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 be dealing with chronic pain in ways that are effective. This is important because an increasing number of studies showing serious consequences of having chronic pain. It may cause damage to certain areas of the brain, just as chronic stress does. Chronic pain also may lead to psychological problems, such as depression; social problems, such as isolation or decreased earning potential; and functional problems, such as decreased activity or disability.
Overall, people do far better when they're aggressively dealing with chronic pain and with 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 in terms of dealing with chronic pain, 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, which eases pain, promotes sleep and reduces fatigue, has been approved by the FDA to treat 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 result will be worth the effort.
Daniel Clauw, MD, Rheumatologist