Tag Archive | Flexeril

Chapter 2-Three Things We Know About Fibromyalgia

There is a lot of good content in this chapter, so bear with me as I share it.  Let me know what you think!  The information in this chapter discussion are not meant to diagnose or treat fibromyalgia.  Always, check with your doctor before beginning any treatment.

Despite being the second most prevalent rheumatologic disease, there has been relatively little research undertaken to understand Fibromyalgia.

1. Fibromyalgia is Associated with Disordered Pain Processing

The evidence in the medical literature is strongly supportive of abnormal processing of pain information in the central nervous system to physically induced pain such as pressure, heat, cold, or electrical stimulation resulting from generalized lowered pain thresholds in fibromyalgia.  The evidence is strongly supportive of an abnormality in the central nervous system pain processing known as central nervous system sensitization or central sensitization for short.  People with fibromyalgia feel pain more readily and with a much higher sensitivity, than those without fibromyalgia.  There is clear evidence for increased sensitivity to external painful stimuli in patients with fibromyalgia.

There are, also, neurotransmitter abnormalities which can be associated with serotonin level issues.  Not source or cause of pain has been identified in all of the studies.  Studies have not identified the sources or cause of the seemingly spontaneous pain reported in fibromyalgia.

2.  The Treatment of Fibromyalgia is Profoundly Disappointing.

Patients are being told they have a chronic painful disease that may impair their ability to function with no known cause, cure, or highly effective treatment and that they must learn to live with it.

Medications do not seem to help much.  Nonsteroidal anti-inflammatory drugs (NSAIDS) are frequently prescribed despite the evidence indicating that they are no better than the placebo.  Prednisone has not been show to be of benefit, either.  Analgesics are also frequently used in managing fibromyalgia symptoms despite little data regards their effectiveness.  Acetaminophen has shown less benefit.  Tramadol (Ultram) is a weak opioid medication.  There is some benefit using it alone or in combination with acetaminophen.  Antidepressant and other psychoactive medications are used frequently to manage the symptoms of fibromyalgia.  The most used and studied is Elavil and the muscle relaxant Flexeril.  In low doses (10-50 mg daily) Elavil has shown improved pain.  Flexeril in studies (given 10-40 mg daily) have reported improvement in pain, sleep, global well-being, and fatigue.  Long term use of either Elavil or Flexeril is unknown.  Selective serotonin reuptake inhibitors (SSRIs) (like Prozac, Celexa, and Zoloft) are a class of drugs that have been highly successful in treating psychiatric conditions such as depression, anxiety, and phobias.  When given to treat fibromyalgia in studies, they are not consistently showing improvement in pain.  But one study using Prozac and Elavil showed they were more effective in reducing pain and symptoms than either drug alone.  When studies were conducted using Effexor the results were mixed and inconsistent.  Cymbalta (used in studies) showed some improvement in some but not all pain measures, reduction in tender point counts, and some improved quality of life measures in women with fibromyalgia, but not in men.  S-adenosyl-L-methionine (SAMe) is a compound that has antidepressant, anti-inflammatory, and analgesic properties.  One trial showed improved mood and tender points, another showed improvement in mood, pain, overall disease activity and fatigue, and a third study showed no benefit.  Studies using Neurontin and/or Lyrica demonstrated improvements in pain, sleep, fatigue, and global symptom severity in higher doses. A placebo controlled trial to assess the benefit of Lyrica in patients with fibromyalgia showed that 63% of patients achieved significant reduction of pain initially, and after 26 weeks of treatment, 32% of those patients lost the therapeutic response achieved at onset but significantly more patients sustained a defined improvement compared to placebo treatment.  The expectorant guaifenesin has been used to treat fibromyalgia on the assumed, but unproved, theory that there is an excess accumulation of phosphate in the muscles and that this can be excreted by the action of guaifenesin.   A one year double blind controlled trial failed to demonstrate any improvement in global functioning or tender point counts.

The medication trial data do show that Flexeril and Elavil appear to be the most helpful drugs in managing fibromyalgia for reasons to be yet determined.

Study programs providing exercise about 1-3 times weekly for a range of about 6 weeks to 6 months and involved either walking, bicycling, dancing, or swimming with or without accompanying education, showed improvement in pain, pain threshold, tender point counts, fatigue, quality of life, and psychological distress.  But improvement is not uniformly noted.  Maximal exercise has been shown to increase pain sensitivity in patients with fibromyalgia.  The degree of improvement is not dramatic.  Tender point pain threshold improves by 28% and pain is reduced by 11%.  Some patients receive nominal benefit from aerobic cardiovascular fitness training while others cannot tolerate such programs.

Cognitive behavioral therapy (CBT) programs include education, coping skills training, cognitive and behavioral training, and relapse prevention.  All programs are centered around fibromyalgia.  Additional components may include relaxation training, stress management, biofeedback, meditation, exercise, physical therapy, or occupational therapy.  Studies are showing benefits from CBT.  There is improvement in pain, tender point counts, stiffness, stress when stress management is incorporated, distress, functional ability, sleep mood including depression and anxiety, and general healthy assessment.  And it sustained up to 30 months following completion of the program.

It is virtually impossible to perform blinded studies with regard to the patient and the treatment provider for non-medication interventions.  Hands-on type treatments are subjective in their application and difficult to standardize.  Some of those treatments are Electromyography (EMG) biofeedback, hypnosis and relaxation training, meditation, neck support, acupuncture, nutritional interventions and dietary supplements, whirlpool baths with valerian, dietary modifications, static magnet therapy, chiropractic intervention, massage therapy.  As with all the other treatments reviewed, the treatment trial data clearly tell us that fibromyalgia is not a homogeneous disease or process and that we have no clue as to what to target any treatment against nor how to measure its benefit.

3.  Patients with Fibromyalgia Do Not Do Well In the Long-Term

Patients with fibromyalgia in general do not do well in the long term, although those with milder symptoms may do better because inherently they have less severe symptoms and involvement.

2 Bad Days in a Row & Warm Water Therapy

Well, yesterday was a REALLY bad day.  The pain has been building up.  The pain is in my thighs and arms.  It would not go away with any of the medications I have.  I have tried the Flexeril, Ibuprofen, Tramadol, and Vicodin.  Nothing is touching the pain.  It escalated to the point that I couldn’t even walk.

As a precaution I have all of my meds and a glass of water on my nightstand.  I have basket of all of my meds.  It’s kind of crazy, but I have to prepare for the worst.  And the worst happened yesterday.  The meds worked well enough to get me out of bed and up the stairs to eat breakfast and then up again at dinner time.  But I just had my breakfast and dinner held until I could get out of bed.

I am very fortunate to be living with my parents, who help me out a lot.  I try not to ask much of them.  But they are kind enough to take my dog out and feed him in the morning.  He’s an early riser and grandma takes him potty when she gets up for work.  Then he likes to go in with Papa and have his cuddle time in the morning.  It really helps me out.  I can’t get out of bed before ten on most days.  It’s not because I’m lazy, it’s because I am so very exhausted.

My mom and I are taking a class through a local medical facility.  It’s a warm water arthritis class.  It had to be okayed by our doctors.  I’m hoping it helps both of us out.  She had fibromyalgia too.  I am looking forward to it.  It starts tomorrow.  Then I got a script from my doctor to go for warm water physical therapy.  I found a place in town to go too.

All in all, these past 2 days have been really rough.  I am still in pain, but I was able to get out of bed and shower today.  That’s a huge thing, sometimes!  It takes a lot out of me to shower on bad days.

Bad Fibro Day & Baclofen

I had a very rough day today.  The pain started at 3 AM.  I tried not taking anything because I needed to be some where today.  But when I rolled over at 6:30 AM, I couldn’t take the pain and needed to take my meds.  It was a pain like I haven’t had in quite some time!  It was widespread pain.  My arms, legs, back, and neck were killing me.  It was awful!

My doctor gave me a new medicine called Baclofen.  It’s another muscle relaxant.  It is stronger than Flexeril.  My insurance company said they were not going to insure the Flexeril any longer.  I was very nervous because it was helping with my pain.  But my doctor gave me some samples of Baclofen to try.  It works. It does appear to be stronger.  So I can now begin using it for my pain, along with my other basket full of meds by my bed.

Something to do today & Friends

Well, I had an errand to run today and had to do it no matter how I felt.  My aunt was counting on me and I already rescheduled.  We were supposed to do it on Tuesday.  So I felt obligated to do it.  I hate having to cancel on people when I am not feeling well.  It’s so inconvenient for the other person.  They get up and get ready and then I call and cancel their plans.  I hate it.  I feel like such a loser.  But the pain and exhaustion gets the best of me and I can’t function.

A few weeks ago I had plans with a friend that I just reconnected with after not talking for years.  I felt completely awful and couldn’t function.  I woke up at 4 am in horrible pain.  So I took my meds and knew I had to be up at 8 am.  So I set my alarm and when I woke up, I still felt awful.  My entire body was in pain and the medication, Flexeril, wasn’t working at all.  But it makes me extremely loopy.  So I sent her a text message at 8 am to let her know that I wasn’t going to be able to make it.  I didn’t want to call because I didn’t want to wake her up.  WELLLLL, that wasn’t the case at all.  I woke up at noon too missed phone calls and tones of texts.  In my loopy state, I sent my aunt the text that I couldn’t make it for coffee (to which she replied to me that she had no clue what I was talking about).  And texts, phone calls, and voice mail from my friend wondering where the heck I was.  I would have been so upset with me if I were her.  And that’s the life of a Fibromyalgia Sufferer!  My life is one big mixed up mess.

I feel awful that my life consists of constantly cancelling on people.  And I don’t know if they really understand what I am going through or not.  But I have to look at it from their perspective thinking how annoying I must be to have in the family or be friends with.