I was diagnosed with fibromyalgia a few weeks ago. Back in March when all this started my dr who is a general practitioner put me on Zoloft for being foggy headed, forgetful, and depressed by the pain and feeling useless at 34 years old. Three weeks ago he started me on flexeril 10mg at night to help me sleep cause the pain was so bad. After three weeks flexeril hasn't made me tired or helped my sleep. Today I went to see him and he now wants me to stop flexeril. Now he wants me to start transitioning from Zoloft to cymbalta and switch flexeril for trazadone. He also gave me norco to use until cymbalta kicks in which I will be careful with because of the addiction potential. My question is should I trust my general practitioner dr or go see a Rheumatologist for a second opinion? I like how Zoloft makes me feel in regards to the brain fog, memory, and mood most days. I have read horror stories about switching antidepressants and how hard it is to find one. My dr gave me a referral to a Rheumatologist after I asked who he would see if he had this disease. The latest study I read said cymbalta helps 21% of fibromyalgia patients and causes severe side effects in 22% of people. I'm not sure if possible benefit out weighs the possibility for harm. My dr even said it's a strong drug and takes awhile to get use to and can cause stomach problems. From what I've been reading there might be better options like gabapentin or tramadol regular or extended release. With one of those I might be able to someday get off the Zoloft since they both can help with fibro fog. Sorry if I rambled lol. I would appreciate any input from others here on what to do? From my understanding tramadol gabapentin are basically guaranteed more or less to work where cymbalta is very iffy. Feel free to correct me if that's wrong. If you think I should listen to the current recommendation to switch and see how it goes also let me know also. Thank you all for having a site like this to help.
Do what works for u! Its your body and life.
Hello
I see a rhuemy for lupus she doesnt treat fibro except to diagnose it. My primary doctor does my meds for it cymbalta did help me but I could not afford to take it after I was taken out of work. It can take a while to find the right combanation of drugs and therapy to work i can not take flexril because of mood changes. I no you will get tired of hearing eat right exercie and take your meds but i did this for many years and it worked really well. Several people have good results with massage, yoga, warm baths. Find something you like to do to help relive stress. I look forward to getting to no you
Hi Tony and welcome, My GP treats my fibro, although I have seen a Rheumy several times over the years. I can't comment on the Cymbalta because I haven't taken it. Also, Flexeril didn't help me at all or make me sleepy and I had a bad reaction to Trazadone so I can't take that. I do take a low dose of Gabapentin and it helps with brain fog for sure and fatigue feeling as long as I get some sleep. But it doesn't help the overall pain level for me. Every med combo works differently for everyone. And I will second with Purple Butterfly said, I know it is hard, but the more you can exercise gently and eat the better you usually feel. My physical therapist said it is about re-wiring the pain signals in your brain - one of these days I am going to get around to researching that aspect as I had someone else mention that to me this week. Hang in there and feel free to ask all the questions you want. This is a great group of people.
I was dx'd in April and put on Cymbalta, which didn't do anything for me but I had no side effects with. What I did not realize at the time is that you need to wean off really, really slowly or you will have withdrawal symptoms. I can't comment on Zoloft, since it did nothing for me either. The sleeping problem was solved by accident. I am on Klonopin for anxiety (taken as needed and 1 before bed) and on Flexeril (3 times per day), I forgot one dose and had both of them at bedtime and slept the best sleep I had in years.
I talked with my Doc and she said that's fine, as long as it works. I now take the Flexril only at bedtime.
I am now on Gabapentin, slowly worked up to 3200mg per day, no side effects. It lessened my muscle pain and twitches, unfortunately my joint pain is still alive and kicking. Every so often I have a foggy day, oh well, between the depression, anxiety and foggy head, I like the foggy head best. hehehe Not trying to make fun of it. Unfortunately no one will be able to tell what will work for you and what wont. Sadly, we all are Guinea Pigs to our own diseases. If the Zoloft works for you, go back on it.
As for Tramadol (Ultram), no help for me.
Be careful about seeing a Rheumy, make sure you call around to find one who specializes in Fibro.
Hope you can get relief soon, Farida
Tony,
Welcome. I've had Fibro since 1991 and have tried just about everything various rheumatologists were trying at the time. Everyone with FM is different in how they respond to medications but there are a few things I'd like to point out. I cannot imagine being diagnosed or beginning treatment for FM with any doctor other than a rheumatologist. If you needed surgery for a detatched retina, you would go to a doctor that specializes is eye surgery, not trust your GP. The same is true for FM. Rheumatologist deal with FM day in and day out, these days more than ever. I highly recommend you go and get a second opinion from a rheumy on the course of treatment your GP is suggesting.
I had terrible side affects with cymbalta. These days, my FM is mostly in check. I take flexeril twice a day as well as Lyrica at night. Frankly, FM is so far down the list of physical issues that I thank my rheumy every appointment I have. He has been managing my FM for more than a decade and has made it a fairly insignificant part of my life, a place I once thought I would never be.
I wish you the best of luck along with the following standard recommendations I give everyone with FM - move! Despite the fact that there are days where movement seems as likely as running faster than Usain Bolt, you must get up and move anyways. The example I like to give is to think of your body as a sponge. Before you move, the sponge is dry. Have you ever tried to bend a dry sponge? Moving wets the sponge. Learn all you can about FM because it removes the mystery and you'll know how to better deal with it. Stay away from narcotics for the treatment of FM a it is not the answer to a long-term, chronic illness.
Best of luck to you.
For me, gabapentin causes brain fog. I have a good friend who has been on it for around 15 years. She told me that eventually, I will “level out” on it and the meds will no longer cause the brain fog. I’ve been on it around 2 ½ years.
I discovered that breathing is a wonderful thing for the brain fog and also for the pain when I’m doing labor intensive (i.e. cleaning the house or on a long walk) activities. I found myself holding my breath at work about 5 years ago. (I have an overly analytical mind—drives hubby up the wall LOLOL) So, I analyzed this and found that when I had to do things that required my arms to be lifted (a major trigger for my fibro) I’d hold my breath. And then I remembered that when I’d do things such as stubbing my toe, for a brief moment, I involuntarily held my breath. Apparently, this is part of the body’s mechanism for dealing with pain. I surmised that decades of holding my breath (most of the time unknowingly), had contributed to problems with brain fog. I could be wrong. But on days when I can remember to breathe through activities, both the brain fog and the pain are better.
As for the Zoloft, I can’t take any anti-depressants. They cause major problems with my mood/personality/paranoia. (And btw, just because you’re paranoid doesn’t mean they’re NOT out to get you! ;) LOLOL When I do a scan on my cell phone for WiFi connections, for a brief moment, one named “FBI Surveillance 2” shows up on the list and then disappears! Weird!) Not to mention the weight gain. Which, by the way, gabapentin has caused for me and can cause in others. My doc has me on Xanax for several reasons. 1) For the muscle relaxation properties—it does do this, although I’d prefer actual muscle relaxers given everything I have wrong with me. 2) To help me not have stress. Stress is a major trigger for my fibro. 3) To help me sleep—and it does do that.
I would definitely get a second opinion and see someone who specializes in this, if possible. I, myself, see an Internist. Partly because I have other things wrong with me and partly because I could get into see her sooner than I could a Rheumatologist after I moved. I wish you luck getting the meds balanced and working for you!
Hi Tony. I am new here as well but I have had Fibro for 7 years. I live in a smaller town and all 3 of the rhuemies here have no experience treating Fibro. But I have had great luck with my neurologist. He has a much better handle on Fibro. Luckily my internists is great too. Unlike most Fibro suffers Fibro is my primary problem so it makes it a bit easier to determine which meds do what for me. I developed Fibro after treatment for a severe intestinal infection.
It is really important to know what each type of medication does. gabapentin is actually an anti seizure med while tramadol is a pain medication. Trazodone is an anti-depressant. Flexeril is a muscle relaxant that has very mild and mostly ineffective anti-depressant.
Here is some info that may be helpful.
Flexeril Cyclobenzaprine may be helpful for sleep and pain control in fibromyalgia.
The usual starting dose is 5-10 mg taken at bedtime. The dose may be increased to 20-30 mg, taken either at night or in divided doses during the day. Compared with amitriptyline, cyclobenzaprine is associated with better patient acceptance due to fewer side effects and more rapid onset of relief.
Cyclobenzaprine has been studied in the treatment of fibromyalgia. In a study of 120 fibromyalgia patients, those receiving Cyclobenzaprine (10 to 40 mg) over a 12 week period had significantly improved quality of sleep and pain score. Interestingly, there was also a reduction in the total number of tender points and muscle tightness.
A meta-analysis of cyclobenzaprine showed that it was superior to placebo for treating fibromyalgia but that it was not as effective as antidepressants.
I had no luck with trazadone, gabapentin,or lyrica but Cymbalta works well for me. Starting the drug was difficult, I had 3 weeks of side effects but after that the side effects went away and my pain was much improved.
Like all the other members said, everyone is different and you will need to find the combo that works best for you. I have found that being dehydrated increases my pain significantly as does stress.
I wish you good luck in your journey and a support forum like this is one of the best things you can do for yourself.
Please let me know if there is anything I can help you with.
Traci
Thank all of you so much for taking time out of your day to help a stranger. This website is great! I don’t know what I would do without it. I’m going to wait until tomorrow and call the rheumatologist and try to make appointment . If he is busy and I can’t get in for a few weeks I think I will start the cymbalta so I can get another med trial out of the way to start finding what works for me.
If I reach the point where I can’t take this pain any longer I’ll start cymbalta regardless.
Tony, just make sure to ask if they specialize in Fibro. I called several offices in my area and none of them did. So, I guess being a rheumy does not automatically make them knowledgeable about fibro but they probably have further educated themselves about it.
Best of luck, Farida
I called the dr that was recommended by my p doc and I can't get in to see him till October 14th! He does treat fibro so that's good news but that's a long wait! I'm going to call back tomorrow and try to talk to his nurse and explain my situation and hope he can try to squeeze me in earlier. If not ill try looking online and calling some offices Friday in hopes to get in. Is this usual? To get into a rhem? Or is it cause I'm a new patient?
It is common for there to be a wait with any doctor if you are a new patient as new patient appoiontments take longer. I would schedule the appointment with the nurse for the 14th and ask to be put on the list to be called should anyone cancel their appointment. That often works really well for me.
I know a month sounds like forever but I would suggest that the treatment of FM is a marathon, not a sprint. I hope you get to see the doctor sooner. In the meantime, here is the best medicine I can offer:
- Educate Yourself - The More you Know, the less of a mystery is FM
- Exercise - movement is ESSENTIAL. Remember the sponge analogy?
- Make sure you are seeing the correct doctor (usually a rheumatologist for FM)
- Connect with others that have FM. Affirmation is essential and communication with others who have what you have is better than whatever pill is the new FM wonder drug.
- Learn the parameters of pain. Once you know FM is not progressive you will accept your limitations and strive to over achieve.
- Try not to limit yourself with your activities. People with FM can do anything if they understnd the obstacles FM presents and how to ivercome them.
- In a pinch, laughter is the best medicine. Don't laugh (or do)! I am being serious here. In the beginning, FM is very myserious and it is easy to be anxious or depressed. But in so many cases laughter is good for the body, brain and soul.
I wish you the very best of luck, Tony.
Called around and got appointment tomorrow morning at a different doctor that’s not reviewed as good as the other one. This ones says she treats fibro and few reviews says she is great. Others say she reruns same tests that my doctor just ran to make more money. If she does that I’ll know she is phony. I kept appointment with the original doctor that’s a month away just in case I don’t gel with this one. Month away appointment dr has 30 years in rheumatology and the one I’m seeing tomorrow has 12. As long as the one tomorrow seems somewhat compassionate and knowledgable I’ll go back.
Make sure that you bring all of your test results to the upcoming appointment. It is good for the doctor to have them even if she decides to redraw them. She can use them for comparison. Some labs fluctuate frequently, so having them redrawn after a month or even a few weeks is not bad practice. Patients often complain that doctors are just doing this for money, but it's generally not the case. If the doctor doesn't have their own lab, and the bloods aren't drawn there, the doc isn't making a cent off of it.
As you have seen, there are so many drugs and combinations that no one can tell you what will work for you. You want to be on something that helps control the symptoms of fibro and provides really good relief. I got lucky, and picked a winner with my first draw from the medication lottery: Lyrica. Even luckier, I felt relief the first day that I took it. It was AMAZING! I am wishing you the same kind of luck. I do faintly recall some initial side effects, but they only last a week or two, and I was so happy that the pain was gone that I can't even remember what they were! All of these meds have potential side effects, but, to me, they are no where near as bad as living with the uncontrolled, unremitting pain that I experienced before. With supervision, each drug (including your Zoloft) can be safely tapered so that you can try something different. If you can, you might want to stay on the Zoloft until you see the new doc and get your second opinion. The bottom line is that you can, with correct treatment, have your life back. We should fear what our lives would be like with untreated fibromyalgia, not the drugs.
All of the advice that has been given so far has been great: get moving, see a rheum, get on a good med plan. Until you are able to see the new doc, you can try warm Epsom salts baths, daily, for pain, gentle stretching each morning, walking, and good nutrition. You may also want to prepare for your appointment. Get your visit notes and labs from your GP, make a list of your typical symptoms, and any limitations they may cause, and make a list of your questions for the new doctor.
Best of luck to you!
This is for those who wanted clarification of my previous post. Opiates should never be used as first line treatment for fibromyalgia. I’m not just saying this because I have something against opiate use for acute or chronic pain, because I absolutely do not. Because of the nature of fibromyalgia, it has been proven clinically, that opiates do not have the same effect on fibro that medications which address the root problems that cause the pain that we experience. Simply put, all pain is not the same and thus, all pain can’t be resolved using the same treatments. Below, are a couple of studies, from reputable sources, that support this:
http://www.medscape.com/viewarticle/780357
http://chronicfatigue.about.com/od/treatingfmscfs/a/Opiates-For-Fib…
There is also some research that indicates that use of opiates for long term fibro pain control can actually make the pain worse over time. It’s late, and l am not thinking at my best.
There are fibromyalgia sufferers take Ultram/ tramadol, but not as their first line treatment. It is preferred, by the medical community, to help patients find pain relief through SSRIs, SNRIs, tricyclics, etc., PT, yoga, exercise, etc. (addressing the cause of pain) before moving to tramadol. At this time, tramadol is not used as a first line treatment for fibromyalgia, but there is some promising research regarding use of tramadol to control pain in fibromyalgia sufferers. There is a lot of controversy over using opiates to treat fibromyalgia, but tramadol is not exactly an opiate (it’s an opiate agonist, and is a synthetic opioid) and it acts more selectively than your natural opiates do. Therefore, some can have success with controlling their pain with it. It doesn’t have as much risk for addiction or dependence as opiates do, but there is still SOME risk. As one might guess, a healthy respect for it is warranted.
For a newly diagnosed patient, such as the OP in this discussion to be put on Norco (acetaminophen & hydrocodone) for pain doesn’t make sense when there are several better, safer medications that has been shown, in several studies, to be more effective than opiates. With most conditions, we want to fix the actual problem, get to the root that is causing the troubles and treat it. When those options haven’t been adequately explored, and a patient is given pain medications instead, we have, essentially, put a bandaid on a tumor. It just doesn’t work.
Anytime someone says something negative about opiates, people tend to take offense, whether it was intended or not. Let’s face it…it’s a touchy subject. There’s so much negative press about the drugs, risks, consequences, and more that we are concerned that others might think negative things or make assumptions about us personally. I’m sure that I’m not the only one who has had a bad experience with a healthcare professional when reviewing a med list or talking about our medical history. Remember that I have FMS too. Part of me strongly believes that people deserve better treatment than just throwing pain pills at it. Another knows that, for chronic conditions, we should try everything else before using pain pills as a long term solution because we have other options. And, I am well aware that there are outliers who will never be well managed with standard treatments. I hope I clarified things and answered questions instead of causing more confusion, but if you want to ask me to explain anything further, please ask.
I agree with opiates not working for Fibro pain, I used Oxy once in a while when my back pain is excruciating, I had Vicodin before but that made me sick. When my Fibro pain got too intense, I tried a Vicodin or Oxy and neither did anything for the pain at all though it killed my back pain.
My thought in this is that the Fibro pain is not regular pain and that is why it does not respond to pain killers. I'm not a big fan if opiates, but they are a good thing if taken with care. On the other hand withholding opiates for a person who needs them regularly due to sever chronic pain for fear of addiction is senselessly cruel. There is a difference between addiction and dependence. For Fibro, at least for me they are a total no-go.
I agree with the statement that "opiates should never be used as first line treatment for fibromyalgia." I also agree that never saying never means to be open to the possibility of listening to the doctor you trust, even if he suggests taking arcotics. For me, it was an appointmnt seeing my rheumy when he gave me an ultimatum - either take ten mg of methadone a day to get the baseline pain under control OR find a new rheumy.
It was tough love because I had vowed to never again take narcotics for chronic pain as I had a rough exprience that resulted in me waking up at a rehab facility not knowing where my previous two days had gone.
Ultimately, I decided my rheumy had my best interests at heart, took the methadoneand had five years of controlled pain.
Well, I never!
So went to rheumatologist today and told her my doctor diagnosed me with fibro and explained meds I tried. She checked out reflexes and range of motion. Went over all my blood work. She said there were tests she needed to run to confirm it's fibro. Today she did x-rays of my pelvis which were normal. No idea why just pelvis. Took 5 more vials of blood to run tests that are different than my doctor including genetic factors. She wants to see me in 2 weeks and before that appointment I have to do a sleep study. She said depending on results from sleep study I might have to get a mri of my pelvis before confirming my dr's diagnosis. She told me to continue taking norco as needed, doubled my tramadol to 200mgs, and put me on once a day 20mg piroxicam. So maybe the tramadol will be strong enough for me to sleep better. I asked if taking a stronger dose of flexeril or throughout the day is a option. She said that with fibro patients she will prescribe whatever they want to try for the pain as long as it doesn't interfere with other meds. So I'm hoping this is a good sign that someday I won't be in pain with her help and advice of my fellow fibrotonian's here on what has worked for them. She said she thinks it's fibro but wants to rule every possible thing out. Anyone tried piroxicam? I read it's a nsaid and I tried voltaren for a few weeks which is similar and it did nothing. She said piroxicam is a lot stronger than voltaren. Thanks everyone here for your help. This place has been a blessing for me to find.