Over The Counter And Non-Prescription Fibromyalgia Medications

While there are no over the counter (OTC) medications available to treat fibromyalgia as an entire cluster or grouping of symptoms, there are some options available to treat individual symptoms. Different individuals with fibromyalgia may find these OTC options very effective in addressing concurrent medical conditions that may make the pain, sleeping difficulties and related symptoms more manageable.

One of the challenges that doctors have when prescribing medication for fibromyalgia is that the pain is not the same type of pain that occurs because of an injury or inflammation. The pain of fibromyalgia is related to the hypersensitivity of the pain management system within the central nervous system and the brain as opposed to actual pain in the peripheral pain receptors. The OTC pain medications are designed to block the transmission of chemicals from the peripheral pain receptors to the central nervous system, literally leaving the central nervous system without the messages necessary to process painful sensations.

Many people want to avoid the possible side effects that are common with both fibromyalgia specific medications such as Lyrica®., Cymbalta®. and Savella®. and choose OTC products that are readily available and tend to be much better tolerated. It is important to realize that many patients with fibromyalgia find that these options help to control and manage the symptoms but they do not treat or cure the condition.

If you are taking any prescription medications, it is important to talk to your doctor before using over the counter medications. It is also essential to avoid combining over the counter medications as this can cause serious drug complications. Adding herbal medications or nutritional supplements to over the counter or prescription medications also is potentially dangerous without reviewing the possible concerns in combining these treatments.

Analgesics

Analgesics are pain killer drugs and they act as described above to block the pain receptor at the skin from sending messages through to the central nervous system to be processed by the brain. They include a variety of different pain relief OTC medications including Tylenol and generic versions of this drug. All can be effective in reducing pain that is not related to fibromyalgia but have little effect on the pain experienced due to the fibromyalgia.

As with all medications, analgesics must be taken as recommended and daily dosages should not be exceeded. Often, the relief from these medications is very short term but can be effective in managing pain from other sources. Since fibromyalgia patients often find that fibromyalgia flares when overall body pain increases, this can be a good way to prevent this specific type of pain. 1

Most people have little if any reaction or side effects form the use of analgesics. Prolonged use or high dosage rates can results in some side effects such as liver disease, bleeding and bruising as well as pains in the back and sides.

NSAIDS

These drugs are used to prevent pain as well as decrease inflammation. They are non-steroidal anti-inflammatory drugs and can be marketed as ibuprofen, Aspirin, naproxen, and ketoprofen. There are multiple brand names for these medications but all are typically available both as an OTC and prescription option. Generally NSAIDS are well tolerated by most individuals and actually work to reduce the number of prostaglandins, the cells that produce the sensations of pain within the body.2 However, individuals with fibromyalgia have a hypersensitivity to pain, and the anti-inflammatory properties of NSAIDS do not change this process. Most studies show that NSAIDS are no more beneficial than placebo and thus are not recommended.

There is increasing evidence that the prolonged use of NSAIDS may actually cause additional health concerns. These include diarrhea and constipation, increased frequency and duration of headaches, as well as dizziness and possible skin rashes. The most serious complications of long term use are gastrointestial bleeding from ulcers and kidney damage. Most medical professionals recommend limiting use of these drugs to only acute injuries and not for chronic pain conditions. It is important to discuss the use of these medications with your doctor and determine if OTC or prescription options are most effective.

Sleep Medications

There are a range of OTC sleep medications that are available that may provide some relief to individuals with fibromyalgia. These include analgesics and NSAIDS combined with mild sedatives in the form of “PM” medications. These are generally considered safe with no serious side effects and no dependency concerns when used as directed. In addition, they may also provide some minor relief of the pain of fibromyalgia and they will assist in management of non-fibromyalgia pains.

Another option may individuals consider is the use of antihistamines to aid in sleep. While strictly sold OTC to provide relieve from allergies, sinus problems and colds, they do have a sedative effect for most people. Antihistamines commonly used to aid with sleep for people with fibromyalgia include those containing promethazine and diphenhydramine (benadryl®.). These medications should not be used on a regular basis as they can cause serious side effects ranging from blurred vision and dizziness to confusion and feelings of anxiety. In some individuals the use of antihistamines can. also lead to heart palpitations and increase the risk of insomnia.

Another option to aid in sleep is melatonin. It is a hormone that is available over the counter as a supplement. This hormone is what signals your brain that it is dark outside and thus, time for sleep. Many patients, with and without fibromyalgia, have found relief from their sleep difficulties by simply taking a little melatonin before sleep. In addition, melatonin is considered very safe, with few side effects at routinely recommended doses.

It is important to limit the number of medications that are being used to control the pain and symptoms of fibromyalgia. Studies show that women with fibromyalgia tend to use more medications for pain than women without fibromyalgia and that the effectiveness of the medication is often not considered. This includes prescription medications, over the counter medications and nutritional and herbal supplements that are marketed to help relieve pain. 3

References

1 Dadabhoy, D., & Clauw, D. (2006). Therapy Insight: fibromyalgia—a different type of pain needing a different type of treatment. Nature Clinical Practice Rheumatology , 364-372.

2 Zhao, Y., Sun, P., Watson, P., et al. (2010). Comparison of Medication Adherence and Healthcare Costs between Duloxetine and Pregabalin Initiators among Patients with Fibromyalgia. Pain Practice , 204-216.

3 Shaver, J. L., Wilbur, J., Lee, H., et al. (2009). Self-Reported Medication and Herb/Supplement Use by Women with and without Fibromyalgia. Journal of Women’s Health , 709-716.

This article was originally published on July 11, 2012 and last revision and update of it was 9/7/2015

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