The wonderful thing about comprehensive medicine, which combines holistic and pharmaceutical therapies, is that you have a full tool kit to deal with your problems. Otherwise, it's like going into a shoe store and having only 1 pair of shoes to try on. Using comprehensive Medicine, almost every one can find "a shoe that fits" so you can get your life and health back!
While going after and eliminating the underlying causes of the pain, it is perfectly reasonable to use pain medications to get pain free. The toxicity of chronic pain is far greater than the toxicity of these medications.
The main problem is that these medications can cause side effects, especially when started at high dose. It is reasonable to start with a higher dose if needed to get pain free quickly, but if the side effects become problematic, immediately lower the dose to the level that is comfortable (even if this is simply one half tablet daily at bedtime). As your body adapts to the side effects over a week or two, the dose can then be raised. Starting at too high a dose, without stopping and retrying at a lower dose in the face of side effects, is the major reason that people do not tolerate medications for pain that otherwise would be very helpful.
Three new medications have recently been FDA approved for addressing fibromyalgia pain. Although each of these medications can be a godsend in any given individual, they are not, in my experience, the most effective pain medications for fibromyalgia. Below I have listed the medications I recommend be tried for fibromyalgia pain in the order that I find them to be the most effective. Medications can often be combined, and it is reasonable to use a non-sedating medication like Cymbalta or Skelaxin during the day in combination with a sedating medication like Neurontin or Lyrica at bedtime.
Below is the order in which I recommend adding pain medications in fibromyalgia. It may take six weeks to see a medication's full effect, but usually you'll have a good sense of whether it is going to help by three weeks of use. Though it may take a high dose of a single medication (which may cause unacceptable side effects) to be effective, often combining a low dose of several medications will allow effectiveness without the side effects. Do not combine medications within a single group below, but rather add one from each group as you go along.
What Order to Try the Medications In
Topical Meds for Small Areas of Severe Pain
For small areas of especially problematic pain, begin with the topical treatment below. I like to use this along with Comfrey Cream. Put the prescription nerve pain cream closest to the skin, with the Comfrey over top of it. Give it two weeks to work. It can be very effective and with virtually no side effects.
- Nerve Pain cream from a compounding pharmacy (e.g., ITC pharmacy 303-663-4224; they can guide your physician on prescribing this). Apply a pea sized amount to up to four areas 2-3 times a day and give it two weeks to work. Most compounding pharmacies can make up the pain creams.
Medications by Mouth
- GABA Stimulating medications:
- Neurontin (gabapentin) or
- Lyrica (pregabalin)
- Serotonin and Norepinephrine-raising medications (usually nonsedating):
- Cymbalta (duloxetine) 20-60 mg a day (caution: this can be addictive), or
- Effexor (venlefaxine) 75 mg 2-3x day, or
- Savella (Minalcipran) 100 mg a day
- Low-dose naltrexone 3-4.5 mg at bedtime. This may initially disrupt sleep and takes two months to work. You cannot use this with narcotics or mu receptor medications.
- Mu receptor medications. Unfortunately, with the current crackdown on narcotics the government is treating this medication like a narcotic. I believe this is a severe mistake as I've never seen anybody addicted to this medication. Nor have the rehabilitation medicine physicians I've spoken with:
- Ultram (tramadol). This is a medication that raises both serotonin and endorphins. It is usually well tolerated at 50-100 mg three times a day. It may be sedating and often causes nausea at doses over 300 mg. This excellent pain medication is available in generic form, so it's relatively inexpensive despite being highly effective. It's main drawback is that it leaves one unable to use low-dose naltrexone.
- Elavil (amitriptyline) 10-25 mg at bedtime.
- Doxepin (sinequan)10-25 mg at bedtime. If the Elavil is too sedating or causes other problematic side effects, use this instead.
- Flexeril (cyclobenzaprine) 5 mg. Using just half a tablet at breakfast and early afternoon decreases sedation considerably. Then you can use one half of one tablet at bedtime for sleep and nighttime pain.
- Klonopin (clonazepam, addictive like valium). This can be helpful at bedtime for restless leg syndrome or severe muscle pain that interferes with sleep.
- Namenda (memantine). This is not addictive and is especially helpful for allodynia (pain on being touched) and nerve pain.
- These can be helpful but can also be addictive. I therefore recommend using the other medications described. Nonetheless, these medications are sometimes necessary in a small percent of fibromyalgia patients, and I believe taking them is much less toxic for patients than being in severe pain.
There are many other techniques in the healthcare toolkit, including numerous holistic modalities, that can be very helpful for pain. One that is growing in popularity, but just beginning in the U.S., is called Kinetic Chain Release (developed by Hugh Gilbert from Scotland). A technique called Frequency Specific Microcurrent can also be very helpful.
In the last 30 years, I have personally helped over 3,000 patients with fibromyalgia and other chronic pain conditions. I can count on my fingers how many we were not able to get adequate pain relief. This has also been the experience of many other pain specialists that combine natural and prescription pain therapies, while using techniques to eliminate trigger points and the underlying causes of muscle pain.
You can get pain free — NOW!
Jacob Teitelbaum, M.D. is one of the world's leading integrative medical authorities on fibromyalgia and chronic fatigue. He is the lead author of eight research studies on their effective treatments, and has published numerous health & wellness books, including the bestseller on fibromyalgia From Fatigued to Fantastic! and The Fatigue and Fibromyalgia Solution. Dr. Teitelbaum is one of the most frequently quoted fibromyalgia experts in the world and appears often as a guest on news and talk shows nationwide including Good Morning America, The Dr. Oz Show, Oprah & Friends, CNN, and Fox News Health.