Fibromyalgia Drugs Miss the Mark in Large Survey

Which of the drugs recommended by the American College For Rheumatology for FM have you tried"

  • Lyrica (pregbalin)

    Votes: 4 40.0%
  • Cymbalta (Duloxetine)

    Votes: 8 80.0%
  • Savella (Milnacipran)

    Votes: 1 10.0%
  • Neurontin (Gabapentin)

    Votes: 7 70.0%
  • Tramadol

    Votes: 4 40.0%
  • Flexeril (cyclobenzaprine)

    Votes: 5 50.0%
  • Elavil (amytriptyline)

    Votes: 7 70.0%
  • Effexor (venlaxafine)

    Votes: 5 50.0%
  • I have tried other drugs

    Votes: 6 60.0%

  • Total voters
    10

Cort

Founder of Health Rising and Phoenix Rising
Staff member
Three drugs are approved for use by fibromyalgia patients in the U.S. and five more are recommended by the American College of Rheumatology. That would seem to be a pretty good basket of drugs to choose from but a recent large survey suggested that quantity was no reflection of quality.

This study used a retrospective analysis of insurance company records to determine which drugs over 240,000 FM patients tried and which ones they stuck with over two years. (Now that's a big database..) Most of the patients diagnosed with FM were women but a substantial percentage were men (32%).

[fright]
Pain-collage.jpg
[/fright]The news was not good for the FM drug makers. For one, most doctors don't appear to know how to administer these drugs. For another, despite the fact that FM patients in the U.S. and Europe spend about $1.8 billion a year on FM drugs, they do not appear to be happy with their treatment; they frequently switched drugs and ultimately often let them lapse.

J Manag Care Spec Pharm. 2016 Mar;22(3):263-71. doi: 10.18553/jmcp.2016.22.3.263.Treatment Patterns Associated with ACR-Recommended Medications in the Management of Fibromyalgia in the United States. Liu Y1, Qian C2, Yang M2.

The survey suggested that most doctors were either reluctant to begin drug treatment or didn't know of it. Less than a third of FM patients began treatment using drugs recommended by the American College of Rheumatology (pregabalin (Lyrica), gabapentin (Neurontin), duloxetine (Cymbalta), milnacipran (Savella), cyclobenzaprine (Flexeril), tramadol, amitriptyline (Elavil) and venlafaxine (Effexor)). Of those who did the fact that many received a lower than suggested dose suggested doctors were not fully informed.

Of the six drugs assessed (Lyrica, Neurontin, Cymbalta, Savella, Flexeril, Tramadol) Cymbalta was the most commonly used. It was also the most successful drug; it was the only drug that patients used for more than 50% of the time covered by the survey. Over 50% of patients dropped all the other medications before six months was up.

Many of those who continued their use of a drug weren't satisfied with it as 50% added another drug within a year.

For the others either doctors weren't giving their patients with more options or the patients simply weren't interested in trying them as only 30% of patients tried another drug within 90 days of their first drug not working out.

All in all the survey suggested that doctors are not well informed about FM drugs, that patients may be receiving too low of doses of the drugs to be effective, that they are not satisfied with their drugs and switch them often and that they may not be offered all the options present to them.

This may not be an unusual finding for FM and similar pain conditions. A similar survey of diabetic patients with neuropathic pain also indicated that they tended to receive lower than recommended doses and that they frequently discontinued the drugs they did get. The authors concluded that treatment efficacy for neuropathic pain was very poor.

Another study concluded that prescriptions of amitriptyline, duloxetine, gabapentin, or pregabalin had little for no effect on health care utilization by FM patients; that is, being prescribed one or more of these drugs did not reduce their number of doctor visits. (Duloxetine was better than Lyrica in this regard possibly because it was able to reduce depression.) This study also found high drug discontinuation rates for FM.

Four drugs are likely to enter the market for FM over the next couple of years. If these studies are accurate they will probably find a receptive audience.
 
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ShyestofFlies

Well-Known Member
My pdoc just prescribed Fetzima - which is a drug developed from savella. It is apparently *not* recomended for fibro (because then who would buy savella?) but it is prescribable for major depression- and has a chance to do some off label help with pain as it is an SNRI. I have been on it one week so far, today is my second time taking 40 mg up from 20. I will report back if it does anything. I've actually read a minority of reviews say it makes pain worse, and I don't know if it's this or coming off cymbalta or just the swing of the flare, but my pain does seem to be worse at least the allodynia.

What is interesting about Fetzima is the seratonin to neurepinephrine ratio- 1: 2 while most other snris are 10 : 1. I'm unsure if Savella is the same way.


I have tried cymbalta, effexor, and a handful of ssris. None have touched the fibro, some gave me nasty side effects (the snris make me so sick and the ssris don't work). I still have to rely on my psychiatrist to prescribe me meds for this instead of a dedicated fibro doc and that's frustrating the hell out of me.

I think there is a fine line with fibro and cfs drugs- are the drugs just mostly ineffective, or are se sensitive to the drugs because of chemical sensitivity? The world may never know...
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
My pdoc just prescribed Fetzima - which is a drug developed from savella. It is apparently *not* recomended for fibro (because then who would buy savella?) but it is prescribable for major depression- and has a chance to do some off label help with pain as it is an SNRI. I have been on it one week so far, today is my second time taking 40 mg up from 20. I will report back if it does anything. I've actually read a minority of reviews say it makes pain worse, and I don't know if it's this or coming off cymbalta or just the swing of the flare, but my pain does seem to be worse at least the allodynia.

What is interesting about Fetzima is the seratonin to neurepinephrine ratio- 1: 2 while most other snris are 10 : 1. I'm unsure if Savella is the same way.


I have tried cymbalta, effexor, and a handful of ssris. None have touched the fibro, some gave me nasty side effects (the snris make me so sick and the ssris don't work). I still have to rely on my psychiatrist to prescribe me meds for this instead of a dedicated fibro doc and that's frustrating the hell out of me.

I think there is a fine line with fibro and cfs drugs- are the drugs just mostly ineffective, or are se sensitive to the drugs because of chemical sensitivity? The world may never know...
Good luck with it...

A new drug in clinical trials for FM, TD-9855 I think it, also has more NE - they call it an NSRI instead of an SNRI. The company believes it will be more effective than SNRI's

Good luck finding an FM doc!
 

Cort

Founder of Health Rising and Phoenix Rising
Staff member
Im suprised xyrem has been more heavily pushed as theres a strong correlation between pain and sleep dysfunction.

Also newer sleep meds approved for fibro and insomnia would be great.
The sublingual form of Flexeril could be good. ...It apparently helps with getting restorative sleep and reduces pain and the same time. In clinical trials now.
 

Paw

Well-Known Member
I find muscle relaxants to be some of the most reliable forms of relief. Been using sublingual cyclobenzaprine (3 mg), but my FM and RLS seem to need full dosing (for better sleep).

Anyone know whether long-term regular use is safe and effective? My favorite is baclofen.
 

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