# New drug treats a questionable disease: Fibromyalgia



## Jeffrey Roberts

*New drug treats a questionable disease*Created: Sunday, January 20, 2008 4:23 PM ESTBy: Dr. Terry Gaff Some medical problems have been sources of chronic frustration to both patients and physicians because they seemed to be present in a fair number of people, but did not have any specific treatment. This led to very few good articles and discussions about these problems since the medicines most of us prescribed for the problems were "off label" (not the FDA-approved) uses for the drugs. When the FDA (Food and Drug Administration) finally approves a drug for a problem, there seem to be articles everywhere I look. That is what happened when Requip was approved for use in Restless Leg Syndrome and it seems to be happening with fibromyalgia now. On the other hand, the new interest in fibromyalgia needs a two-pronged discussion because there are a lot of doctors who do not believe it is a real disease. They think of fibromyalgia as a label given to patients with many painful physical complaints, but normal test results. This is commonly called a "wastebasket diagnosis" used when all the clearly definable diseases have been tested for and eliminated as possibilities.Now, fibromyalgia may get some of the attention many of us feel it deserves since Pfizer is bringing out a new television advertising campaign for Lyrica (known generically as pregabalin), the first medicine approved to treat this painful condition. For patient advocacy groups and doctors who specialize in fibromyalgia, the Lyrica approval is a milestone. They hope Lyrica and two other drugs that may be approved this year will legitimize fibromyalgia. As presently diagnosed, fibromyalgia primarily affects middle-aged women, many of whom sufferer from other hard to define conditions, like irritable bowel syndrome. The predominant features of fibromyalgia include chronic, widespread pain and lowered pain threshold with very tender areas scattered around their bodies called "trigger points." Other features often accompanying fibromyalgia include fatigue, depression, anxiety, sleep problems, headache or migraine, bowel irregularity, diffuse abdominal pain, and urinary frequency. Because fibromyalgia patients typically do not respond to conventional painkillers like aspirin, drug makers are focusing on medicines like Lyrica that affect the brain and the perception of pain. Those who treat fibromyalgia estimate that 2 to 4 percent of adult Americans, as many as ten million people, suffer from the disorder. However, those figures are sharply disputed by doctors who do not consider fibromyalgia a medically recognizable illness and who say that diagnosing the condition actually worsens suffering by causing patients to obsess over aches that other people simply tolerate. Further, they warn that Lyrica's side effects, which include severe weight gain, dizziness and swelling (also called edema), are very real, even if fibromyalgia is not. Despite the controversy, the American College of Rheumatology, the FDA and insurers recognize fibromyalgia as a diagnosable disease. Drug companies are aggressively pursuing fibromyalgia treatments, seeing the potential for a major new market. Hoping to follow Pfizer's lead, two other big drug companies, Eli Lilly and Forest Laboratories, have asked the FDA to let them market drugs for fibromyalgia. While the approval of medicines for use in fibromyalgia is hopeful, a cure for this problem is nowhere in sight. In addition, drug side effects or lack of effectiveness in any individual case can eliminate the usefulness of the drug. Other drugs are also used in the management of fibromyalgia as follows: • Ultram (tramadol) is recommended for management of pain. • Simple pain relievers and weak narcotics. (Corticosteroids and strong narcotics are not recommended.) • Antidepressants decrease pain and often improve function. It is very important to keep in mind other non-drug forms of management for fibromyalgia as follows: • Heated pool treatment, with or without exercise. • Individually tailored exercise programs can be helpful. These may include aerobic exercise and strength training. • Relaxation, rehabilitation, physical and occupational therapy, psychological support, and other modalities may be useful. Though my television watching time is somewhat limited, I am looking forward to seeing how the Lyrica ads approach the confusing and controversial subject of fibromyalgia. It would be nice if they would displace some of the ads for erectile dysfunction that seem to be on every few minutes.Dr. Terry Gaff practiced family medicine in Albion for 17 years and is now medical director of the emergency department at Parkview Noble Hospital in Kendallville and the Noble County EMS. He welcomes your questions. He can be reached at [email protected]Copyright © 2008 KPC Media Group, Inc.http://www.kpcnews.com/articles/2008/01/20...1e493830277.txt


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## M&M

This is an excellent article! I have also read a lot lately about the side effects of Lyrica. The main one I've read the most about is the weight gain, and I've read that it can continue even after going off of the medication. Of course, the majority of patients can usually take any medication with zero side effects.I'm very interested in hearing from any patients here who have taken, or are currently taking, Lyrica! It is indeed a milestone as Dr. Gaff states!


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## MyOwnSavior

I read about this drug in the paper, and wondered if it wouldn't help with Irritable Bowel Syndrome. I wouldn't say that I have Fibromyalgia or anything like that, but oftentimes I do have "phantom" pain that frankly I don't see a cause for. Though, the article I read (unfortunately I can't create a link to it because it was an article in the local paper, though Jeffrey's original post captured the gist of it) did seem to (if I remember correctly) tend to suggest it would be good for any kind of chronic pain sufferer... So, I was wondering exactly what class of drugs Lyrica belongs in. It sounds as if it has Narcotic-like properties (alters the brain's perception of pain) but not the addictive side effects. If this is true then perhaps, again, it would also be good for IBS... I say that because there are times when the Cymbalta I'm on doesn't seem to be working, and so I'm looking for a drug that would eliminate a lot of the annoying symptoms I get from time to time. But I've never been able to get a hold of a doctor that would give me any painkillers, and so if Lyrica isn't one it might be worth pursuing...Any info will be greatly appreciated.


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## M&M

The generic name of the drug in Lyrica is pregabalin. It is an anticonvulsant drug that has been used in the past to treat epileptic seizures; epilepsy being a neurological condition. It controls the extra electrical impulses between nerves that cause seizures, so it’s main purpose is to control nerve impulses. It has also commonly been used to treat diabetic neuropathy and post-herpetic neuralgia. Diabetes damages nerve endings, so Lyrica is effective at quieting the incorrect impulses those nerves send out. And shingles also can leave a person’s nerves sending out incorrect signals and impulses, resulting in pain. So Lyrica can also help quiet those incorrect (or over-active) nerve signals.That is one of the main things that sets Lyrica apart from other pain killers. It is designed to treat neuropathic pain – a pain characterized as a burning or tingling kind of pain. That’s why it can work for patients with Fibromyalgia. There is often very little (if any) inflammation in a Fibro patient’s body – that’s why most of your typical pain meds don’t work for them. So Lyrica can go in, and actually work with the nerve endings, and help control the pain signals they’re sending.I do not believe it is a narcotic. That also means that there are lots of kinds of pain it wouldn’t help, as much chronic pain is not neurological. A lot of chronic pain comes from a clear, physical cause; such as injuries, arthritis, tendonitis, etc. Lyrica would be contra-indicated in those cases, as those patients are treatable with conventional pain meds that reduce inflammation. But I do see your point in wondering if it would help with IBS pain as well. I think it’s a good question and I don’t think I could even offer a guess as to whether it would help IBS or not!I hope this is helpful, even though I can’t answer your IBS/Lyrica question!


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## MyOwnSavior

Yes, that did help, quite a bit actually. It's interesting that it works in treating nerve pain, because I believe that the Cymbalta that I am currently taking does the same type of thing (or at least, it's been shown in clinical trials to do that). Therefore, I can't imagine that the Lyrica would have a much greater effect on my IBS related issues than the Cymbalta... so maybe I'll just stick with that for a while. The only problem is the price ($100 every month), and when you factor in the cost of Nexium (another $100 per month) and Align ($33 per month) ...Of course, since Lyrica is a new drug (or it's new to treating Fibro, I'm not sure which it is, I thought I read Lyrica itself was new, but if it's already generically available...) it's probably more expensive than my current meds...Anyway thanks for the info, I'll have to do some more research on this drug, and see what my doctor thinks about it. Maybe I could even take Lyrica and Cymbalta _together_ to help get rid of IBS pains? Of course if it's an anticonvulsant (maybe similar to Bentyl - or was that an antispasmodic? I'm so confused&#8230 then wouldn't it aggravate reflux symptoms in those who also have GERD? Sorry for the tons of random questions but as you can see there are a lot of issues that I need to get sorted out&#8230; one of my personality quirks is that when I set my mind to getting something done, I want to get everything associated with it done as well (as you can probably tell from my round of 1,000 questions here, haha).


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## Rowe2

Thanks for the info Jeff and Marilyn..I was actually prescribed Lyrica two months ago..I started gaining weight immediately and couldn't tell a difference in the pain. I know each person will be different on medications, so I pray this is answer for others..MOS..Cymbalta has helped with my IBS spasms and helps control my huge appetite. It helped some with the pain of FM and RA for a while, but stopped. I've recently started Mobic, and can tell a HUGE difference in my pain, but I feel it has targeted the RA.


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## M&M

Bentyl (dicyclomine) is an antispasmodic. That means it suppresses smooth muscle contraction. Because of the way this drug works, it does have the side effect of worsening GERD.Lyrica (pregabalin), on the other hand is an anticonvulsant. That means it suppresses the rapid (or excessive) firing of neurons that start a seizure. There is a range of anticonvulsants that all work by blocking various receptors, or by inhibiting the release of various chemicals in the body.So these 2 drugs work it totally different ways.There is a correlation between Cymbalta use and use of Lyrica. Cymbalta has often been used to treat diabetic neuropathy and other chronic pain conditions. So it’s possible that if Cymbalta has helped your pain the past, Lyrica could help it as well. I’ve read many reports of people who took Cymbalta for pain in the past, and were switched to Lyrica when the Cymbalta stopped working for them.Lyrica is a serious drug though, and comes with serious side effects. It can worsen depression, and is known to cause extreme weight gain – weight gain that can continue after stopping the medicine. But, if your pain is so severe you can’t function, then maybe weight gain would be an acceptable result to deal with.I think it would be worth a conversation with your doctor, if your pain isn’t under control, or isn’t bearable currently. Lyrica is priced very similarly to Cymbalta, so it isn’t a cheap drug either, unfortunately. Normally, I don’t think patients are just written a scrip for Lyrica. It’s usually used when a previous med stops working, or the pain is so severe that you’d rather die than continue living.Hope this helps!


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## MyOwnSavior

Rowe2 said:


> MOS..Cymbalta has helped with my IBS spasms and helps control my huge appetite. It helped some with the pain of FM and RA for a while, but stopped. I've recently started Mobic, and can tell a HUGE difference in my pain, but I feel it has targeted the RA.


I've always wondered about that. With certain medications I've been on in the past, I felt as if they worked great in eliminating pain... for a little while (sometimes as little as two months after I started taking them). I know that was the case with the Effexor XR, and it seemed to be the case with the Cymbalta. But now I don't know, I feel like it's helping me again. It's like it's off and on; or maybe my IBS has just progressed to the point where it's off and on? Either way, I'm not too familiar with Mobic, but as you say it does seem to be designed to treat arthritis, which may explain why you feel (what I believe is what you are saying, correct me if I'm wrong) it has a much bigger effect on treating that type of pain. Still, I may ask my GI doctor about it if Cymbalta suddently just seems to stop working for me in the future.


M&M said:


> Bentyl (dicyclomine) is an antispasmodic. That means it suppresses smooth muscle contraction. Because of the way this drug works, it does have the side effect of worsening GERD.Lyrica (pregabalin), on the other hand is an anticonvulsant. That means it suppresses the rapid (or excessive) firing of neurons that start a seizure. There is a range of anticonvulsants that all work by blocking various receptors, or by inhibiting the release of various chemicals in the body.So these 2 drugs work it totally different ways.There is a correlation between Cymbalta use and use of Lyrica. Cymbalta has often been used to treat diabetic neuropathy and other chronic pain conditions. So it's possible that if Cymbalta has helped your pain the past, Lyrica could help it as well. I've read many reports of people who took Cymbalta for pain in the past, and were switched to Lyrica when the Cymbalta stopped working for them.Lyrica is a serious drug though, and comes with serious side effects. It can worsen depression, and is known to cause extreme weight gain - weight gain that can continue after stopping the medicine. But, if your pain is so severe you can't function, then maybe weight gain would be an acceptable result to deal with.I think it would be worth a conversation with your doctor, if your pain isn't under control, or isn't bearable currently. Lyrica is priced very similarly to Cymbalta, so it isn't a cheap drug either, unfortunately. Normally, I don't think patients are just written a scrip for Lyrica. It's usually used when a previous med stops working, or the pain is so severe that you'd rather die than continue living.Hope this helps!


That does indeed help very much. Thanks for the information. Thankfully I'm not at the place anymore where my IBS pain is so bad that I'd rather die than continue living, so I'm thinking I'll probably want to avoid Lyrica for the present time. However, it is still helpful to know that a drug like this is available if that should ever happen (again) in the future. Unfortunately although Cymbalta gets rid of a fair bit of my IBS related pains, I never really have had much success with it in getting rid of chest pains (maybe from GERD, maybe not... recent developments have caused me to wonder). I say that even though I'm taking Nexium, Cymbalta, and now Prescription strength Zantac as well (which a new GI doctor decided I should take before going to bed at night; or in the morning in my case - third shift is no fun







). Still, the IBS pains that I used to have dwarf these new chest pains by comparison, but they are disconcerting, to say the least (especially when they're accompanied by blood in the saliva/phlegm), but luckily that is a fairly rare occurrence and the amount of blood is usually pretty small and not constant (i.e. it'll happen for two or three times that I bring up phlegm, but then it'll "go back to" normal color). So I don't know...Either way, thanks to everyone who took the time to reply to me, and I apologize for taking so long to reply in return...


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