Fibromyalgia is a common health problem. A recent study found that about 5 percent of women and 2 percent of men have fibromyalgia. That means over 100,000 Albertans and over 1 million Canadians have it.
Fibromyalgia is a syndrome. That means people can have many symptoms at the same time. Symptoms of fibromyalgia often include pain throughout the body, feeling very tired, having trouble sleeping (insomnia), and not feeling refreshed when you wake up in the morning. Not everyone with fibromyalgia has the same symptoms or is affected the same way. Some people have problems with memory and concentrating (“fibro fog”) or sleep, and some people don’t.
Research has shown that fibromyalgia may be caused by the nervous system not processing information the right way. How or why this happens is not known, but more research is being done.
Your doctor will tell you if you have fibromyalgia. It is important to tell your doctor about
all of your symptoms. This is to make sure other health problems (chronic fatigue syndrome, myofascial pain syndrome, polymyalgia rheumatica, multiple sclerosis) aren’t mistaken for fibromyalgia.
Some people have more than one health problem at a time. That means you can have fibromyalgia and another health problem like chronic fatigue at the same time.
Doctors used to be reluctant to tell people that they had fibromyalgia because they might get upset and discouraged. A lot has changed and now Health Canada has approved treatments for fibromyalgia.
People who are diagnosed with fibromyalgia often feel validated that they have a real health problem to explain their challenges. It helps people to know that the pain is not in their head and they are not crazy.
Pregabalin and Gabapentin
Pregabalin is approved by Health Canada to treat fibromyalgia. It can help with pain and sleep. Some people also feel less anxious when they take it. It is approved for anxiety disorders in Europe, but not in Canada. Side effects include dizziness, feeling very tired, retaining fluid, and weight gain. Not all drug insurance plans cover pregabalin.
Gabapentin is approved by Health Canada, but not for fibromyalgia. It works like pregabalin and has similar side effects. It often takes people a little longer to work up to a dose of gabapentin that helps their symptoms.
Pregabalin and gabapentin are similar. If one medicine doesn’t work for you or you have bad side effects, you can often try the other medicine. You normally start both medicines with a low dose at night and slowly increase it. Once you tolerate the medicine, you might take it once or twice during the day.
With pregabalin and gabapentin:
Try to give the medicine a chance to work. Many people only take a low dose of medicine and don’t feel any different, so they decide the medicine doesn’t work for them.
Another treatment approved by Health Canada for fibromyalgia is an antidepressant medicine called duloxetine (Cymbalta®). It is used to treat many chronic pain problems. It can help people with fibromyalgia, even if they aren’t depressed. Some people find it boosts their energy level. Common side effects include nausea, headache, and dry mouth. Rarely, people have seizures or liver damage. Like all antidepressant medicines, they make some people feel down and may increase the risk of suicide. Talk to your doctor to see if Cymbalta® is right for you.
Another antidepressant medicine called milnacipran (Savella®) is approved in the United States for fibromyalgia, but it isn’t available in Canada.
Exercise is important for anyone with fibromyalgia, but it can have risks. Many people with fibromyalgia are very tired after exercising, so it is important to pace yourself. Take the time to write down what you can do over a 2 week period before you start any exercise therapy. Use this as a guide and only increase your activity by 10 to 20 percent at a time. For example, if you can walk about 4 blocks at a time, increase to 5 blocks until your body gets used to it. Don’t increase your activity too quickly or you might have more pain or other symptoms.
Living with constant pain is very hard. If you have fibromyalgia, it is a good idea to think about seeing a psychologist who specializes in pain treatment. This will help you learn strategies to cope with sudden pain flare-ups and lower the long-term negative effects of pain on your relationships and goals. You can learn about many things to help you such as deep breathing and relaxation, marriage counselling, and goal setting. A psychologist can help you manage your pain whether you are depressed or not. Research shows only a few people with fibromyalgia have significant psychological health disturbances.
If you are interested in CAM, talk to your doctor. Not all CAMs are covered by healthcare or benefits.
Research is being done to see if supplements like Omega 3 fatty acids (containing mostly EPA) and magnesium might help fibromyalgia. Research shows that magnesium citrate can help fibromyalgia, but it can cause loose bowel movements. If you are thinking about taking supplements, talk to your doctor.
Current as of: May 10, 2018
Author: Chronic Pain and Rheumatology, Alberta Health Services
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