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Gabapentin is the Best Medications to Treat Fibromyalgia

The symptoms of fibromyalgia include pain and tenderness throughout the body that is often associated with other conditions that reduce a person’s ability to function and affects her quality of life. People with fibromyalgia often have difficulty sleeping, feel tired during the day, and experience irritability and depression, all of which can affect their life at work and at home.

Between 1 percent to 5 percent of adults in the U.S. have fibromyalgia, with women much more likely to develop it than men—about 80 to 90 percent of fibromyalgia sufferers are women. It can strike children and teens, but it’s more common in older adults, with most cases occurring between the ages of 40 and 70.

Because there is not a single, specific cause of fibromyalgia and the symptoms can vary from patient to patient, choosing an effective treatment can be challenging. Experts say the best, overall strategy includes medications and nondrug therapies, such as exercise, counseling, and stress relief.

The medications used to treat fibromyalgia includeantidepressants (amitriptyline, nortriptyline, fluoxetine, paroxetine, duloxetine, milnacipran), a few anti-seizure medications (gabapentin, pregabalin), and a muscle relaxant (cyclobenzaprine). But studies show that the benefits of these medications are generally small. There is no clear evidence that one drug is better than another, and all of them probably lose their benefit over time.

Each drug differs in the risks it poses to you. All antidepressants should be used with caution in those with a history of suicide attempt or who are at risk of suicide, especially in people 25 years old or younger. Amitriptyline, cyclobenzaprine, gabapentin, and pregabalin all cause increased sedation and should be used with caution in the elderly.

The medications differ substantially in price, so cost might be an important factor in determining which one you choose. The monthly cost for these drugs ranges from as little as $6 to more than $500. Taking into account the evidence of their effectiveness and safety as well as their price, we have chosen three Consumer Reports Best Buy Drugs as initial options to consider if you and your doctor have decided that a medication is appropriate for your fibromyalgia symptoms:

Generic amitriptyline
Generic gabapentin
Generic paroxetine-IR (immediate release)

All of these medications have been on the market for 15 years or more and have been widely used. They are all available as inexpensive generics and are at least as effective and safe as the other fibromyalgia medications.

Although side effects of sedation, dry mouth, and dizziness are common, serious side effects are rare.

Gabapentin and pregabalin are classified as antiseizure medications, but they are also used to help relieve pain in people with fibromyalgia. Both medications alter the brain chemistry. Pregabalin decreases levels of chemicals in the brain called neurotransmitters that build up because of the constant firing of the nerves in the spinal cord and the brain. It also increases other neurotransmitters that help suppress the constant firing of the nerves, which helps relieve pain. It’s unclear which neurotransmitters are affected by gabapentin or pregabalin.

Both drugs improve pain, sleep, fatigue, and the quality of life in people with fibromyalgia to about the same degree as amitriptyline. In clinical trials, 70 percent of people with fibromyalgia who took gabapentin for 12 weeks said they felt better compared with 40 percent of those who took a placebo. In addition, 51 percent of those who took gabapentin experienced a reduction of one-third in their pain compared with those who took a placebo.

In another trial, between 40 percent and 80 percent of people who took pregabalin said their pain was reduced by nearly a third, compared with 28 percent to 38 percent of those who took a placebo. For doses of 300 mg to 600 mg per day of pregabalin, 20 percent to 24 percent of patients said their pain was reduced by half compared with 12 percent of patients taking placebo.

One of the most common side effects of pregabalin and gabapentin is sedation. This is why they are often given at higher doses at night, which seems to help with sleep. Other side effects can include confusion, blurred vision, dizziness, liver and kidney impairment, and problems with concentration. In particular, they should be used with caution in elderly people due to side effects of confusion, dizziness, and sedation. Both drugs can also cause swelling, so people with heart failure should not take them. Gabapentin has been shown to increase the risk of suicide in depressed people and should be avoided in those at increased risk of suicide attempt.

Above report is from http://www.consumerreports.org/cro/2014/02/evaluating-prescription-drugs-used-to-treat-fibromyalgia/index.htm

What is Fibromyalgia and How to Treat Fibromyalgia ?

What is Fibromyalgia?

Fibromyalgia (fi·bro·my·al·gi·a) is a condition that causes pain all over the body (also referred to as widespread pain), sleep problems, fatigue, and often emotional and mental distress. People with fibromyalgia may be more sensitive to pain than people without fibromyalgia.

This is called abnormal pain perception processing. Fibromyalgia affects about 4 million US adults, about 2% of the adult population. The cause of fibromyalgia is not known, but it can be effectively treated and managed.

Fibromyalgia is a clinical entity characterized by the combination of ill-defined symptoms including chronic widespread pain, with concomitant fatigue, sleeping disorders and cognitive disturbances. The severity of these symptoms can vary significantly during the course of the disease. Fibromyalgia has been described as an arbitrarily created syndrome that lies at the extreme end of the spectrum of poly-symptomatic distress.

The term poly-symptomatic was used to emphasize the variety of multiple different symptoms that can be found in fibromyalgia patients, while the distress can have a physical and/or a psychological component. This exact nature of fibromyalgia makes it difficult to be clearly defined, often overlapping with disorders that are characterized by similar symptoms.

It is important to note that fibromyalgia is not an exclusion diagnosis as it can co-exist with other clinical conditions.

What are the Signs and Symptoms of Fibromyalgia?

The most common symptoms of fibromyalgia are

Pain and stiffness all over the body
Fatigue and tiredness
Depression and anxiety
Sleep problems
Problems with thinking, memory, and concentration
Headaches, including migraines

Other symptoms may include:

Tingling or numbness in hands and feet
Pain in the face or jaw, including disorders of the jaw known as temporomandibular joint syndrome (also known as TMJ)
Digestive problems, such as abdominal pain, bloating, constipation, and even irritable bowel syndrome (also known as IBS)

Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals.

Symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event.

Women are much more likely to develop fibromyalgia than are men. Many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression.

While there is no cure for fibromyalgia, a variety of medications can help control symptoms. Exercise, relaxation and stress-reduction measures also may help.

In general, treatments for fibromyalgia include both medication and self-care. The emphasis is on minimizing symptoms and improving general health. No one treatment works for all symptoms.

What are the Risk factors for Fibromyalgia?

Known risk factors include:

Age. Fibromyalgia can affect people of all ages, including children. However, most people are diagnosed during middle age and you are more likely to have fibromyalgia as you get older.
Lupus or Rheumatoid Arthritis. If you have lupus or rheumatoid arthritis (RA), you are more likely to develop fibromyalgia.

Some other factors have been weakly associated with the onset of fibromyalgia, but more research is needed to see if they are real. These possible risk factors include:

Sex. Women are twice as likely to have fibromyalgia as men.
Stressful or traumatic events, such as car accidents, post-traumatic stress disorder (PTSD)
Repetitive injuries. Injury from repetitive stress on a joint, such as frequent knee bending.
Illness (such as viral infections)
Family history
Obesity

How is Fibromyalgia Diagnosed?

Doctors usually diagnose fibromyalgia using the patient’s history, physical examination, X-rays, and blood work.

How is Fibromyalgia Treated?

Fibromyalgia can be effectively treated and managed with medication and self-management strategies. You can learn about self-management strategies in the section below titled How can I improve my quality of life?

Fibromyalgia should be treated by a doctor or team of healthcare professionals who specialize in the treatment of fibromyalgia and other types of arthritis, called rheumatologists. Doctors usually treat fibromyalgia with a combination of treatments, which may include:

Medications, including prescription drugs and over-the-counter pain relievers
Aerobic exercise and muscle strengthening exercise
Patient education classes, usually in primary care or community settings
Stress management techniques such as meditation, yoga, and massage
Good sleep habits to improve the quality of sleep
Cognitive behavioral therapy (CBT) to treat underlying depression. CBT is a type of talk therapy meant to change the way people act or think

In addition to medical treatment, people can manage their fibromyalgia with the self-management strategies described below, which are proven to reduce pain and disability, so they can pursue the activities important to them.

What are the Complications of Fibromyalgia?

Fibromyalgia can cause pain, disability, and a lower quality of life. US adults with fibromyalgia may have complications such as:

More hospitalizations. If you have fibromyalgia you are twice as likely to be hospitalized as someone without fibromyalgia.
Lower quality of life. Women with fibromyalgia may experience a lower quality of life.
Higher rates of major depression. Adults with fibromyalgia are more than 3 times more likely to have major depression than adults without fibromyalgia. Screening and treatment for depression are extremely important.
Higher death rates from suicide and injuries. Death rates from suicide and injuries are higher among fibromyalgia patients, but overall mortality among adults with fibromyalgia is similar to the general population.
Higher rates of other rheumatic conditions. Fibromyalgia often co-occurs with other types of arthritis such as osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis.

How is Fibromyalgia Treated?

You and your doctor can treat fibromyalgia with medicines, lifestyle changes, and complementary therapy. However, fibromyalgia can be hard to treat. It’s important you find a doctor who is familiar with the disorder and its treatment.

Doctors may prescribe one or more of the following medicines to help treat the symptoms of fibromyalgia:

Ibuprofen, aspirin, or naproxen you can buy over the counter.
Narcotic medicines to treat severe pain.
Duloxetine and minacipran to help the pain and fatigue.
Pregabalin to help treat nerve pain.

Making lifestyle changes can also help you manage your fibromyalgia, including:

Getting enough sleep.
Exercising.
Adjusting your work demands.
Eating well.

You can also try complementary therapies such as:

Massage therapy.
Movement therapy.
Chiropractic therapy.
Acupuncture.
Diet supplements.

If you are using or would like to try a complementary therapy you should speak with your doctor, who may know more about if it is safe to try.

Fibromyalgia Medications

Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include:

Pain relievers. Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may be helpful. Your doctor might suggest a prescription pain reliever such as tramadol (Ultram, Conzip). Narcotics are not advised, because they can lead to dependence and may even worsen the pain over time.
Antidepressants. Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia. Your doctor may prescribe amitriptyline at night to help promote sleep.
Anti-seizure drugs. Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin, Gralise) is sometimes helpful in reducing fibromyalgia symptoms, while pregabalin (Lyrica) was the first drug approved by the Food and Drug Administration to treat fibromyalgia.

Drugs associated with Fibromyalgia

How to Treat Fibromyalgia by Gabapentin ?

New research supported by the National Institutes of Health’s National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) shows that the anticonvulsant medication gabapentin, which is used for certain types of seizures, can be an effective treatment for the pain and other symptoms associated with the common, often hard-to-treat chronic pain disorder, fibromyalgia.

In the NIAMS-sponsored, randomized, double-blind clinical trial of 150 women (90 percent) and men with the condition, Lesley M. Arnold, M.D., director of the Women’s Health Research Program at the University of Cincinnati College of Medicine, and her colleagues found that those taking gabapentin at dosages of 1,200 to 2,400 mg daily for 12 weeks displayed significantly less pain than those taking placebo. Patients taking gabapentin also reported significantly better sleep and less fatigue. For the majority of participants, the drug was well tolerated. The most common side effects included dizziness and sedation, which were mild to moderate in severity in most cases.

NIAMS Director Stephen I. Katz. M.D., Ph.D., remarked that “While gabapentin does not have Food and Drug Administration approval for fibromyalgia¹, I believe this study offers additional insight to physicians considering the drug for their fibromyalgia patients. Fibromyalgia is a debilitating condition for which current treatments are only modestly effective, so a study such as this is potentially good news for people with this common, painful condition.”

Fibromyalgia is a chronic disorder characterized by chronic, widespread muscle pain and tenderness, and is frequently accompanied by fatigue, insomnia, depression, and anxiety. It affects three million to six million Americans, mostly women, and can be disabling.

The precise cause of fibromyalgia in not known, but research suggests it is related to a problem with the central nervous system’s processing of pain. As with some other chronic pain conditions, people with fibromyalgia often develop a heightened response to stimuli, experiencing pain that would not cause problems in other people. Yet, unlike many other pain syndromes, there is no physical evidence of inflammation or central nervous system damage.

Although gabapentin has little, if any, effect on acute pain, it has shown a robust effect on pain caused by a heightened response to stimuli related to inflammation or nerve injury in animal models of chronic pain syndromes. Researchers have suspected that it might have the same effect in people with fibromyalgia. The new research, published in the April 2007 edition of Arthritis & Rheumatism, indicates the suspicions were correct.

Although the researchers cannot say with certainty how gabapentin helps reduce pain, Dr. Arnold says one possible explanation involves the binding of gabapentin to a specific subunit of voltage-gated calcium channels on neurons. “This binding reduces calcium flow into the nerve cell, which reduces the release of some signaling molecules involved in pain processing,” she says.

How gabapentin improves sleep and other symptoms is less clear, and there are probably different mechanisms involved in fibromyalgia symptoms. “Gabapentin improved sleep, which is an added benefit to patients with fibromyalgia who often report unrefreshing or disrupted sleep,” Dr. Arnold says.

What is important is that people with fibromyalgia now have a potential new treatment option for a condition with few effective treatments. “Studies like this give clinicians evidence-based information to guide their treatment of patients,” says Dr. Arnold.

Gabapentin Dosage for Fibromyalgia

Twenty-nine studies (3571 participants), studied gabapentin at daily doses of 1200 mg or more in 12 chronic pain conditions; 78% of participants were in studies of postherpetic neuralgia, painful diabetic neuropathy or mixed neuropathic pain. Using the IMMPACT definition of at least moderate benefit, gabapentin was superior to placebo in 14 studies with 2831 participants, 43% improving with gabapentin and 26% with placebo; the NNT was 5.8 (4.8 to 7.2). Using the IMMPACT definition of substantial benefit, gabapentin was superior to placebo in 13 studies with 2627 participants, 31% improving with gabapentin and 17% with placebo; the NNT was 6.8 (5.6 to 8.7). These estimates of efficacy are more conservative than those reported in a previous review. Data from few studies and participants were available for other painful conditions.

Adverse events occurred significantly more often with gabapentin. Persons taking gabapentin can expect to have at least one adverse event (66%), withdraw because of an adverse event (12%), suffer dizziness (21%), somnolence (16%), peripheral oedema (8%), and gait disturbance (9%). Serious adverse events (4%) were no more common than with placebo.

There were insufficient data for comparisons with other active treatments.

What Is Gabapentin Off Label Usages ?

Neurontin is the trade name for the generic drug gabapentin. It is useful as an anti-epileptic drug and as an analgesic, particularly for pain of the neuropathic or neurogenic type. (pain from irritation or inflammation of nerves). When used for controlling epilepsy, it is usually used in conjunction with another anti-epileptic drug.

It is used much more extensively in the medical field to treat pain than it is to treat epilepsy.

How Gabapentin Works

Gabapentin is believed to work by altering the release of glutamate and other neurotransmitters in your brain.1 Neurotransmitters send messages from one brain cell to another. Glutamate is really helpful for certain things, like learning new information. That’s because it gets your brain cells stirred up and active.

Kind of like a toddler with chocolate, though, if you have too much glutamate running around, your brain cells can become overstimulated. That can make all kinds of things go wrong.

Glutamate has more than one job, though. It also helps transmit pain signals in your brain and nerves. Too much glutamate may play a role in hyperalgesia, which essentially turns up the volume of pain.

To counter the effects of glutamate, you have another neurotransmitter called gamma-aminobutyric acid (GABA).2 It calms your cells and quiets your brain. When GABA and glutamate exist in balance with each other, things go well. (It’s likely out of balance in fibromyalgia, though.)

Some diseases and conditions—including fibromyalgia—may interrupt this balance and let glutamate run amok. Gabapentin is believed to reduce your brain’s release of glutamate so the cells can calm down and your brain can function better.

Gabapentin belongs to a class of drugs known as anticonvulsants, used to help control seizures in the treatment of epilepsy. Neurontin will only be able to control seizures for as long as you take it. It can’t cure epilepsy. Gabapentin capsules, tablets, and oral solution are used to help control certain types of seizures in people who have epilepsy.

Gabapentin capsules, tablets, and oral solution are also used to relieve the pain of postherpetic neuralgia (PHN; the burning, stabbing pain or aches that may last for months or years after an attack of shingles). Gabapentin extended-release tablets (Horizant) are used to treat restless legs syndrome (RLS; a condition that causes discomfort in the legs and a strong urge to move the legs, especially at night and when sitting or lying down).

Gabapentin is in a class of medications called anticonvulsants. It has also been reported to be helpful in controlling the pain of fibromyalgia.

Gabapentin for Fibromyalgia

Research suggests that people with fibromyalgia have too much glutamate in certain parts of their brain, so gabapentin has long been prescribed for it. But is it effective? Research is mixed.

Two reviews of the evidence disagree. One released in 2016 found that gabapentin is an effective fibromyalgia treatment,3 while another, published in 2017,4 reported only low-quality evidence.

A 2014 review of gabapentin for fibromyalgia and neuropathy found that about 35 percent of study participants saw their pain drop by at least 50 percent while on the drug.5 It’s important to note, though, that 21 percent saw similar drops when taking a placebo.

In studies comparing gabapentin with pregabalin (Lyrica), including one published in The Journal of the American Medical Association, pregabalin appeared to perform better.

An extended-release form of gabapentin showed promise in one small trial published in Pain Practice.3 Researchers say it improved pain, sleep, and quality of life. This was a preliminary trial, though, so more work needs to be done before we’ll know for sure whether it’s safe and effective long term.

Gabapentin treats seizures by decreasing abnormal excitement in the brain. Gabapentin relieves the pain of PHN by changing the way the body senses pain. It is not known exactly how gabapentin works to treat restless legs syndrome.

Gabapentin Off Label Usages

Gabapentin is also sometimes used to relieve the pain of diabetic neuropathy (numbness or tingling due to nerve damage in people who have diabetes), and to treat and prevent hot flashes (sudden strong feelings of heat and sweating) in women who are being treated for breast cancer or who have experienced menopause (”change of life”, the end of monthly menstrual periods). Talk to your doctor about the risks of using this medication for your condition.

Pregabalin (Lyrica), a drug similar to gabapentin, was the first medication approved by the Food and Drug Administration (FDA) to treat fibromyalgia. While gabapentin hasn’t been approved by the FDA for the treatment of fibromyalgia, some doctors may prescribe it off-label for such use.

Gabapentin and pregabalin were originally approved to treat certain types of epilepsy and nerve pain. Both drugs work by limiting the release of pain-communicating chemicals by nerve cells in the brain and spinal cord. The most common side effects of both drugs are dizziness and drowsiness.

It is also used to control pain associated with shingles and has been evaluated for pain conditions, including migraine, as its pain-modulating properties may regulate the perception of pain.

Anticonvulsant drugs, such as gabapentin, are becoming increasingly popular for migraine prevention.

Efficacy of gabapentin in migraine prophylaxis research on a history of migraine episodes for a mean of about 21 years shows that Gabapentin is an effective prophylactic agent for patients with migraine. In addition, gabapentin appears generally well tolerated with mild to moderate somnolence and dizziness.

Gabapentin is generally well tolerated. The main side effects are dizziness and drowsiness. Occasionally there maybe some fluid retention, unsteadiness or G.I upset, mainly diarrhea.

The effective dose of gabapentin varies greatly. Some persons need only 200-300 mg a day whereas others may need 3000 mg or more a day. It may take several weeks to become effective, so it is important to stay on it for an adequate length of time.

Gabapentin has a lot of off-label usage. It is widely used nerve related diseases. Most of them are reviewed by patients and reviewed high.

General speaking, Gabapentin can be off label used to treat Cough, Hot Flashes, Occipital Neuralgia, Trigeminal Neuralgia, Transverse Myelitis,
Alcohol Withdrawal, Pruritus, Bipolar Disorder, Migraine, Anxiety, Postherpetic Neuralgia, Insomnia, Restless Legs Syndrome, Vulvodynia, Benign Essential Tremor, Peripheral Neuropathy, Fibromyalgia, Diabetic Peripheral Neuropathy, Pain, Neuropathic Pain, Reflex Sympathetic Dystrophy Syndrome, Epilepsy, Hiccups, Syringomyelia, Periodic Limb Movement Disorder, Spondylolisthesis, Burning Mouth Syndrome, Pudendal Neuralgia, Small Fiber Neuropathy, Nausea/Vomiting, Chemotherapy Induced.