I know that many of you have tried neurontin-some with success and some with side effects. As this information from Johns Hopkins suggests neurontin can be very helpful for pain, fatigue, and improving sleep. If you decide to ask your doctor about whether you might be a candidate for Neurontin, or perhaps to give Neurontin another try try to start on the absolute lowest dose possible (true for all meds in we FMS/CFS sufferers)…..yours, Dr. Don

New Option for Fibromyalgia Treatment

If you have fibromyalgia, you know that getting plenty of sleep and regular exercise are extremely important. While treatment options for the pain and fatigue of fibromalgia are limited, two new medications offer hope.

The treatment of fibromyalgia involves managing the symptoms. Drugs typically used include antidepressants, pain relievers, sleep medications, muscle relaxants, anti-anxiety agents, antiseizure medications, and medications used to control headaches.

Last spring, the FDA approved pregabalin (Lyrica) for the treatment of fibromyalgia. In clinical trials, Lyrica reduced pain of fibromyalgia better than placebo. This medication is also approved to treat neuropathic pain (pain from damaged nerves) in people with diabetes and pain in people who have had shingles (postherpetic neuralgia). It is also used to treat certain types of seizures.

Recently, results from a 12-week study reported in the journal Arthritis & Rheumatism (Volume 56, page 1336) suggest that the epilepsy drug gabapentin (Neurontin) could offer some relief. The researchers randomly assigned 150 individuals with fibromyalgia to take gabapentin (1,200-2,400 mg) for 12 weeks or placebo (inactive) pills. They found that compared with placebo, gabapentin significantly reduced pain and fatigue and improved the quality of sleep, as measured by several standardized tests. In fact, more than 50% of the gabapentin group reduced their pain severity score by at least 30% compared with only 31% of those taking placebo.

Currently, the FDA has not approved gabapentin for the treatment of fibromyalgia. However since Lyrica has a similar mechanism of action, you could ask your doctor about trying it for your fibromaylagia pain and fatigue.

“Pristiq” is the latest in the group of anti-depressants known as SNRIs, or serotonin and norepinephrine reuptake inhibitors. Also in this class is Cymbalta (duloxetine), which is the only anti-depressant that has an FDA approval for fibromyalgia. “Venlafaxine” (Effexor, Effexor XR) is another SNRI and is quite similar to Pristiq which is the trade name for “desvenlafaxine.
I suspect we will be hearing more about Pristiq because it is so similar to Effexor and Cymbalta. I began prescribing Effexor for FMS and pain patients several years ago because it seemed to work better on their depression/pain overlap than the SSRIs which are “selective serotonin reuptake inhibitors”. Examples of SSRIs are Paxil, Zoloft, Celexa, and many others.

This is called “off-label” prescribing by the FDA and simply means that the physician is prescribing a medication for something the FDA has not approved it for. It is entirely accepted and legal and is done with all kind of medications we know can help a particular problem but has not gone through the arduous FDA process.

We know that the neurotransmitters serotonin and norepinephrine seem to be involved in FMS (see “What causes Fibromyalgia”), CFS, and other chronic pain syndromes. Therefore a medication that boosts the levels of these could potentially be helpful.

My concern with Pristiq is that it is not very flexible in it’s dosing at this time. Those of us with FMS and related disorders can be unusually sensitive to medications. My axiom is to “start low and go slow.”
Start with a very low dose and gradually increase the dose if until there is a response.
On the other hand the fact that it is sustained-release is a plus. This allows for once/daily dosing and more constant drug levels.
This does not mean to try Pristiq if your physician recommends it. It may work great for you. I suspect, however, that a lower dosage form of Pristiq will be needed if it is to become helpful in our quest.

Yours, Dr. Don

P.S. If any of you have tried or are on Pristiq I would love to hear from you in the comments section or by email!!!