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New study on fibro drugs- fibro pain treatment "as good as it gets"

happyHBmomhhappyHBmom Posts: 2,070
edited 03/15/2015 - 10:40 AM in Fibromyalgia

Basically, from a meta-analysis of medication to treat fibro pain (a new statistical analysis of old data lumped together) duloxetine, milnacipran and pregabalin.
Outcomes of interest were improvements in pain, fatigue, sleep disturbance, depressed mood and health-related quality of life, as well as adverse events.
The authors concluded that the three drugs were superior to placebo for all outcomes noted above, with the exceptions of duloxetine for fatigue, milnacipran for sleep disturbance, and pregabalin for depressed mood.
The most frequent 'class' effects seen with the two serotonin norepinephrine reuptake inhibitors (SNRIs—duloxetine and milnacipran) included nausea, headache, hyperhidrosis and constipation, and the most serious adverse effects were rare cases of uncontrolled hypertension, hepatotoxicity or suicidality. The most frequent class effects seen with the α2δ-subunit calcium-channel ligands (pregabalin as well as similar compounds such as gabapentin) are dizziness, somnolence, weight gain and peripheral edema.
In clinical practice, it is common to use one drug from each of these classes in combination. This approach is beginning to be supported by data showing much higher overall response rates in fibromyalgia patients treated with an SNRI and an α2δ-subunit calcium-channel ligand together, rather than with either class separately.
And this is the part that I thought particularly interesting, and something we've noted quite often in treatment of other sources of chronic pain:
Finally, perhaps the most important lesson from the meta-analysis by Hauser et al.[1] is that, as measured by standardized effect sizes, the overall analgesic efficacy of these drugs is no different for fibromyalgia than of other analgesics for other chronic pain states. Many practitioners feel that they can effectively treat 'real' pain states such as osteoarthritis, whereas they feel they do not have anything to offer individuals with fibromyalgia even though the data suggest otherwise. The standardized analgesic effect sizes of the three fibromyalgia drugs range from −0.19 to −0.33, which are small-to-modest. However, these effect sizes are nearly identical to those of acetaminophen, NSAIDs and opioids noted in meta-analyses of analgesic agents for osteoarthritis of the knee. For chronic pain treated with a single class of drugs, these effect sizes are 'as good as it gets'.
Because of the modest overall analgesic efficacy seen with any class of analgesic drug in any chronic pain state, we should be particularly aggressive about using more nonpharmacological therapies in treating patients with chronic pain, no matter what the 'cause' of the pain. Nonpharmacological approaches such as education, cognitive behavioral therapy and exercise have large effect sizes in fibromyalgia as well as in nearly any other chronic pain state studied, but at present these treatments are rarely used in clinical practice.


  • Jag11JJag11 Posts: 2
    edited 10/19/2012 - 7:16 AM
    Personally I never got any noticeable pain relief from either Lyrica or Cymbalta and I was on Cymbalta for the last 3 or 4 years because I also have Major Depression and the Cymbalta did help to lessen the intensity of the Depression. I have also found a negative feedback loop exists for me with Pain and Depression, meaning that being in pain all or a lot of the time is in and in itself depressing.and it can become a vicious circle. What I have found to be LIFE CHANGING however is taking Suboxone (Buprenorphine with Naloxolone) which has dramatically and radically improved my pain situation. A lot of Docs however are either completely ignorant of or prejudiced against Suboxone because it's primary indication in this country is for Opiate addiction, although it is mainly used throughout the world for pain relief. In fact there are now low dose Buprenorphine Patches available in the US which are indicated for Pain Relief.
  • Hazel22HHazel22 Posts: 1
    edited 12/02/2012 - 4:02 PM
    "we should be particularly aggressive about using more nonpharmacological therapies in treating patients with chronic pain, no matter what the 'cause' of the pain."

    My partner suffers from FM and tried several medications before having success with XXXXX It's a safe, non-toxic pain reliever that is available without prescription.

    Post edited, Solicitation at Spine-Health is never permitted
  • uniquelysusieuuniquelysusie Posts: 1
    edited 03/14/2015 - 3:56 AM
    I have taken every medicine used for FM over the last 5 years with no or just little relief. I was on Oxycodone low dose for 2 yrs. which helped most of all, but stopped working and PCP reluctant to increase dosage. I have heard about Suboxone for FM pain. Any experiences or advice from anyone? I am seeing my doctor in 2 days for checkup on last med which isn't working for me, so I would like to know if it beneficial to ask her about Suboxone. Thank you.
  • I am prescribed Suboxone for my chronic pain. I was diagnosed with Fibromyalgia 5 yrs. ago. I also have arthritis, carpal tunnel and spinal stenosis. I have been on every med know to treat my fibro. It either didn't work or I had allergic reactions. I could barely function until my pm doctor prescribed subs. I take 4 MG twice a day. I could get by on 4 mg 1 x day if needed. It works!!! The problem is my insurance won't pay for it because it's supposed to be used for people getting off opiates. I'd rather pay cash than suffer every day. That's my choice.
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