Reality Health

By Dr. Sara Levine

Dear Dr. Levine,
My doctor recently diagnosed me with fibromyalgia. He did quite a lot of testing and said that all of the test results were good.   He wrote me a prescription for an antidepressant that is heavily advertised in the media and scheduled a follow up visit in 2 months.  I am not depressed.  In fact, I am quite happy and hopeful, especially now that I know that my pain is not caused by cancer or some other dread disease.  How is an antidepressant going to cure my constant pain, poor sleep, and mediocre energy level?

Fibromyalgia is a generalized chronic pain (at least three months duration) condition that affects the upper and lower body on both the right and left sides of the body.  People usually have tenderness in specific areas of their body.  Some people with fibromyalgia suffer from generalized fatigue, sleep disturbances, headaches, tingling sensations, numbness, psychiatric symptoms, and/or gastrointestinal symptoms.  In order to establish a diagnosis of fibromyalgia, a physician must establish that one’s symptoms are not caused by another condition.  Many illnesses have overlapping symptoms with fibromyalgia, yet are treated differently. 

Although there can be a genetic predisposition to getting fibromyalgia, there is no proven cause for the disorder.  The disorder is chronic and can affect people for several months or many years.  Therefore, treatment focuses on improving symptoms of pain, fatigue, sleep disturbances, and any other debilitating symptoms. 

There is a higher prevalence of depression in those who have fibromyalgia, but your doctor is not using an antidepressant for treatment of depression in your case.  Rather, he is using the medication to help decrease your symptoms and allow you to function better despite any persistent symptoms.  Pregabalin and duloxetine are two FDA approved medications for fibromyalgia.

However, many medications are used “off-label” for fibromyalgia.  This means that they are FDA approved for other medical conditions, but have not been specifically studied for effectiveness over at least a 6 month period for treatment of fibromyalgia. 

However, based on experience and data from treatment of many patients who suffer from a variety of pain conditions, physicians have found that several antidepressant medications can be quite helpful at decreasing a number of symptoms caused by fibromyalgia. These not only include duloxetine, but also others.  Some people also need other medications to treat other symptoms such as persistent fatigue and sleep disturbances. 

Your doctor has started you on a medication that will likely take a few weeks to have any significant effect.  There are a number of potentially effective medications that are used to help minimize symptoms of fibromyalgia and maximize your ability to function.  If this medication does not prove effective, do not lose hope. Aspects of your lifestyle can be changed that may help you.

Make sure that you eat a healthy varied diet.  Try to get more sleep, quit smoking, and avoid alcohol.  Starting a structured exercise program is crucial.  Start gradually and increase your activity as tolerated.  It will increase your stamina, improve your general energy level, and help you sleep better.  Do not expect a complete cure of your fibromyalgia. With a consistent program of medication and healthy lifestyle changes, however, you should finally begin to appreciate an improvement in your symptoms.

Sincerely,

Sara Levine, M.D., F.A.A.P.