NSAIDs for Fibromyalgia & Chronic Fatigue Syndrome

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The lack of inflamamtory findings

The diagnosis of fibromyalgia (FM) is considered when patients complain of diffuse muscle and soft tissue pain with tender points. Pure or primary FM (not assoicated with any other inflammatory disease) is non-inflammatory beasue of it poor response to anti-inflammatories and the lack of inflamamtory findings on blood work and exam. However patients with inflammatory diseases such as RA can have diffuse musuloskeletal pain that feels like FM but responds to anti-inflammatories and thus likely casued by inflammation.

What are NSAIDs?

When we talk about NSAIDs, we are usually referring to those over-the-counter (OTC) pain relievers that are readily available at your grocer or pharmacy. These include ibuprofen (Advil and Motrin), naproxen sodium (Aleve), and aspirin (Bayer and Excedrin).  Most people assume that acetaminophen (Tylenol) is in the NSAID family, but it’s not technically in this same group of OTC drugs. In fact, not only does acetaminophen have no effect on inflammation, but researchers are still not sure exactly how it works.  It is technically an analgesic or pain killer.  There are several other types of prescription NSAIDs, but we are going to focus on the ones that are most well-known.

Anti-inflammatory drugs are pain killers

One of the most common types of painkillers is anti-inflammatory drugs. A commonly used type of anti-inflammatories is called NSAIDs, which stands for non-steroidal anti-inflammatory drugs. Popular OTC NSAIDs include:

  • >Advil, Motrin (ibuprofen)
  • >Aleve, Naprosyn (naproxen)
  • >Bayer, Bufferin, Excedrin (aspirin)

These drugs are also available in prescriptions strengths. Prescription-only NSAIDs include:

  • >Relafen (nabumetone)
  • >Feldene (piroxicam)
  • >Orudis (ketoprofen)
  • >Voltaren (diclofenac)
  • >Lodine (etodolac)
  • >Celebrex (celecoxib)

Not all fibromyalgia pain comes from inflammation

Ibuprofen, naproxen sodium, and aspirin are typically taken for general pain. Sometimes they are suggested to treat pain levels associated with different kinds of surgery. Thus, it makes sense to think of these as a way to seek relief from fibromyalgia pain. The problem is that not all fibromyalgia pain comes from inflammation. In fact, the lack of inflammation with fibromyalgia is one of the key distinctions between that and inflammatory conditions like rheumatoid arthritis. However, there is at least one study that suggests that inflammation in the fascia, the fibrous sheath covering the muscles, plays some role in Fibromyalgia. Nevertheless, inflammation is not a marker in diagnosing fibromyalgia at this stage.

 

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Dangers of NSAID

According to the American Journal of Medicine, more than 100,000 people are hospitalized due to NSAIDs each year in the U.S. Additionally, 15-20,000 die each year from NSAID-related problems such as ulcers and gastrointestinal bleeding, and as many as 60 percent of NSAID users may develop digestive side effects. NSAIDs are also linked to an increased risk of dying from heart attack or stroke. These drugs can lead to liver or kidney problems, as well.

Potential side effects of drugs like Vioxx-COX-2 Inhibitors:

 Fibromyalgia Pain Relief Vioxx is what doctors call a “COX-2 inhibitor.”Fibromyalgia Pain These drugs were developed to reduce pain and inflammation without the risk of ulcers and other potentially deadly gastrointestinal side effects posed by aspirin and similar medications. But in solving one serious problem, COX-2 inhibitors might be causing another.Just before Celebrex and Vioxx were approved and launched, a group of researchers led by Garret FitzGerald, MD, chair of the department of Pharmacology, and director of the Institute for Translational Medicine and Therapeutics at Penn, observed that both drugs suppressed prostacyclin in humans.

Prostaglandin

Most medical researchers agree that the pain relief associated with anti-inflammatory drugs is just a helpful benefit of what they actually do. That is, they block a type of lipid, called a prostaglandin, from being fully synthesized within the body. Prostaglandins do many things, but they ultimately are responsible for a vital role within the process of inflammatory reaction in the body.  So blocking them from spreading or even starting prevents the inflammatory response within the body.  And no inflammation means no pain from inflammation.

Fibromyalgia pain does not often stem from inflammation in the first place.

Sounds great, right? Not so fast. You see, the problem is that fibromyalgia pain does not often stem from inflammation in the first place. However, fibro patients often suffer from other conditions as well. Those other conditions, such as arthritis, that are rooted in inflammation do respond quite well to anti-inflammatory drugs. With that said, there is really only one way to figure out if anti-inflammatories will work for you: try them for yourself. You may find that it relieves some of your pain, but not all of it. On other days, however, it might be the perfect remedy and give you the relief you need to make it through your whole day pain-free. And if works, that’s what matters.

Potential side effects of other NSAIDS:

Fibromyalgia Pain a person taking NSAIDs is seven times more likely to be hospitalized for gastrointestinal adverse effects. The FDA estimates that 200,000 cases of gastric bleeding occur annually and that this leads to 10,000 to 20,000 deaths each year. NSAIDs more than double a person’s risk of developing high blood pressure, possibly leading to more medication. In one study, 41% of those who had recently started on medication to lower their blood pressure were also taking an NSAID.

Talk to your doctor

You and your doctor should decide together whether NSAIDs are appropriate for you, based on your diagnoses, symptoms, overall health and lifestyle factors. It’s important to note that one NSAID may work better for you than others, so it may take experimentation with different drugs to achieve the best results. If you don’t feel NSAIDs are effective at reducing your pain, talk to your doctor about possible alternatives and weigh the risk against the benefits.

 

Related article: Systematic Inflammation found in Fibromyalgia

 

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Reference:

  • NSAIDs for Fibromyalgia and Chronic Fatigue Syndrome By Adrienne Dellwo via verywell health

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