Milnacipran HCl (Savella)
Pregabalin (Lyrica), duloxetine (Cymbalta), and milnacipran HCl (Savella)are medications approved by the FDA for the treatment of fibromyalgia. Fibromyalgia is a chronic disorder characterized by widespread pain and tenderness, general fatigue, and non-restful sleep. Doctors do not currently know the cause of fibromyalgia, but it is believed that people with this condition have experienced a rewiring of pain pathways in the brain due to repeated nerve stimulation. As a result, the central nervous system (your brain and spinal cord) experiences an increased sensitivity to pain signals. Many people with lupus have fibromyalgia; in fact, much of the pain that people with lupus feel is due to this condition. Both pregabalin and duloxetine were originally developed to treat other conditions (epilepsy and depression, respectively), but they have also proven successful in reducing some of the physical and emotional symptoms of fibromyalgia.
Pregabalin helps fibromyalgia by reducing pain by up to 25% and improving sleep and fatigue. Many people also report that this medication helps to improve their overall vitality. It is not known exactly how pregabalin works to combat symptoms of fibromyalgia, but some believe that it binds to a protein in nerve cells that is responsible for heightened pain sensitivity. Like other medications, pregabalin can have some side effects, including dizziness, drowsiness, dry mouth, edema, blurred vision, weight gain, swelling of the hands and feet, constipation, exaggerated feelings of happiness/wellness, balance disorder, increased appetite, and difficulty concentrating.
Duloxetine also helps to improve pain and promote an overall feeling of improvement in patients with fibromyalgia. It is not known exactly how duloxetine works in the body against the symptoms of fibromyalgia, but it is known that this medication increases the activity of two neurotransmitters in the brain, serotonin and norepinephrine. These neurotransmitters are known to be linked to emotion and mood, but research also suggests that they are involved in the brain’s natural pain-suppressing system. Duloxetine can have some side effects, including nausea, dry mouth, constipation, decreased appetite, drowsiness, increased sweating, and agitation. More information on duloxetine can be found under the information sheet, “Antidepressants.”
Like duloxetine, milnacipran also increases the activity of the neurotransmitters serotonin and norepinephrine and was first used as an antidepressant. However, the drug has been shown to significantly improve pain and physical function in people with fibromyalgia and was approved this year by the FDA for the treatment of this condition. Like pregabalin and duloxetine, it is not known precisely how milnacipran works to combat fibromyalgia.
While pregabalin, duloxetine, and milnacipran can help reduce discomfort, there are many things that you can do on your own to help ease and manage the symptoms of fibromyalgia. Some people believe that limiting their daily activities helps to reduce pain and fatigue. However, doctors recommend that people with fibromyalgia continue to engage in their regular daily activities. Scheduling daily rest times may help you to keep a normal schedule; spending too many hours resting may make your symptoms worse and prevent you from adjusting to life with fibromyalgia.
In addition, since responses to stress can cause physical symptoms such as headache, increased pain, and muscle tension, try to practice stress management skills. There are some stressors that you can control, and there are some that are simply out of your hands. Focus on what you can control, and direct your energy toward future growth. Practice stress management by identifying stressors, focusing on what you can control, using coping techniques when a stressor is beyond your control, practicing relaxation techniques, and sometimes, simply letting go.
In addition, try to practice a healthy lifestyle. Research has shown that light stretching activities such as Tai chi and yoga can help to relax muscles and improve some of the pain associated with fibromyalgia. In addition, molecules released by your brain after exercise—usually about 30 minutes of moderate or intense activity—help you to achieve a ‘natural high,’ and many people report that exercise simply makes them feel better overall. Other lifestyle elements, such as a supportive social network and a healthy diet, can also help to ease feelings of emotional and physical discomfort and promote an overall sense of well being. Remember that you play the most important role in maintaining your own personal health. Your doctor can help you to devise strategies if you feel you need more help in managing your fibromyalgia.