Posted by merm on 3/26/2009, 5:47 am, in reply to "Re: Current Drug Therapies for FM/CMP PAY ATTENTION TO WHAT YOU ARE TAKING"
Remeron (mirtazapine): This antidepressant is unrelated to SSRIs, tricyclics or MAO inhibitors. It seems to cause fewer occurrences of common side effects.
Restoril (temazepam): This hypnotic may be useful to improve sleep. There are few reports of "hangover" effect.
Serzone (nefazodone HCl): This antidepressant is unrelated to SSRIs, tricyclics, or MAO inhibitors. It inhibits serotonin and norepinephrine, but has a low bioavailability that varies.
Sinequan (doxepin HCl): This tricyclic antidepressant and antihistamine combination can cause sedation. It may enhance the effects of Klonopin, and can reduce muscle twitching by itself.
Soma (carisoprodol): This central nervous system muffler works rapidly. Effects last from four to six hours. It helps patients to detach themselves from their pain, and can damp the sensory overload of FMS. It should not be used as the only pain control. There are some reports of dependency. It can cause respiratory depression given in conjunction with propoxyphene. Treatment of FMS with the combination of carisoprodol, acetaminophen and caffeine is effective (Vaeroy, Abrahamsen, Forre et al. 1989).
Sonata (zaleplon): This is a short–term-acting hypnotic. You don’t have to take it every night if you don’t always have insomnia, because you can take it at bedtime or even later on those nights you have difficulty. You do need four hours to sleep it off (Elie, Ruther, Farr et al.1999).
Ultram (tramadol HCl): This medication for moderate to severe pain acts on the central nervous system. It may cause constipation, nausea, dizziness, headaches, weariness, tightening of jaw and neck muscles, and vomiting. Some doctors have reported psychological addiction to Ultram that is even harder to break than narcotic addiction. This medication can lower the seizure threshold.
Wellbutrin (bupropion HCl): This antidepressant is sometimes used in FMS in place of Elavil, but it can promote seizures.
Xanax (alprazolam): This anti-anxiety medication may be enhanced by ibuprofen. It aids the formation of blood platelets, which store serotonin, and it raises the seizure threshold. It must not be used during pregnancy. When you stop taking it, taper off gradually.
Zanaflex (tizantidine hydrochloride): This muscle relaxant may help with RLS. It may help to reduce muscle tightness, and may have sedative effects. This is another medication you may have to take just before bed, as there have been reports of loss of muscle control. Some patients also mention hallucinatory effects.
Zofran (ondansetron) This medication helps about 50% primary FMS patients, according to one study (Hrycaj, Stratz, Mennet et al. 1996). The response was not the same in post-traumatic FMS.
Zoloft (sertraline HCl): This is commonly used to help with sleep problems. There have been several reports of night sweats with strong ammonia odor. It may be useful for PMS (Yonkers, Halbreich, Freeman, et al. 1997).
Most people who find Benedryl stimulating rather than sedating seem to have the same response to Pamelor, Paxil, and Ultram. I don’t know why, but I suspect it may be a clue to the parameters of a subset of FMS.
Medications, Pain and Opioids
Too often readers have told me, "My doctor would not prescribe this medication because it is too hard to get someone off it." It’s hard to stop taking a medication that will relieve your pain. It’s nearly as hard as trying to figure out why any doctor in his/her right mind would want you to do so. In the best of all worlds, early FMS and single TrPs would be promptly diagnosed and treated. In our present reality, central sensitization and allodynia of FMS coupled with the pain generated by TrPs can make this world a living hell for patients who haven’t been promptly diagnosed and treated.
We must deal with reality as it is today, unhampered by outmoded belief systems.
Pain control is imperative to reduce any further sensitization of the nervous system, as well as to allow appropriate bodywork without additional shock to the pain sensing system.
I am not advocating opioids as the first method of pain control, or as the singular method of pain control.
When other options have failed, medical literature documents that opioids, in conjunction with a thorough pain control program including bodywork, mindwork and life style adjustment, are a logical and humane option in the treatment of severe FMS and CMP.
The rest of this section will be from medical journal articles. For more information on this subject, see "The Fibromyalgia Advocate".
The treatment of non-cancer pain with opioids may work for patients who don’t gain sufficient reduction of pain by other therapies (Dertwinkel, Wiebalck, Zenz et al.1996).
Opioids may be the only hope of relief to many people with chronic pain (Shannon and Baranowski). 1997).
Higher levels of opioid use are not associated with higher levels of disability or depression (Ciccone, Just, Bandilla, et al. 2000).
Chronic opioid use at the proper dosage, tailored to patients’ need and tolerance, did not significantly impair perception, cognition, coordination, and behavior. (Galski, Williams and Ehle, 2000).
From a purely pharmacological point of view, opioids have perhaps the best side effect profile of any drugs we have available form pain (Horning, 1997).
Unlike the chemically dependent patient whose function is impaired by medications, the chronic pain patient’s level of function may improve with proper use of medications, including opioids (Seas and Clark, 1993).
Addictive behaviors aren’t common in chronic pain patients (Fishbain, Rosomoff and Rosomoff, 1992).
There are possible side effects with opioids, and some people do have a tendency towards addiction, but, according to these and many other references, this is not common in chronic pain patients.
Opioids often slow intestinal motility. Measures should be taken to prevent constipation.
Temporary sleepiness and confusion is common after initial opioid therapy, and after dose increases.
Nausea may occur for the first 3 or 4 days.
Some opioids are available in suppository form if nausea and vomiting is present.
Transdermal patches are also available.
The liquid form may be very useful because of the ease with which you can vary the dose.
For example, hydromorphone hydrochloride 5 mg per ml is available. My doctor suggests this form because it isn’t combined with NSAIDS, and because you can adjust the dosage. On days when pain is severe you may need your full dose, but on good days you can take a lesser amount. Excerpted from "Fibromyalgia and Chronic Myofascial Pain: A Survival Manual (Chapter 21) edition 2" by Devin J. Starlanyl and Mary Ellen Copeland coming June 2001. (Vitamins and minerals are addressed in Nutrition chapter.) MERMWELLNESSTRAINGROUP
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