Complications in Administering Medications for Fibromyalgia
By Jan Warner LISWS, PhD
Although fibromyalgia (FM) is a fairly common condition, people are suffering without relief. Providers are frustrated, as there is no medical treatment protocol found to be completely safe and effective. In fact, it’s important to mention the level of frustration some medical providers and researchers have towards fibromyalgia patients. Some providers even question the existence of fibromyalgia, as Fitzcharles and Yunus (2012) note: "There have been physicians who have disputed the validity of a condition presenting with subjective complaints and associated with considerable functional impairment, without objective clinical findings" (p. 2). In addition to provider frustration and limited effectiveness, Häuser, Sarzi-Puttini, Tölle, and Wolfe (2012) report that allopathic treatment of fibromyalgia is characterized by the numerous side effects (see Table 1.0), such as weight gain, over-sleeping, and dizziness.
Some of the most commonly prescribed medications for fibromyalgia are nonsteroidal anti-inflammatories (NSAIDS), such as pregabalin for pain symptoms. With the growing nationwide recognition on the dangers of opioids, this method of treatment is being removed from modern medical protocols. Often what remains is the use of NSAIDS. However, “one in 1,200 patients will die from complications as a result of taking NSAIDs” (White, 2006, p. 225), which are used primarily for treating chronic pain. The American Chronic Pain Association (2017) writes in their integrated guidebook:
In general, 30 percent of hospital admissions among the elderly may be linked to an adverse drug-related event or toxic effect from opioids and sedatives (i.e., a tranquilizer). Nearly one-third of all prescribed medications are for persons over the age of 65 years. Unfortunately, many adverse drug effects in older adults are overlooked as age-related changes when in fact the person is experiencing a medication-related problem. (p. 13).
Tramadol, not designed for FM, is also prescribed for pain however it has the potential for abuse and addiction. Medications designed for mood disorders, not FM are also used. Doctors prescribe psychiatric medications for depression and anxiety such as duloxetine and milnacipran (Nüesch, Häuser, Bernardy, Barth, & Jüni, 2013).
Plus, if the wrong medications are combined, serious, even life-threatening interactions can occur. As a case in point, if pregabalin is taken along with commonly prescribed blood pressure medicines, the combination can cause peripheral edema (Gracely et al., 2002), which is swelling in the peripheral vascular system typically in the lower limbs of the body.
Therefore, a service gap has been created in treating chronic pain disorders, including fibromyalgia, as frustrated physicians remove ineffective and precarious medications from treatment options, and as insurance companies restrict the number of sessions and payments for psychotherapy for the treatment of the negative affects that often accompanies chronic pain. In the United States and five other industrialized countries (Gracely et al., 2002), this service gap means that they do not get appropriate care and are suffering without many options.
References
American Chronic Pain Association. (2017). ACPA resource guide to chronic pain management: An integrated guide to medical, interventional, behavioral, pharmacologic and rehabilitation therapies (2017 ed.). Rocklin, CA: American Chronic Pain Association.
Fitzcharles, M., & Yunus, M. B. (2012). The clinical concept of fibromyalgia as a changing paradigm in the past 20 years. Pain Research and Treatment, 2012, 1-8. doi:10.1155/201 2/184835.
Gracely, R. H., Petzke, F., Wolf, J. M., & Clauw, D. J. (2002). Functional magnetic resonance imaging evidence of augmented pain processing in fibromyalgia. Arthritis & Rheumatism, 46(5). doi:10.1002/art.10225
Häuser, W., Sarzi-Puttini, P., Tölle, T. R., & Wolfe, F. (2012). Placebo and nocebo responses in randomised controlled trials of drugs applying for approval for fibromyalgia syndrome treatment: systematic review and meta- analysis. Clinical Experimental Rheumatology, 30(6 Suppl 74), 78-87.
Nüesch, E., Häuser, W., Bernardy, K., Barth, J., & Jüni, P. (2013) Comparative efficacy of pharmacological and non-pharmacological interventions in fibromyalgia syndrome: Network meta-analysis. Annals of the Rheumatic Diseases, 72(6), 955-962.
White, P. (2006). A background to acupuncture and its use in chronic painful musculoskeletal conditions. The Journal of the Royal Society for the Promotion of Health, 126(5), 219-227. doi:10.1177/1466424006068238.