Fibromyalgia is a disorder which causes pain in the body that ranges from mild to severe. It can also cause symptoms of fatigue, sleep disruptions, memory issues, and mood problems.
Fibromyalgia affects the way the brain processes pain signals, causing a person’s sense of pain to be heightened. Fibromyalgia is a chronic disorder with no cure available, but there are a number of medications available to treat symptoms.
Gabapentin, known by its trade names Neurontin, Horizant, and Gralise, is an anticonvulsant that is sometimes prescribed to treat symptoms of fibromyalgia.
This video produced by the Drug Classroom gives a brief summary of the medication. Gabapentin works by acting on electrical activity in the brain. Research has shown that patients suffering from fibromyalgia can manage their chronic pain with gabapentin.
Gabapentin is similar to the drug Lyrica that has been approved by the FDA to treat fibromyalgia. Gabapentin itself has not yet been approved by the FDA for the treatment of fibromyalgia. It is approved to treat epilepsy, neuropathy, restless legs syndrome, and hot flashes.
What are the Symptoms of Fibromyalgia?
Fibromyalgia symptoms affect patients both physically and mentally. This video by Nucleus Medical Media gives a quick overview of fibromyalgia. Symptoms vary from person to person but can be severe in some patients.
According to the National Fibromyalgia Association, it is estimated that 10 million Americans suffer from fibromyalgia, with the majority of sufferers being women.
Symptoms of fibromyalgia include generalized musculoskeletal pain, fatigue, sleep disorders, memory problems, stiffness, depression and anxiety, migraines, overactive bladder, irritable bowel syndrome, gastroesophageal reflux, and tension headaches. The generalized, chronic pain of fibromyalgia can be difficult to treat.
In addition to a generalized muscle pain, patients with fibromyalgia often feel what is known as tender point pain. Tender point pain occurs in areas that are painful when pressed, typically around joints.
These areas are usually felt directly under the skin rather than deep in the muscle tissue. These areas are about the size of a penny and when touched may cause the patient to pull away.
Tender point pain is often used as a tool to help physicians diagnose fibromyalgia. During an exam, the physician will apply pressure to the specific areas commonly causing pain for sufferers. The exam may also include control areas where the physician will apply pressure in order to rule out other conditions.
Social isolation among patients with fibromyalgia is common due to the chronic pain they suffer. The pain takes an emotional toll on patients and can cause them to withdraw from social activities and friends. This social isolation can lead to increased incidences of depression.
How is Fibromyalgia Diagnosed?
In order to diagnose fibromyalgia, multiple tests and observations about symptoms are made by a physician. In the past, it took an average of five years for a proper diagnosis to be made.
Although there is not one test that can irrefutably diagnose fibromyalgia, today’s healthcare professionals are more aware of the disorder.
There are currently no diagnostic tests available to diagnose fibromyalgia. Blood tests and other imaging may be performed in order to rule out other illnesses.
The diagnostic criteria for fibromyalgia include pain and other symptoms occurring over the last week based on the total number of tender points and the severity of the pain.
Other symptoms that must be present for a proper diagnosis include fatigue, waking up feeling tired, and cognitive problems. Symptoms that have lasted at least three months with a similar severity are also diagnostic of fibromyalgia.
What Causes Fibromyalgia?
The cause of fibromyalgia is undetermined. Scientists do understand the disorder is not autoimmune and does not involve inflammation or damage to the muscles or joints. There may be a genetic component to the disorder as it tends to run in families.
Usually, there is a trigger associated with the initial onset of fibromyalgia. This can include events like arthritis, injuries, or traumas. In addition to physical stresses, emotional stress can also trigger the onset of the disorder.
Are there Complications of Fibromyalgia?
Although fibromyalgia itself does not cause observable damage to the tissues, it is not without it is not without complications.
According to the Centers for Disease Control, patients with fibromyalgia experience more hospitalizations, greater long-term disability due to pain, experience higher death rates due to suicide, and have higher rates of arthritis and lupus than those without the disorder.
What is the Treatment for Fibromyalgia?
Because there is no cure for fibromyalgia and the pain associated with the disorder tends to be chronic, pain management options must be carefully weighed. Opiate-based medications to treat pain can lead to severe addictions, especially for patients with chronic pain issues.
Opiates can also increase fibromyalgia patients’ sensitivity to pain, thereby worsening the symptoms. In order to avoid dependence on opioids, other pain medications are prescribed.
What is Gabapentin?
Gabapentin has gained popularity with patients and physicians for treating the chronic pain associated with fibromyalgia.
Although the exact cause of fibromyalgia is unknown, doctors believe that those who suffer from the disorder have a hyperactive sympathetic nervous system. Gabapentin works by quieting the nervous system and results in a reduction of pain.
Gabapentin specifically alters the release of the neurotransmitter in the brain called glutamate. Glutamate stimulates certain cells in the brain.
It also works to help transmit pain signals in the nerves. If too much glutamate is present, the nerve cells become overly sensitive to pain signals, causing increased pain felt throughout the body.
The neurotransmitter, gamma-aminobutyric acid (GABA) works to counteract the effects of glutamate. When the two neurotransmitters are in balance, they work together properly and pain is experienced normally.
It is thought that fibromyalgia occurs due to an abundance of glutamate in the brain. Gabapentin acts like GABA to keep glutamate levels in check.
Gabapentin is typically prescribed as a daily medication. It is not used like other pain medications where patients only take them when they are experiencing pain symptoms. It usually will not provide immediate relief but should be taken every day to lessen a patient’s sensitivity to pain.
Although gabapentin has shown promise in treating fibromyalgia, it is not yet approved by the FDA to treat the disorder. Doctors have been prescribing it for off-label use and insurance companies most often cover the cost for this purpose.
According to Fibromyalgia News Today, a small study suggests that gabapentin relieve pain symptoms and improved the quality of life for its subjects who suffered from fibromyalgia. Study participants also reported improvements in the quality and quantity of their sleep.
Although some studies suggest that gabapentin is effective in treating fibromyalgia, other studies have suggested it is only slightly more effective than a placebo according to Cochrane Library.
It is often compared to Lyrica, but Lyrica has been shown in studies to be more effective at controlling symptoms of fibromyalgia. Research is currently being done on an extended-release form of gabapentin to determine its effectiveness in treating the disorder.
What are the Side Effects of Gabapentin?
Gabapentin can be useful for fibromyalgia sufferers, but it does have some side effects and drawbacks. The medication can produce a morning “fog” where patients feel groggy upon waking and experience lack of focus. The time of day that patients take gabapentin may need to be adjusted to avoid grogginess during the day.
In addition to a groggy feeling, patients may also experience dizziness, drowsiness, swelling of the hands and feet, weight gain, and involuntary eye rolling or muscle jerking.
The frequency and severity of these side effects usually increase as the dosage is increased. Some patients who take gabapentin can have increased anxiety, depression, and experience suicidal thoughts.
Tolerance to gabapentin can be experienced over time and dosages will need to be adjusted accordingly. If a patient decides to they would rather not take gabapentin anymore, they will need to be weaned gradually off the medication in order to prevent withdrawal symptoms.
Although gabapentin is not a narcotic and is not classified as a controlled substance, it does share similar withdrawal effects with opiate-based medications.
Some of these withdrawal symptoms include sweating, anxiety, muscle pain, and insomnia. The recreational use of gabapentin has also increased in recent years. Fortunately, even at high doses, there is little to no risk of overdose.
Gabapentin may help fibromyalgia sufferers, but should also be used in conjunction with other therapies and medications.
Physical therapy, antidepressants, and other pain medications can be used in addition to gabapentin to lessen the severity and frequency of pain flare-ups. This can lead to a healthier long-term outlook for patients diagnosed with fibromyalgia.
In addition to medical therapies, when emotional stressors are removed from patients’ lives, their outlook improves.
Stress can be a trigger for fibromyalgia symptoms, and when the stress is eliminated, in many cases, the symptoms are also eliminated. While this is not a cure for the disorder, many patients report not needing medications when their stress level is reduced.
