Meds I have found the most helpful in adressing both pain and sleep are at the bottom in this chart. Elavil and Pamelor (amitryptalline and nortryptalline) seem very beneficial -but start them in very low doses and only under your physicians supervision. While classified as “anti-depressants” in low dose they can be added to newer anti-depressants like SSRI’s and SNRI’s

Drug Class     Benefits     Risks

Over-the-counter NSAIDs
(nonsteroidal anti-inflammatory drugs)

* Aspirin (Bayer, Excedrin)
* Ibuprofen (Advil, Motrin)
* Ketoprofen (Actron, Orudis KT)
* Naproxen (Aleve)

Relieves pain and reduces swelling.     Side effects include a risk of ulcers and bleeding. Not for long-term use unless recommended by your health care provider.
Over-the-counter acetaminophen

* Tylenol
* Panadol
* An ingredient in Excedrin

Relieves pain.     They can also cause liver toxicity in high doses. Not for long-term use unless recommended by your health care provider.
Over-the-counter combined sleep aids/pain drugs

* Advil PM (ibuprofen and diphenhydramine)
* Tylenol PM (acetaminophen and diphenhydramine)

Relieves pain and helps with sleep.     These drugs help you sleep by including an antihistamine, an ingredient in cold medicines that may also work as a sedative. However, according to the National Institutes of Health, the effectiveness of antihistamines as a sleep aid is not well established and they can have side effects like daytime drowsiness and decreased cognitive function. Not for long-term use.
Opioid painkillers

* codeine
* morphine
* OxyContin (oxycodone), Percocet (oxycodone with acetaminophen)
* Vicodin (hydrocodone with acetaminophen)

Relieves more severe pain.     Side effects include nausea, constipation, and a risk of addiction. Some of these medicines can disrupt the natural sleep cycle, reducing the amount of deep sleep you get.
Muscle relaxants

* Flexeril (cyclobenzaprine)
* Lioresal (baclofen)
* Skelaxin (metaloxalone)
* Soma (carisoprodol)

Relieves more severe pain.     Relieves pain from spasm and helps with sleep. Side effects include drowsiness, dry mouth, constipation and confusion. Should not be used for long-term pain relief.
Benzodiazepines

* Ativan (lorazepam)
* Dalmane (flurazepam)
* Halcion (triazolom)
* Klonopin (clonazepam)
* Restoril (temazepam)
* Valium (diazepam)

Used to reduce anxiety, benzodiazepines can also aid with sleep.     These drugs are not for long-term use. Side effects can include daytime sleepiness, cognitive impairment, and dependence. They can also reduce the amount of REM sleep.
Nonbenzodiazepine hypnotics

* Ambien (zolpidem)
* Lunesta (eszopiclone)
* Sonata (zaleplon)

Aids with sleep, while not causing the same disruptions to the sleep cycle that benzodiazepines do. They are generally considered to be safer for longer use.     Side effects can be similar to those of benzodiazepines, although generally less severe.
Anticonvulsants

* Gabitril (tiagabine)
* Carbatrol, Tegretol (carbamazepine)
* Neurontin (gabapentin)
* Topamax (topiramate)

Originally used to prevent seizures, these drugs can also help with nerve pain.     Side effects include drowsiness and dizziness. You should never stop taking these medicines abruptly.
Antidepressants

* Aventyl, Pamelor (nortriptyline)
* Desyrel (trazodone)
* Elavil (amitriptyline)
* Serzone (nefazodone)

Reduces pain, particularly for headache, nerve pain, and fibromyalgia; some can aid sleep.     These drugs may not be effective for other types of pain, like sports injuries or back pain. Antidepressants are powerful drugs that can have serious side effects. Talk to your health care provider about side effects you should watch out for.

The older antidepressants (or as I prefer to call them “neurotransmitter boosters”) can be very effective in helping with pain and sleep as this article originally published in the Journal of the AMA (JAMA) reveals. They are inexpensive (all generic). They should be started in very low doses.
Too many patients I have seen were placed an the amount used for depression which is way too high for us “FMSers” I have found starting with 10 mg of amitriptylline (Elavil) or nortryptalline at bedtime to be a good starting dose. Even if you are on one of the newer SSRIs or SNRIs you could ask your doctor about adding a low dose of one of these “tricyclics” at bedtime.

NOTE THAT THIS STUDY FOUND THEM MORE EFFECTIVE THAN THE NEWER ANTIDEPRESSANTS IN SEVERAL WAYS. OF COURSE, ALWAYS ASK YOUR PHYSICIAN BEFORE MAKING ANY CHANGES.

yours, Dr. Don

(By Linda Searing

THE WASHINGTON POST

Published: March 5, 2009

The question: Might antidepressants help relieve the pain, sleep problems and other symptoms that afflict people with fibromyalgia?

This study: It analyzed data from 18 studies, involving 1,427 people with fibromyalgia, mostly women, who had been randomly assigned to take an antidepressant or a placebo for up to about two years. At the end of the studies, people who took antidepressants reported, on average, less pain, fewer sleep problems, less depression and an improving quality of life compared with those who took a placebo. Generally, conventional antidepressants — tricyclic and tetracyclic drugs, sometimes called typical antidepressants — were deemed more successful in pain relief than were SSRIs (selective serotonin reuptake inhibitors) and other second-generation, or atypical, antidepressants. ( read Cymbalta, Savella )

Who may be affected? People with fibromyalgia, a disorder characterized by widespread pain and tenderness as well as fatigue. It is more common in women than in men. Medication can help relieve symptoms, but no cure for the condition has been found.

Caveats: Most data came from the participants’ assessments of symptoms. The studies did not include data on other illnesses participants might have had or on other treatments or medications they might have taken. Only one antidepressant used in the studies, duloxetine (Cymbalta), has been approved by the Food and Drug Administration to treat fibromyalgia.

Find this study: Jan. 14 issue of the Journal of the American Medical Association.