs for FM by themselves reduced the number of doctor visits or hospitalizations or emergency room visits significantly. We've just seen, though, that adherence rates for Cymbalta top the big three FDA approved drugs for FM.

FM patients using Cymbalta also use the medical system less than those taking Lyrica. A 2014 study came to a similar conclusion: FM patients on Cymbalta saw the doctor less and spent less money on medical costs and took their medication more consistently than those on Lyrica. The possible flaw in that scenario? Doctors may be funneling their more severely ill patients to Lyrica.

Cymbalta demonstrates how easily drugs can transcend categorization. First approved for both depression and anxiety, Cymbalta has now been approved to treat neuropathic pain in diabetes, pain in fibromyalgia and osteoarthritis pain.

Taking the Older Drug Route



Or you might try older drugs. In 2014 Consumer Reports recommended that FM patients focus on effectiveness, safety and price and try these three older drugs first.: generic amitriptyline (Elavil), generic gabapentin (Neurontin), Generic paroxetine-IR (immediate release Paxil). (Lyrica is an updated version of gabapentin.)

Other Possibilities

Medical Marijuana and low dose naltrexone are two less mainstream medications that fare very well in patient surveys.
Low Dose Naltrexone
Medical Marijuana


Conclusion

The current batch of FM drugs is hardly the cat's meow. This and other studies suggest, though, that if you're going to go the drug route that combining them - perhaps in lower doses - may be better. This study found that fibromyalgia patients who used FDA approved drugs in combination with other drugs stayed on them longer than patients on mono-therapy.
So, Cort, ironically I stumbled at the same time on a 2013 article touting.... the same, I think. But what happened to the sure fire cure of one of the antidepressants combined with an antiviral? There's one around every corner.
 

marcie myers

New Member
Good to hear :). Always good to have non-drug alternatives. Anyone else doing better on them?
Can't keep up with the magnesium neither have I had my levels tested, but I love my Vitamin D3. For those of you who aren't getting any real sunshine or have very dark skin, the loading dose is 50,000 units. A handful. Better gotten from some real sunshine but get some somehow. It's connected research-wise to many diseases when you have insufficient amounts including colon cancer and depression. And more but I can't remember. The magnesium closes the doors on each cell so that more calcium can't come in consequently having something to do with cellular energy. As little as I understand it...
 

Kat

Member
Good to hear :). Always good to have non-drug alternatives. Anyone else doing better on them?
I need magnesium, at least 1000mg/day; without it i start getting crazy muscle twitches and vibrations. Most of the other supplements I take don't obviously improve my function, but I sure notice if I don't take them: Vit D, Co-Q10, milk thistle, curcumin.
 
So far as pain disorders go, fibromyalgia (FM) ranks right up there in nastiness. Estimates vary, but the highest estimates puts rates of disability in FM at about 25%; far higher than in most other pain disorders (@10%).

[fright]View attachment 2502 [/fright]There are no solutions for fibromyalgia yet. Recommended treatment protocols generally call for a multi-dimensional approach that includes drugs, physical therapy, behavioral interventions to calm a twitchy nervous system down and get better sleep, and exercise to induce an analgesic response.

Fibromyalgia may be amongst the poorest funded diseases, but it does have three FDA approved drugs. Lyrica was the first to be approved in 2007, followed by Cymbalta and Savella in 2009. Many other drugs - Drugs.com lists over 30 - are used in FM, and over time a substantial database of their effectiveness is being formed.

Now comes an intriguing study that suggests that some people may have given up on the FDA approved drugs too soon.

Combination Drug Therapy for Fibromyalgia

Healthcare Costs and Medication Adherence Among Patients with Fibromyalgia: Combination Medication vs. Duloxetine, Milnacipran, Venlafaxine, and Pregabalin. Nicole M. Marlow, PhD, MSPH,a Kit N. Simpson, DrPH,b Ivana A. Vaughn, MPH,a Ara Jo, MS,a James S. Zoller, PhD, MHA,b E. Baron Short, MD, MSCRc Pain Practice April 18th, 2017. 10.1111/papr.12585

These results suggest that patients in the combination therapy cohort were better able to achieve a therapeutic effect given the complementary pharmacologic activities of this treatment regimen, specifically a SNRI with pregabalin. The authors

The researchers - none of whom were allied with the pharmaceutical industry - looked at FM drug use and adherence over a three year period in South Carolina. They included a long, long list of medications (opioids. anticonvulsants, SSRI's, SNRI's, anti-inflammatories, anti-migraine drugs, benzodiazepines, ADHD drugs, sedatives/hypnotics, muscle relaxants) in their study.

Their goal - to determine if FM patients who combined one of the big three FDA approved drugs (Lyrica, Cymbalta, Savella) with other drugs stayed on them longer than patients who were just taking the FDA approved drugs. Staying on the combo treatment longer presumably indicated that the drug combo was working. Dropping one of the drugs more quickly, on the other hand, presumably indicated that the drug combo didn’t work.

They also determined if medical costs went down. (Successful drug use often causes the numbers of doctor's visits and medical issues to go down.)

The study found that FM patients taking Lyrica, Cymbalta or Savella who also took another drug tended to remain on the drug combo longer than if they were just taking Lyrica, Cymbalta or Cymbalta. That suggested to the authors that combining drugs was probably generally helpful in FM.

Increased adherence rates could be important because drug adherence rates in FM because of side effects, lack of effect, and probably cost, to put it bluntly, suck. Adherence rates for Lyrica by itself bombed out at about 22% in this study. Savella adherence rates were better but still poor (31%) and Cymbalta's were a relatively decent 45%. Combining each of those drugs with another one increased adherence rates by about 60% in Cymbalta (34%) and 30% in Savella (43%) and rates in Cymbalta remained about the same (45%). Other studies have found similar adherence rates (Savella - 20%, Lyrica - 24%, Cymbalta - 45%.).

[fright]View attachment 2503 [/fright](The best dose to take? The highest adherence rates (@40%) for Cymbalta occurred at its highest dose of >60 mgs. Another study suggested that FM patients taking 60 mgs of Cymbalta had the best chance of having a good response. Lyrica (300 mgs) was next, followed by Savella (200 mgs) and then Lyrica again (150 mgs.).

Instead of going down overall, costs to the medical system went up for combination drug protocols. This was caused not by increased doctor's or ER visits or hospitalizations, but simply because the FM patients on combination therapies were taking more drugs and were staying on them longer.

Unfortunately, because the study was unable to assess pain levels or functioning, it was impossible to tell if some FM patients went on or stayed on the drug combos longer or simply because they were more desperate. In general, though, the authors noted that longer drug adherence is usually associated with better treatment outcomes.

This isn't the first study to suggest that it might be better to combine drugs than to fly solo in FM. A 2012 Spanish FM study found that the least effective course of action was to stay on one drug, and the most effective was to combine an antidepressant and an anti-convulsant. (For some reason pain drugs were not included in the study.) Some sort of synchronicity appeared to be occurring; using these drugs together increased the effectiveness of the antidepressant drug by about 50% and the effectiveness of the anticonvulsant drug by 100%.

Adding Savella (milnacipran) to Lyrica more than doubled the rate of those responding to it (from 21-46%) in a 2013 open-label study. Another study found that pain relief was significantly greater for FM patients on both Lyrica and Cymbalta than for those using just one drug. The jump in the percentage of patients stating they'd attained at least moderate pain relief was startling. Sixty-seven percent of patients on the drug combo reported attaining at least moderate pain relief compared to 38.5% on Lyrica alone and 42% on Cymbalta alone. One potential downside of the drug combination, however, was increased drowsiness.

Another study suggested that if you're adding antidepressants to your drug mix, Paxil (paroxetine) might be the best option. FM patients on Paxil plus Lyrica had significantly lower symptom scores, tolerated their medications better, and reported more improved life satisfaction, mood, and sleep quality (P < 0.05) than FM patients taking Lyrica and either amytriptyline or Effexor (venlaxafine). Effexor, in particular, was poorly tolerated by the FM group.

Cymbalta First?

If you're going to focus on one FDA approved drug, which should you try? One rather massive study had some sobering news. None of the FDA approved drugs for FM by themselves reduced the number of doctor visits or hospitalizations or emergency room visits significantly. We've just seen, though, that adherence rates for Cymbalta top the big three FDA approved drugs for FM.

FM patients using Cymbalta also use the medical system less than those taking Lyrica. A 2014 study came to a similar conclusion: FM patients on Cymbalta saw the doctor less and spent less money on medical costs and took their medication more consistently than those on Lyrica. The possible flaw in that scenario? Doctors may be funneling their more severely ill patients to Lyrica.

Cymbalta demonstrates how easily drugs can transcend categorization. First approved for both depression and anxiety, Cymbalta has now been approved to treat neuropathic pain in diabetes, pain in fibromyalgia and osteoarthritis pain.

Taking the Older Drug Route



Or you might try older drugs. In 2014 Consumer Reports recommended that FM patients focus on effectiveness, safety and price and try these three older drugs first.: generic amitriptyline (Elavil), generic gabapentin (Neurontin), Generic paroxetine-IR (immediate release Paxil). (Lyrica is an updated version of gabapentin.)

Other Possibilities

Medical Marijuana and low dose naltrexone are two less mainstream medications that fare very well in patient surveys.
Low Dose Naltrexone
Medical Marijuana


Conclusion

The current batch of FM drugs is hardly the cat's meow. This and other studies suggest, though, that if you're going to go the drug route that combining them - perhaps in lower doses - may be better. This study found that fibromyalgia patients who used FDA approved drugs in combination with other drugs stayed on them longer than patients on mono-therapy.
I have ME and Fibromyalgia. I have taken both Cymbalta and Lyrica and gave each a 2 month trial period. Neither of them helped much with the pain but both of them made me feel as if I were going crazy. The doctor that I was seeing at the time knew very little about either condition and very obviously felt that I was being somehow being uncooperative by not feeling much better. He guilted me into continuing to take Lyrica and I reluctantly agreed- however, when I got home and, when trying to park, backed into one of the carport posts- nearly bringing the roof down on me, my car and my daughter- and then got hysterical about it (most unlike me) I stopped taking it. It took a few days but the effect did wear off. Ironically, my daughter (now 48) complained to me a few weeks ago that she was feeling very weird and shaky and 'stressed'. A few days later I found out that her doctor had put her on Lyrica. She stopped taking it and those symptoms stopped within a few days.
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
I need magnesium, at least 1000mg/day; without it i start getting crazy muscle twitches and vibrations. Most of the other supplements I take don't obviously improve my function, but I sure notice if I don't take them: Vit D, Co-Q10, milk thistle, curcumin.
What kind of magnesium do you use?
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
Nothing good so far on the big three....:banghead:
I have ME and Fibromyalgia. I have taken both Cymbalta and Lyrica and gave each a 2 month trial period. Neither of them helped much with the pain but both of them made me feel as if I were going crazy. The doctor that I was seeing at the time knew very little about either condition and very obviously felt that I was being somehow being uncooperative by not feeling much better. He guilted me into continuing to take Lyrica and I reluctantly agreed- however, when I got home and, when trying to park, backed into one of the carport posts- nearly bringing the roof down on me, my car and my daughter- and then got hysterical about it (most unlike me) I stopped taking it. It took a few days but the effect did wear off. Ironically, my daughter (now 48) complained to me a few weeks ago that she was feeling very weird and shaky and 'stressed'. A few days later I found out that her doctor had put her on Lyrica. She stopped taking it and those symptoms stopped within a few days.
 

Cwren58

Member
I've done some switching around. I dropped lyrica-- it is not much better than gabapentin but costs 6 times more with my insurance. 6 x! So I'm back on 2400mg Gabapentin daily, plus cyclobezaprine? muscle relaxer--3x daily. I used Amrix for a while til the program I was on at a specialy pharmacy ran out. It is a better time release version of flexeril. I also use Vimovo from a specialty pharmacy. I is a combo pill 500mg Naproxen mixed with prilosec. It takes care of almost all my pain-- the only thing it is not helping is my spine--which it is really meant to treat, it shouldn't have worked on fibromyalgia but It really does help. Currently my worst pain is SI joints--both sides. I've tried it all for that-injections, radio frequency ablation, and all the pills and PT. Pain doc says it is fibro--I don't think so. It will be 5 years that I"ve had it--in June. I remember the moment it started. Just like I remember exactly when I began to experience fibro back in 1985.

Always looking for different approach. Does anyhow know if LDN works? we have a compounding pharmacy near by I am going to tell my pain doc about it when I see him in a week or two. Wish I could find a cure for brain fog.
 

Cwren58

Member
Cymbalta kicked off the crash that has taken me out for nearly a decade.

It did help pain but also made me unable to do anything but stare at the wall. I felt dead inside. And when the dose started to wear off, it felt like someone had dipped me in gasoline and lit a match.

It also has severe sexual side effects, even at low doses.

I would not wish this drug on my worst enemy. Well, maybe. :)

I tried that and when I was on it-- I suddenly began to have odd seizures at night that would wake me up. I dropped it but the seizures did not stop and I had constant vertigo. I went to neuro who said I had epilepsy after tests. I cannot say cymbalta caused it-- but it sure seems so to me.
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
I've done some switching around. I dropped lyrica-- it is not much better than gabapentin but costs 6 times more with my insurance. 6 x! So I'm back on 2400mg Gabapentin daily, plus cyclobezaprine? muscle relaxer--3x daily. I used Amrix for a while til the program I was on at a specialy pharmacy ran out. It is a better time release version of flexeril. I also use Vimovo from a specialty pharmacy. I is a combo pill 500mg Naproxen mixed with prilosec. It takes care of almost all my pain-- the only thing it is not helping is my spine--which it is really meant to treat, it shouldn't have worked on fibromyalgia but It really does help. Currently my worst pain is SI joints--both sides. I've tried it all for that-injections, radio frequency ablation, and all the pills and PT. Pain doc says it is fibro--I don't think so. It will be 5 years that I"ve had it--in June. I remember the moment it started. Just like I remember exactly when I began to experience fibro back in 1985.

Always looking for different approach. Does anyhow know if LDN works? we have a compounding pharmacy near by I am going to tell my pain doc about it when I see him in a week or two. Wish I could find a cure for brain fog.
Definitely try LDN - check out that resource page and some of the LDN sites. Two studies have shown that it can work in FM (no guarantees of course) and a study is underway in ME/CFS.

Medical marijuana is another good option.
 

Cwren58

Member
I've done some switching around. I dropped lyrica-- it is not much better than gabapentin but costs 6 times more with my insurance. 6 x! So I'm back on 2400mg Gabapentin daily, plus cyclobezaprine? muscle relaxer--3x daily. I used Amrix for a while til the program I was on at a specialy pharmacy ran out. It is a better time release version of flexeril. I also use Vimovo from a specialty pharmacy. I is a combo pill 500mg Naproxen mixed with prilosec. It takes care of almost all my pain-- the only thing it is not helping is my spine--which it is really meant to treat, it shouldn't have worked on fibromyalgia but It really does help. Currently my worst pain is SI joints--both sides. I've tried it all for that-injections, radio frequency ablation, and all the pills and PT. Pain doc says it is fibro--I don't think so. It will be 5 years that I"ve had it--in June. I remember the moment it started. Just like I remember exactly when I began to experience fibro back in 1985.

Always looking for different approach. Does anyhow know if LDN works? we have a compounding pharmacy near by I am going to tell my pain doc about it when I see him in a week or two. Wish I could find a cure for brain fog.

*correction--my seizures began just after I stopped using Cymbalta due to it making me too sleepy.
 

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