Q: What is the best and safest painkiller I can use long term for fibromyalgia? I suffer from severe headaches, muscle and joint pain, as well as back pain.
A:Fibromyalgia is a condition of unknown caused marked by widespread pain. Besides pain in joints, muscles and the spine, common symptoms include poor quality sleep and soreness when pressure is applied in certain areas (called tender points). Headaches, fatigue and trouble concentrating are also common.
A number of common medical conditions can mimic fibromyalgia. Thyroid disease, arthritis, and sleep disorders are examples. Unfortunately, there's not a test available to establish the diagnosis. Doctors make the diagnosis of fibromyalgia by the combination of chronic, widespread pain, tender points, other typical symptoms and the absence of another explanation for the symptoms.
There is no single best or one safest treatment. In fact, it's hard to predict which, if any, medication will be helpful in this condition. Common treatments include:
- Analgesics, such as acetaminophen (Tylenol and others) and tramadol (Ultram)
- Antidepressants, including amitriptyline (Elavil), fluoxetine (Prozac) and duloxetine (Cymbalta)
- Muscle relaxants, such as cyclobenzaprine (Flexeril)
- Anti-seizure medicines, including gabapentin (Neurontin) and pregabalin (Lyrica)
In some people, a combination of medicines, such as amitriptyline and fluoxetine, may be more effective than either alone.
Most of these medications have not been compared directly with each other in scientific studies of fibromyalgia. So, it's impossible to know if one is truly better than another. In addition, the overall success rate for medication treatment of fibromyalgia is modest at best. And because many trials evaluating medications for fibromyalgia were short-term, the best treatment over the long-run is unknown.
With regard to safety, none of these medications is clearly safer than the others. Each may cause side effects. It's important to consider their potential risks and benefits before taking them.
Keep in mind that medication is just one of options to treat fibromyalgia. Because medications may cause side effects and may not work in this disorder, it’s important to explore other treatment options.
For example, exercise and physical therapy may be more effective than medication treatment. While people with this condition usually feel unable to exercise, most can do so as long as they start slowly and increase exercise duration and intensity slowly.
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