Fibromyalgia pain relief is a challenging subject that at all of us who suffer from this syndrome face. I, like many of you, have been to many doctors who are quick to treat my symptoms with pain medications, but did little to focus on how to make me well again. While this might offer some temporary relief to the pain experienced with Fibromyalgia, it’s really just a quick fix that isn’t effective in the long run. Additionally, pain medications carry with them many side effects that can be harmful and even make us sicker or more susceptible to disease.
Before I get into the different types of pain medications, I’d like to reinforce the importance of finding a physician who is willing to help you find what is causing your symptoms versus just masking them. Fibromyalgia is a complex syndrome caused by a multitude of things that occur to form the perfect storm so to speak. It makes sense and has proven to be the case with me, that it must be treated from a holistic standpoint in order to be effective.
Fibromyalgia Pain Relief – Drugs
Opioids are narcotic pain medications that require a prescription from a doctor. They are often prescribed for patients who experience chronic pain, including Fibromyalgia sufferers. In addition to having many side effects (that can include death), they are highly addictive. Opioids are most commonly marketed under such names as:
In 2015, the Clinical Journal of Pain published an interesting article regarding the long-term effects of opioids in patients with Fibromyalgia. The study noted that the patients who were using these drugs actually showed less improvement with their symptoms than patients who were taking other types of medications to include Tramadol (a non-narcotic pain medication). (1)
There has been some research that indicates that opioids might also be endocrine disruptors that may affect the hypothalamus and pituitary gland along with bone metabolism. Because both of these glands are “master hormone regulators,” the research also looked at opioid effects on HGH (human growth hormone), thyroid hormone, estrogen, testosterone, cortisol, and prolactin.(2). This is huge cause for concern since the endocrine system affects just about every process in our body. I’ll discuss the importance of hormone balance for patients with Fibromyalgia further in this article, but the early indications of this study are surely cause for alarm.
Over time, long-term opioid use may even heighten pain. People who suffer from Fibromyalgia already experience a physiological condition called hyperalgesia. This is a heightened sensation to pain and is a very real condition. It’s not something that’s “all in your head” and has been proven with the use of MRI scans which show that the pain centers in the brain “light up” much brighter when compared to someone who doesn’t have Fibromyalgia. Chronic use of opioids can actually lead to an even more increased sensitivity to pain. This condition is referred to as Opioid-Induced Hyperalgesia.
Opioid medications carry many side effects such as extreme constipation, intestinal cramping, dry mouth, dizziness, drowsiness, and nausea. They can also cause an overall general depressed mood. They also have interactions with many other medications such as:
- Other pain medications
- Muscle relaxers
- Sleep medications
- Anxiety medications
- Depression medications
- Other medications prescribed for other forms of mental illness
Alcohol and opioids absolutely do not mix and can have deadly consequences. It’s also possible that opioid medications pose an additional risk of overdose/death for those who have Fibromyalgia because of the “Fibro Fog” that we are all too familiar with. When we are not able to think clearly and concentrate or we have short-term memory issues, it’s plausible to forget when or how much medication we’ve already taken.
Opioid addiction and overdose has become a national health crisis. In the 1990s, drug companies increased their marketing efforts for opioid pain medications and advised the medical community that they would not cause addiction! This led to physicians prescribing them for pain at much greater rates than in prior years.
We are now realizing such a crisis that the federal government has gotten involved and is increasing public outreach and awareness and offering programs for addicted consumers. The statistics are sobering. (3).
Acetaminophen (most commonly sold as Tylenol) is frequently taken as a method of fibromyalgia pain relief. It is one of the ingredients in both Vicodin and Percocet, both of which are prescription narcotics. As an analgesic, it does not have anti-inflammatory properties and instead affects pain levels through the central nervous system. It also interacts well with a lot of other medications and is generally well tolerated when taken on a short-term basis.
The side -effects of acetaminophen however can be quite serious. According to the American Liver Foundation, acetaminophen overdose is the number one cause of acute liver failure. In fact, in 2009, the Food and Drug Administration considered banning its use in combination narcotics. After further review, they decided instead to reduce the amount of acetaminophen in these combo drugs.
Chronic acetaminophen use has been shown to cause both serious liver damage and serious kidney damage. It should not be mixed with alcohol since alcohol has also been shown to contribute to kidney and liver damage. One study noted that combining the recommended dosage of acetaminophen with a small to moderate amount of alcohol increases the risk for kidney disease by 123%. (4).
If you take acetaminophen for Fibromyalgia pain relief, also realize that it is an ingredient in many other products such as cold and allergy medications, sleeping medications, etc. For your reference, here is a link for ALL brand names of drugs that contain acetaminophen: https://medlineplus.gov/druginfo/meds/a681004.html.
NSAIDS (Non-Steroidal Anti-Inflammatory Drugs)
NSAIDS are by far the most common types of pain relievers used by people in the United States. They can relieve pain, reduce inflammation, and reduce fever and are the preferred drug for treating arthritis. The most common brand names are Advil, Motrin, Aleve, and Naproxen. Some are available by prescription only including Celebrex and Naprosyn. Plain old aspirin falls into the NSAID category as well which are sold as the brands Bayer, Bufferin, and Excedrin.
Thousands of people also use NSAIDS for Fibromyalgia pain relief. Short-term use of NSAID use can cause an upset stomach and can even erode the digestive and stomach lining leading to ulcers. They thin the blood which can cause easy bruising. Additionally, NSAIDS can affect kidney function because they also increase blood pressure which can reduce blood flow to the kidneys causing them to have to work harder and for fluid to build up. Another serious side effect of NSAIDS is that they can lead to heart attack, heart failure, and stroke. What’s particularly scary about this is that the increased risk can begin after just a couple of weeks of use.
Vioxx was a prescription NSAID that was approved by the FDA in 1999, however it was removed in 2004. The reason for this was because a study was completed that showed that up to 140,000 heart attacks were caused by this drug during the five years that it was on the market. 27% of those were fatal. (5).
There have been numerous credible studies completed over the years reviewing the link between NSAID use and sudden heart attack, heart failure, and stroke. In 2015, the FDA increased their warning about these risks and indicated that this risk is increased with patients both with and without a history of cardiovascular disease. (6)
NSAIDS should never be taken by those who are on blood-thinning or anti-coagulant drugs since serious consequences can occur.
Anticonvulsant Medications for Fibromyalgia Pain Relief
Lyrica (Pregabalin) and Neurontin (Gabapentin) are drugs used to treat seizures, however both have been prescribed to treat Fibromyalgia pain as well. Neurontin is not FDA approved specifically for treating fibro, so when prescribed, it is considered “off label.” Lyrica was actually the first drug that was FDA approved to treat Fibromyalgia in 2007. Studies have been conducted on the effectiveness of both drugs for fibromyalgia pain relief and results have been consistently mixed. Some get significant relief, while others get none. Lyrica might not provide any help for some people, yet Neurontin does, and vice versa.
Common side effects of these drugs are similar and include weight gain, swelling, constipation, headache, insomnia, dizziness, and nausea.
Moderate to severe effects can include difficulty breathing, vision problems, chest pain, memory loss, muscle pain, mood changes, tremors, increased anxiety, and thoughts of suicide.
What I have found is that Lyrica is the most often prescribed drug for fibro pain, however, I also believe that even the “common” side effects make it not worth it. If I’m already feeling bad, these common side effects only make me feel worse. I also find it to be counterintuitive to take a medication whose side effects are going to include muscle pain and memory loss (among others) when I’m already experiencing those things from my Fibromyalgia. Additionally, long-term safety of these drugs has not yet been established for treatment of fibro.
SNRIs (Serotonin Norepinephrine Reuptake Inhibitors)
Cymbalta and Savella are both anti-depressants which have been prescribed to provide fibromyalgia pain relief. The idea is that both serotonin and norepinephrine are chemicals in the brain which affect the neurotransmitters. For Fibromyalgia sufferers, it is believed that these two are not regulated properly which is the reason that pain is amplified.
Neither of these drugs are indicated to increase serotonin or norepinephrine but are supposed to make what we have last longer. Pain relief results are mixed with only about 40% of sufferers noticing any difference at all.
Once again though, the side effects can be pretty scary and far outweigh any pain-relieving properties these drugs may or may not have. They both include warnings for the following:
- Blood pressure changes
- Out of control actions, increased excitement levels
- Dizziness and loss of balance
- Tachycardia (fast/irregular heart rate)
- Loss of contact with reality
- Suicidal thoughts
- Increased or new agitation or anger
- Anxiety and panic attacks
- Severe insomnia
- Hot flashes
I am not going to tell you that it’s unsafe to ever take a pain-relieving medication. There are times when it’s completely appropriate and not likely to harm you. Pain is one of the main symptoms of Fibromyalgia, after all, and managing it is key to a better quality of life.
What I would like to stress instead is that while some pain medications may be safe in the short-term, they are not the answer or the cure to the chronic pain that we all have endured with Fibromyalgia. In almost all of these scenarios with different drugs, the side effects and adverse impact on our health are not only unsafe but can worsen our conditions.
Fibromyalgia Pain Relief Without Pain Medications
At this point, you might think that I’m crazy to advocate this idea, or that I’m one of those women who proudly walk around chewing on nails while saying that I can handle the pain. The reality is that I’m neither of those. I’ve been living with Fibromyalgia for a long time and have sought treatment and help from providers all over the United States.
While I’m not a physician, I have enough experience as a patient to share with you the pitfalls I have encountered and to let you know what has and has not worked for me. In my quest to reclaim my life from this illness, I have done a lot of research and have used myself as the test subject!
I would again like to reiterate that finding a physician who is able to treat the underlying causes of Fibromyalgia is key. A doctor who only throws pain relieving drugs and/or antidepressants at you is not doing you any favors in the long run and will certainly not be able to get you into remission.
With that said, there are other things that we can do to help ourselves. I’m living proof that by doing these things, a quality of life can be realized again!
The Link Between Fibromyalgia and Hormones
Statistically, Fibromyalgia is going to affect 7 women to every 1 man. Most people are diagnosed between the age of 40 and 55. However, this just means just that – the majority. I know plenty of younger folks who have been diagnosed as well.
The Thyroid Gland
The medical community that is well educated about Fibromyalgia agree that one of the commonalities experienced by those afflicted is a dysfunction in the hypothalamus gland. This is the part of the brain that controls things like sleep regulation, temperature, the autonomic nervous system, and the endocrine system which includes hormones. The pituitary gland, called the “master gland,” is attached to the hypothalamus and directly affects the adrenals, thyroid, and sex hormones.
Our entire endocrine system is intertwined and plays a role in the delicate dance of hormone balance. For example, the hypothalamus works to keep the thyroid balanced, but not in and of itself. The thyroid can also become imbalanced because of other causes, and when this happens, it in turn affects the hypothalamus. An under-functioning thyroid gland can not only contribute to Fibromyalgia symptoms, but it can also increase risk in developing it. If the thyroid problem is not treated, it will result in increased severity of Fibromyalgia symptoms.
In a normal functioning thyroid, T4 hormone is secreted into the bloodstream. Our bodies should then convert the T4 into T3 hormone where it is used for energy. Some people do not produce enough T4 hormone; others do, but their bodies become unable to convert the T4 into T3 so the cells aren’t able to function properly or with enough energy. This causes damage to the mitochondria, which are the energy “engines” of our cells.
When this occurs, not only does a person suffer the symptoms of a low functioning thyroid, but the risk of developing Fibromyalgia increases and for those who already have it, symptoms are exacerbated.
Additionally, when the mitochondria don’t get enough energy, our entire immune system and endocrine systems can suffer making us extremely vulnerable to infections, toxins, and hormonal deficiencies. The metabolism slows down. Joints hurt and muscles ache. Chronic fatigue sets in. It even becomes difficult to think straight.
You’re probably thinking that I’m describing some of your exact Fibromyalgia symptoms even though I’m discussing low thyroid. However, these two conditions are so closely related, that I’m actually talking about both.
I want to both caution and educate you on the perils you may encounter when you ask your doctor to test your thyroid gland. It should be a simple and easy process, but many times it’s not and you have to advocate for yourself (sometimes loudly)!
The mass majority of physicians in this country will only test your TSH (thyroid stimulating hormone) and possibly T4 levels. Additionally, they will then look to see if your results fall into a “normal” range. If they do, then they will tell you that there’s nothing wrong with you. If you don’t, then they’re almost always going to prescribe Synthroid or Levothyroxine which are both T4 hormone. This will only potentially help you if you have a T4 deficiency. If you fall into the “normal” range, even though you are symptomatic, you will likely be told that your symptoms are not related to a thyroid problem. Low thyroid symptoms also include things like generalized fatigue, weight gain or the inability to lose weight, dry skin, hair loss or thinning hair, joint and muscle aches, and more. Untreated, thyroid disease can contribute to high cholesterol, high blood pressure, and dysfunctional blood sugar regulation, all of which can lead to more serious diseases.
Instead, when you have your thyroid tested, you will want to have a “complete thyroid panel” of tests run to include TSH, T4, T3, Reverse T3, and Antibodies. If you are one of those people who can’t convert T4 into T3 hormone, this problem will only show up on the comprehensive thyroid panel. Additionally, if you have an auto-immune problem (Hashimoto’s Disease) where your body is basically attacking your thyroid gland, this will also only show up on the complete panel.
Even though it is 2019, many physicians are not up to date on the proper diagnosis, interpretation of results, and treatment of thyroid disease. We suffer because of this, especially when we are not aware that we aren’t even being cared for properly.
Finding Fibromyalgia Pain Relief through Hormone Balancing
Other hormones besides the thyroid also contribute to Fibromyalgia symptoms and other issues when they are not balanced properly.
With peri and postmenopausal women being the “majority” diagnosed with Fibromyalgia, it makes sense that their hormones are going to be all over the place. But, many other things can affect hormonal balance from stress to diet to disease, and even just something as simple as a menstrual cycle. Having a regular menstrual cycle does not mean that you need to be treated for hormone imbalance. I’m interjecting this to show how the fluctuations in hormones through a 28-day cycle can increase pain levels of Fibromyalgia.
A small study was done in 2017 on a possible relationship between the hormonal changes that naturally occur in pre-menopausal women. Results indicated that the sex hormones progesterone and testosterone both had “protective” qualities against the pain of fibromyalgia. (7).
There was also a large study completed by Oxford University regarding HRT (hormone replacement therapy) use and its effects on osteoarthritis. I’m mentioning it because many fibro patients also have arthritis and because joints are also affected by fibromyalgia. The study was several years long and included over 8,000 people.
The subjects they reviewed had undergone either one hip or one knee replacement surgery. It compared those that were on HRT to those that were not and results indicated that the women on HRT had a 40% reduction rate for the need for a second surgery compared to the women who did not use HRT. These are some pretty amazing results about the benefits of replacing hormones and their positive effect on pain levels! (8).
It has been established that the sex hormones affect activity of receptors of pain. Additionally, lower levels of sex hormones coincide with the propensity of musculoskeletal pain.
One of the roles of estrogen is that it is partly responsible for controlling serotonin levels. (Remember that two of the prescribed pain-relieving medications are also involved in keeping serotonin levels stable). Serotonin is mainly produced in the gut however estrogen helps to regulate it. Serotonin affects our sensitivity to pain.
Estrogen also helps to keep synovial fluid (the fluid located in our joint capsules to keep them lubricated) in the joints from drying up which helps to prevent arthritis and keep bone and joint pain from occurring. (Estrogen replacement has long been prescribed to women to prevent osteoporosis).
Progesterone has many benefits that help fibromyalgia patients. It has a “neuroprotective” role which helps to guard against pain severity. It also acts as a natural anti-inflammatory. Progesterone is known as the calming hormone, both for the body and the mind. It also helps greatly with SLEEP. Many women (not just those with fibro) develop sleep problems beginning in their perimenopausal years because this is when progesterone levels really begin to wane. Replenishing progesterone levels goes a long way in helping with both quality and quantity of good sleep.
Testosterone is not just a male hormone; women have it too though in much smaller qualities. As we age, testosterone levels gradually drop and by the time we’re 50, we’re only able to produce a small fraction of what we were producing in our 20s. This is applicable to both sexes. Testosterone is what helps us keep muscle mass and helps prevent our skin from becoming saggy.
Adequate amounts of testosterone also increase collagen production with significantly affects joint health and cartilage. This is the reason why it is so beneficial for fibromyalgia pain relief and has such a protective role against the severity of symptoms.
Cortisol is the hormone produced by our adrenal glands. One of its functions is the fight/flight response along with adrenaline production. When we are chronically stressed, either physically (such as with fibromyalgia), or emotionally/mentally, our adrenal glands produce too much cortisol. As time goes on, they become over-taxed.
This makes us less resilient and unable to cope as well as we should with stresses of all kinds. Our minds and bodies feel fatigued.
The adrenal glands also produce small amounts of both estrogen and testosterone, though they aren’t the main supplier of these hormones. (In women, the ovaries produce most of the sex hormones, and in men, it’s the testes).
When we experience adrenal fatigue, the estrogen and testosterone stores become non-existent and these hormones are further depleted in our bodies. The small study that I referenced earlier about the pre-menopausal women experiencing different levels of pain throughout their cycles also mentioned that higher levels of cortisol combined with lower levels of progesterone caused pain levels to be significantly amplified.
Bioidentical Hormones versus Synthetic
When you have your hormones tested, please be sure and do so by a provider who is experienced in and prescribes bioidentical hormones.
Synthetic hormones carry many serious health risks and can also cause immediate side effects which do nothing to help the patient with fibromyalgia.
Bioidenticals are molecularly identical to the hormones that are produced by the human body. Because of this, your body readily accepts their benefits and you will feel better usually within just a few weeks. Additionally, bioidentical hormone replacement therapy also promotes and protects long-term health.
Alternative Therapies for Fibromyalgia Pain Relief
Low Dose Naltrexone
Low Dose Naltrexone (LDN) is a drug that has been around for a long time. It is classified as an opioid antagonist, meaning that it is used to treat patients with opioid addiction. It’s also been used to treat patients with chronic pain and studies are showing it to be successful, especially with Fibromyalgia. In low doses, it’s also being used to treat Crohn’s Disease and MS.
Scientists have discovered that when used at the dosage amounts to help people with opioid addiction, this drug has no effect on chronic pain. Instead, they’ve discovered that it does help patients with pain issues at very low dosages. They refer to this as the “paradoxical hyperalgesic effect.” The dosage given to chronic pain sufferers is actually about 1/10th of what is prescribed for opioid addiction.
LDN requires a prescription from your physician and the medication needs to be compounded specifically for you. Dosage for chronic pain is anywhere between 3 and 4.5 mg. A study completed in 2009, though small, did show that 6 out of 10 women felt significantly better than women who were taking a placebo. It seems to help some people significantly and others not at all.
A second study was later completed and almost 60% of women with fibromyalgia symptoms were “significantly improved” after taking the LDN. (9).
Cannabidiol (CBD) Oil/Medical Marijuana
CBD oil has been used in eastern medicine for ages for many uses, including pain relief. It is increasing in popularity as many states have passed legislation to legalize it. Not all CBD oil contains THC (tetrahydrocannabinol) which is the substance that makes you feel high. I live in Texas and here, CBD oil is only legal without THC. Medical marijuana is not legal here at this time.
CBD oil is touted by many of its users as being the cure-all for chronic pain from migraines, arthritis, fibromyalgia, and cancer to name a few. I don’t make ANY of these claims. But for me, it does help bring pain levels down and I have been able to replace most of my ibuprofen doses with CBD oil instead. It has only been FDA approved as a treatment for some seizure disorders.
Some small studies that are out indicate that CBD oil may be more effective when it contains THC. However, this is not workable for everybody since it is not legalized in every state and some people have adverse effects from THC, such as anxiety, increases in appetite, mood changes, dry mouth, and mental confusion.
CBD oil can be ingested and can also be applied topically. Medical marijuana can be ingested orally as well by using it in foods and can also be smoked and/or vaped. For those people who have compromised immune systems such as cancer patients, it’s very important to note that medical marijuana may contain a fungus called Aspergillus which could be harmful.
CBD oil and medical marijuana is currently not regulated and therefore is usually not tested for quality although you can find brands that are. As with any supplement or medication, quality obviously makes a big difference on how effective the product is.
You should always inform your doctor before beginning treatment of both CBD oil and medical marijuana. There have been some noted drug interactions with Chlorzoxazone, Theophylline, Clozapine, and Progesterone. Additionally, anything containing THC should not be mixed with benzodiazepines, phenobarbital, fentanyl, or morphine since it could heighten the intensity of these narcotics.
IMPORTANT SAFETY NOTE: DO NOT EVER USE ANY TYPE OF SYNTHETIC THC-CONTAINING PRODUCT. Synthetic THC is not the same product as the THC that is grown in plant form and can have serious side effects, including sudden death. When you think of synthetic THC, picture someone making it in their garage. It’s that bad.
To read more about some of the studies that have been completed along with additional facts, click HERE (10) to read an interesting article from Medical News Today.
Supplements for Fibromyalgia Pain Relief
Many supplements can help ease the pain associated with Fibromyalgia. They include:
- Omega 3 Fatty Acids
- Devil’s Claw
- Cat’s Claw
- White Willow Bark
I’ve tried these myself and found success in helping to treat my pain and have provided some research for you. For more detailed information on these supplements such as how they impact pain and some of the research that has been done, please click HERE (11).
Arnica is an herb that is grown in some parts of America, Siberia, and Europe. Its flowers are used in medicine. It’s extremely versatile and available in the following types of products:
- Tablets and capsules
- Creams and gels to be applied topically
Wikipedia lists hundreds of reviews from consumers which are quite favorable for its use. You can read those HERE: (12).
For Fibromyalgia pain relief, I recommend taking it in tablet or capsule form and applying topically to areas of swelling and/or pain. When applied topically, it works similarly to products such as Ben Gay or Icy Hot (however, I think it works better than those) but without the chemicals and strong odor. It’s easy to find in health food stores or chain stores such as Whole Foods and can also be purchased on Amazon. Here is a link for various forms or organic arnica if you’d like to order some from Amazon: (13).
Regaining Your Life from Fibromyalgia – The Big Picture
I hope that I’ve been able to help guide you through some of the hurdles of overcoming Fibromyalgia. My own struggle with it has been long and arduous, however I was finally able to regain my quality of life with the help of a doctor who specialized in treating Fibromyalgia at its root cause, along with making some lifestyle changes.
I went through the pain medications phase and found that didn’t work for me. The side effects were too dangerous and made me sicker than I already was. I saw doctor after doctor, and even went to the Mayo Clinic (which is where I was officially diagnosed). Conventional medicine didn’t cut it for me. I was fortunate to find a doctor who used a functional medicine approach and specialized in Fibromyalgia and CFS treatment.
As I’ve said before, Fibromyalgia is a complex syndrome and requires a multi-faceted treatment approach to include things that treat the body, mind, and soul such as:
- Treatment for the root cause versus the symptoms
- Treatment and lifestyle changes to include rest, recovery, and rebuilding the immune system
- Regaining the ability to SLEEP
- Healthy diet changes
- A regular exercise-program
- Hormone balancing
- Taking quality supplements
- Guided meditation
I do relapse from time to time and experience flares. When this happens, I’ve learned to listen to my body and step away from my day to day responsibilities to the best of my ability and rest and take care of myself.
I enjoy my life these days and am quite active with a thriving business and an active social life. My husband and I are able to spend time together and with our family and lead a normal life. I hope that by sharing my pitfalls along with what has worked well for me helps you on your road to recovery.