Q: With both fibromyalgia and osteoarthritis, I have constant pain. Even with treatment, it never goes away completely. I’ve just been “dealing with it.” Is that OK?
A: Chronic pain is not a problem you should just put up with; in fact, you should make every effort to reduce it because an increasing number of studies are showing serious consequences of having chronic pain. It may cause damage to certain areas of the brain, just as chronic stress does. It also may lead to psychological problems, such as depression; social problems, such as isolation or decreased earnings potential; and functional problems, such as decreased activity or disability.
Overall, people do far better if they take an active role in aggressively managing their chronic pain-inducing condition(s). You should treat pain, as long as the treatments you use do not have side effects that exceed the benefits. Practicing relaxation techniques and sticking with a regular exercise plan may reduce pain in some of the same ways as pain medications. Massage and some supplements also may provide similar benefits, but these therapies have had less research documenting the benefits.
For moderate-to-severe knee osteoarthritis (OA), the supplement glucosamine may provide some relief, as may the right combination of analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs). The analgesic tramadol (Ultram), four antidepressant medications – amitriptyline (Endep), cyclobenzaprine (Cycloflex), duloxetine (Cymbalta) and fluoxetine (Prozac) – and two anti-seizure medications – gabapentin (Neurontin) and pregabalin (Lyrica) – have been studied in people with fibromyalgia.
In fact, Lyrica, developed to help ease pain, promote sleep and reduce fatigue, became the first drug approved by the FDA to treat fibromyalgia in 2007. Cymbalta and milnacipran HCl (Savella), both designed to help ease fibromyalgia pain, became the second and third drugs, respectively, approved by the FDA to treat the condition. Savella is also designed to help manage the fatigue associated with fibromyalgia.
Tell your doctor that the treatments you tried previously are not resolving your chronic pain, and then work with him to find the right combination of treatments for you. It may take some time, but the end result will be worth the effort.
Daniel Clauw, MD, Rheumatologist
