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Information
about Medications
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Devin
Starlanyl
This information may be freely copied and distributed
only if unaltered, with complete original content including: ©
Devin Starlanyl, 1995-1999
Often, you may have to
try many medications before you find the optimum ones for you. We react
differently to each medication,
and there is no "cookbook recipe" for FMS or MPS. What works well for
one of us can be ineffective
for another. A medication which puts one person to sleep may keep another
awake. Each of us has
our unique combination of neurotransmitter disruption and connective tissue
disturbance. We need doctors
who are willing to stick with us until an acceptable symptom relief level
is
reached.
These are not the only
medications in use for FMS & MPS, but are simply a selection to show
what is
available. It may be necessary
to address each perpetuating factor, such as pain, lack of restorative
sleep, and muscle rigidity,
separately. Medications should be used along with a program of proper diet,
life style changes, mind
work and bodywork.
Medications which affect
the central nervous system are appropriate for FMS&MPS Complex. They
target
symptoms of sleep lack,
muscle rigidity, pain and fatigue. Pain sensations are amplified by FMS,
and so
the pain of MPS pain is
multiplied. FMS&MPS Complex patients often react oddly to medications.
It is the rule rather than
the exception that a FMS&MPS Complex patient will save strong pain
meds from
surgery or injury for
when they REALLY need it -- for an FMS&MPS Complex "flare". This is
a sign that
your needs aren't being
met. I give you the following quotes. I hope you will pass them on to your
doctor.
They are from "PAIN A
Clinical Manual for Nursing Practice", by McCaffrey and Beebe.
Health professionals "often are unaware of their lack of knowledge about
pain control."
"The health team's reaction to a patient with chronic nonmalignant pain
may present an impossible
dilemma for the patient. If the patient expresses his depression, the health
team may believe the
pain is psychogenic or is largely an emotional problem. If the patient
tries to hide the depression by
being cheerful, the health team may not believe that pain is a significant
problem."
"Research shows that, unfortunately, as pain continues through the years,
the patient's own
internal narcotics, endorphins, decrease and the patient perceives even
greater pain from the same
stimuli."
"The person with pain is the only authority about the existence and nature
of that pain, since the
sensation of pain can be felt only by the person who has it."
"Having an emotional reaction to pain does not mean that pain is caused
by an emotional problem.
"Pain tolerance is the individual's unique response, varying between patients
and varying in the
same patient from one situation to another."
"Respect for the patient's pain tolerance is crucial for adequate pain
control."
"THERE IS NOT A SHRED OF EVIDENCE ANYWHERE TO JUSTIFY USING A PLACEBO TO
DIAGNOSE MALINGERING OR PSYCHOGENIC PAIN."
"No evidence supports fear of addiction as a reason for withholding narcotics
when they are
indicated for pain relief. All studies show that regardless of doses or
length of time on narcotics, the
incidence of addiction is less than 1%." ]
This book is so clear and
so well documented that I suggested my local library buy it. I wanted everyone
in the area to have access
to this information. Once you read this book, you get a greater understanding
of pain and pain medications,
as well as coping mechanisms. Many non-pharmaceutical methods of pain
control are also described
thoroughly in this reference.
It's normal to be depressed
with chronic pain, but that doesn't mean depression is causing the pain.
Maintenance with mild
narcotics (Darvocet, Tylenol #3, Vicodin-Lorcet-Lortab) for nonmalignant
(non-cancerous) chronic
pain conditions be a humane alternative if other reasonable attempts at
pain
control have failed. The
main problem with raised dosages of these medications is not with the narcotic
components, per se, but
with the aspirin or acetaminophen that is often compounded with them. For
medical journal documentation
on the use of narcotics for non-malignant chronic pain, see "The
Fibromyalgia Advocate".
Narcotics should not be given in conjunction with benzodiazepines, as the
latter
antagonize opioid analgesia.
Narcotic analgesics are
sometimes more easily tolerated than NSAIDS, the Non-Steroidal
Anti-Inflammatory Drugs.
Neither FMS nor MPS is inflammatory. NSAIDS may disrupt stage 4 sleep.
Prolonged use of narcotics
may result in physiological changes of tolerance or physical dependence
(with- drawal), but these
are not the same as psychological dependence (addiction). Under-treatment
of
chronic pain of MPS/FMS
results in a worsening contraction which results in even more pain. "Anti-
anxiety" medications are
not an indication that your symptoms are "all in the head". These medications
don't stop the alpha-wave
intrusion into delta-level sleep, but they extend quantity of sleep, and
may ease
daytime symptom "flares".
Stay tuned to the Fibromyalgia
Network for news of more medications of possible use in FMS&MPS
Complex.
Guaifenisen:
Guaifenisen appears to reverse the process of FMS. It is in experimental
use. I have a whole
chapter in both books on it. A flawed study was done that seemed to show
it was no better than
placebo.
Please see the frame on Guaifenisen
Folic acid:
This vitamin is often in short supply in FMS & MPS. Drs. Travell and
Simons found it especially
effective for Restless Leg Syndrome.
Relafen (nambumetone):
this is a NSAID that is often well tolerated because it is absorbed in
the intestine, sparing the
stomach.
Benedryl (dyphenhydramine):
a helpful sleep aid/antihistamine which is safe in pregnancy. This should
be the first sleep
medication tried. some patients have reported urinary retention. The starting
dose is 50 mg 1 hr.
before bed. Increase as tolerated until symptoms are controlled or 300
mgs. About 20% of patients
react with excitation rather than sedation when taking Benadryl. (non-prescription)
Desyrel (Trazadone):
an antidepressant that helps with sleep problems. It must be taken with
food.
Atarax (hydroxyzine
HCl):
suppresses activity in some areas of Central Nervous System to produce
an anti-anxiety effect.
This antihistamine and anxiety-reliever may be useful when itching is a
problem.
Elavil (amitriptyline):
a tricyclic antidepressant (TCA) is cheap and sometimes useful. It generates
a deep stage four
sleep. Most patients will adapt to this med after a few weeks. It can cause
photosensitivity and
morning grogginess. It often causes weight gain, dry mouth, as well as
stopping the normal
movements of the intestine. It may cause Restless Leg Syndrome.
Wellbutrin (bupropion
HCl):
is a weak Specific Serotonin Reuptake Inhibitor (SSRI) and antidepressant
that is sometimes used
in FMS&MPS Complex in place of Elavil. It can promote seizures. It
seems to be less likely to
promote sexual dysfunction than the most SSRIs.
Ambien (zolpidem
tartate):
hypnotic -- sleeping pill, for short-term use for insomnia. There have
been reports of serious
depression, but some people with FMS find it allows them to experience
restorative sleep.
Soma (carisoprodol):
acts on Central Nervous System to relax muscles, not on the muscles themselves.
It works rapidly
and lasts from 4 to 6 hrs. It helps detach from pain, and modulates erratic
neurotransmitter traffic,
damping the sensory overload of FMS and muscular rigidity of MPS.
Flexeril (cyclobensaprine):
this medication can sometimes stop spasms, twitches and some tightness
of the muscle. It is
related chemically to Elavil. It generates stage four sleep, but it may
cause gastric upset and a
feeling of detachment from life.
Sinequan (doxepin):
heterotricyclic antidepressant and antihistamine. It can produce marked
sedation. This medication
may enhance Klonopin, but can reduce muscle twitching by itself.
Prozac (fluoxetine
hydrochloride):
anti-depressant that increases the availability of serotonin, useful for
those patients who sleep
excessively, have severe depression and overwhelming fatigue. Some people
have reported
profound depression from Prozac.
Ultram (tramadol):
non-narcotic, Central Nervous System medication for moderate to severe
pain, in a new class of
analgesics called CABAs -- Centrally Acting Binary Agents. Many people
said it brought more
alertness for longer times, and less "fibrofumble" of the fingers. It can
lower the seizure threshold.
Side-effects reported are grogginess, insomnia (may not be able to take
at night), headache or loss
of sex drive. Some people have reported profound depression resulting from
Ultram.
Hydrocodone/Guaifenisen
Syrup:
This medication is generally given as a cough suppressant. Each teaspoon
contains 5 mg.
Hydrocodone and 100 mg Guaifenisen. It has no aspirin or ibuprofen. It
may be effective for pain
medication, and can be "titrated" because it is in syrup form. The patient
can take very small
amounts and can find the amount which works without causing undue side
effects."
Xanax (alprazolam):
an anti-anxiety medication, that may be enhanced by ibuprofen. It must
not be used in pregnancy. It
enhances the formation of blood platelets, which store serotonin, and also
raises the seizure
threshold. When stopping this medication, you must taper it very gradually.
EMLA:
a prescription only topical cream, that may help cutaneous TrPs. It is
a mixture of topical
anesthetics.
Pamelor (nortriptyline):
this is used to help sleep. Some people find it stimulating, and must take
it in the morning. Others
use it before bed to help sleep. Some reports of depression with use.
Klonopin (clonazepam):
anti-anxiety medication and anticonvulsive/ antispasmodic. It is useful
in dealing with muscle
twitching, Restless Leg Syndrome and nighttime grinding of teeth.
BuSpar (buspirone
HCl):
may improve memory, reduce anxiety, helps regulate body temperature, and
is not as sedating as
many other anti-anxiety drugs. This medication often takes a few weeks
to take effect.
Zoloft (sertraline):
this is an SSRI and antidepressant, and is commonly used to help sleep.
It has less of an effect on
liver enzymes than other SSRIs.
Tagamet, Zantac,
Prilosec, Axid:
often used to counter esophageal reflux. Tagamet may increase stage 4 sleep,
and enhance Elavil.
Acid suppressors may interfere with B-12 absorption.
Paxil (paroxetine
HCl):
serotonin and norepinephrine reuptake inhibitor, and may reduce pain. It
should not be used with
other meds that also increase brain serotonin. Suggested dosage is 10 mgs
(half a scored tablet)
may cause insomnia or drowsiness.
Effexor (venlafaxine
HCl):
Fast acting antidepressant and serotonin and norepinephrine reuptake inhibitor.
Suggested trial
dosage is 25 mg, taken in the morning. Food has no affect on its absorption.
When discontinuing
this medication, taper off slowly. May raise blood pressure.
Inderal (propranolol
HCl):
sometimes helps in the prevention of migraine headaches, although blood
pressure may drop with
its use. Antacids will block its effect, and should not be used. May be
very useful in decreasing
"adrenalin rush".
Librax:
for Irritable Bowel Syndrome. It is a combination of antispasmodic plus
tranquilizer, that helps
modulate bowel action.
Diflucan (fluconazole):
this antifungal penetrates all of the body's tissues, even the central
nervous system. Very short
term use can be considered if cognitive problems and/or depression is present,
and yeast is
suspected. Yeast may also be at the root of irritable bowel, sleep dysfunction
(muramyl dipeptides
from bowel bacteria induce sleep), and other common FMS problems.
Imitrex (sumatriptan):
this is available as an injectable solution or pill that will not prevent
migraines, but it is effective for
migraine pain in many cases. Works on serotonin release instead of blood
vessel spasm, and may
provide relief in less than 20 minutes. It should not be used within 24
hours of ergot (a common
migraine drug) medications. It can increase blood pressure. It may cause
spasm of muscles in
jaw, neck, shoulders and arms. Also reported were tingling sensations,
rapid heartbeat and the
"shakes". Frequent use of Imitrex may cause a rebound reaction, worsening
migraines.
Remeron (mirtazapine)
tetracyclic antidepressant, which effects several neurotransmitters, including
serotonin and
norepinephrine. May cause drowsiness and/or weight gain. Reported increase
in cholesterol with
some patients.
Zanaflex (tizanidine)
is a relatively new medication for muscle tightness and pain. It also reduces
muscle spasm
frequency and myoclonus. Effective dosage varies considerably in patients.
May cause
drowsiness."
COX-2 inhibitors
These medications will be out shortly. They block cyclooxygenase-2, an
enzyme that helps create
enormous mounts of prostaglandins. they not only seem to be effective for
inflammation (FMS &
MPS are not inflammatory), but they may be a promising alternative to narcotics
for pain relief.
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