Q: I finally found a medication (piroxicam) that helped my fibromyalgia pain and allowed me to be active again. However, after taking it for a while, I started having heartburn and stomach pain. My doctor had me stop the medicine. The stomach problems are better now, but my fibromyalgia pain is back. Is there any way I can ease the side effects so I can still take piroxicam? If not, can you recommend another similar drug that might help me?
A: Piroxicam (Feldene) is a nonsteroidal anti-inflammatory drug (NSAID), much like ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn). NSAIDs are notorious for causing gastrointestinal side effects, including the heartburn and stomach pain you experienced. Many people find those side effects can be reduced or eliminated by taking other types of drugs that protect the stomach and intestine.
The two types of drugs that have proven to be most effective are misoprostol (Cytotec), a synthetic prostaglandin that replaces the normal stomach-protective prostaglandins that NSAIDs wipe out, and the proton-pump inhibitors (PPIs), which include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix) and rabeprazole (Aciphex). PPIs block the production of stomach acid but may increase fracture risk.
If these protective drugs don’t help, another option is to try celecoxib (Celebrex) – a type of NSAID called a COX-2 inhibitor, which is designed to be safer for the stomach than traditional NSAIDs, such as piroxicam. However, be aware that Celebrex is not appropriate if you have a sensitivity to sulfonamides, a type of sulfa drug. Every drug carries some potential risks, but not treating medical problems can be risky, too. Before beginning any new drug, it is important to review your medical history with your doctor, who can weigh the risks of the medication against the problems you are trying to ease or prevent.
Dan Clauw, MD, Rheumatologist
For most of us, there is one or two that help but sometimes you get extra problems.
I can't use Lyrica because of the stomach issues and also the drowsiness is causes. I I rely now on ibuprophen, Cymbalta and Prilosec. Its not perfect, but it helps.
Interestingly, what I find really helps during a bad flare is lasix. I discovered that many of my target pain areas are caused by a build up of fluid in these places. Some near the surface I can "push" in with a heel of the hand, or tennis ball. It hurts like heck, but only for a few seconds, and then relief as it squeezes most of the fluid away into the tissues! Sometimes I do this every day, more often once a week to once a month. During bad flares, I take lasix for a day or two and it relieves much of the pain. The dr. has me taking a potassium tablet along with the lasix. I don't have to use it very often. Its manageable at least.
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