Arthritis Advice

The word “arthritis” makes many people think of painful, stiff joints. But, there are many
kinds of arthritis, each with different symptoms and treatments. Most types of arthritis are chronic. That means they can go on for a long period of time.

Arthritis can attack joints in almost any part of the body. Some types of arthritis cause changes you can see and feel—swelling, warmth, and redness in your joints. In some kinds of arthritis, the pain and swelling last only a short time, but are very uncomfortable. Other types of arthritis might be less painful, but still slowly cause damage to your joints.

Common Kinds of Arthritis

Arthritis is one of the most common diseases in the United States. Older people most often have osteoarthritis, rheumatoid arthritis, or gout.

Osteoarthritis (OA) is the most common type of arthritis in older people. OA starts when tissue, called cartilage, that pads bones in a joint begins to wear away. When the cartilage has worn away, your bones rub against each other. OA most often happens in your hands, neck, lower back, or the large weight-bearing joints of your body, such as knees and hips.
OA symptoms range from stiffness and mild pain that comes and goes to pain that doesn’t stop, even when you are resting or sleeping. Sometimes OA causes your joints to feel stiff after you haven’t moved them for awhile, like after riding in the car. The stiffness goes away when you move the joint. Over time, OA can make it hard to move your joints. It can cause a disability if your back, knees, or hips are affected.

Why do you get OA? Growing older is what most often puts you at risk for OA, possibly because your joints and the cartilage around them become less able to recover from stress and damage. Also, OA in the hands may run in families. Or, OA in the knees can be linked with being overweight. Injuries or overuse may cause OA in joints such as knees, hips, or hands.

Rheumatoid arthritis (RA) is an autoimmune disease, a type of illness that makes your body attack itself. RA causes pain, swelling, and stiffness that lasts for hours. RA can happen in many different joints at the same time. People with RA often feel tired or run a fever. RA is more common in women than men.

RA can damage almost any joint. It often happens in the same joint on both sides of your body. RA can also cause problems with your heart, muscles, blood vessels, nervous system, and eyes.

Gout is one of the most painful kinds of arthritis. It most often happens in the big toe, but other joints can also be affected. Swelling may cause the skin to pull tightly around the joint and make the area red or purple and very tender.

Eating foods rich in purines like liver, dried beans, peas, anchovies, or gravy can lead to a gout attack. Using alcohol, being overweight, and taking certain medications may make gout worse. In older people, some blood pressure medicines can also increase the chance of a gout attack. To decide if you have gout, your doctor might do blood tests and x-rays.

Warning Signs

You might have some type of arthritis if you have:

• Ongoing joint pain
• Joint swelling
• Joint stiffness
• Tenderness or pain when touching a joint
• Problems using or moving a joint normally
• Warmth and redness in a joint

If any one of these symptoms lasts more than 2 weeks, see your regular doctor or one who specializes in treating arthritis, called a rheumatologist. If you have a fever, feel physically ill, suddenly have a swollen joint, or have problems using your joint, see your doctor right away.

Treating Arthritis

Getting enough rest, doing the right exercise, eating a healthy, well-balanced diet, and learning the right way to use and protect your joints are keys to living with any kind of arthritis. The right shoes and a cane can help with pain in the feet, knees, and hips when walking. There are also gadgets to help you open jars and bottles or to turn the doorknobs in your house.

Some medicines can help with pain and swelling. Acetaminophen might ease arthritis pain. Some people find NSAIDs (nonsteroidal anti-inflammatory drugs), like ibuprofen, naproxen, and ketoprofen, helpful. Some NSAIDs are sold without a prescription, while others must be prescribed by a doctor. Be very careful about possible side effects of some NSAIDs, whether sold with or without a prescription. Read the warnings on the package or insert that comes with the drug. Talk to your doctor about if and how you should use acetaminophen or NSAIDs for your arthritis pain. The U.S. Food and Drug Administration has more information about these drugs.

Osteoarthritis (OA). Medicines can help you control the pain. Rest and exercise may make it easier to move your joints. Keeping your weight down is a good idea. If pain from OA is very bad, there are shots your doctor can give you.

Rheumatoid arthritis (RA). Treatment can help the pain and swelling. This might slow down or stop joint damage. You may feel better and find it easier to move around. Your doctor might also suggest anti-rheumatic drugs called DMARDs (disease-modifying antirheumatic drugs). These can slow damage from the disease. Other medicines known as corticosteroids (like prednisone) can ease swelling. Another kind of drug, called a biologic response modifier, blocks the damage done by the immune system. These may help people with mild-to-moderate RA when other treatments have not worked.

Gout. The most common treatment for an acute attack of gout is NSAIDs or glucocorticoids like prednisone. They can bring down the swelling, so you may start to feel better within a few hours after treatment. The pain usually goes away within a few days. Glucocorticoids are strong medicines. They should only be taken with a doctor’s prescription. If you have had an attack of gout, talk to your doctor to learn why you had the attack and how to prevent future attacks. If you have had several attacks, your doctor might prescribe medicines to prevent future ones.

Exercise Can Help

Along with taking the right medicine and properly resting your joints, exercise might help with arthritis symptoms. Daily exercise, such as walking or swimming, helps keep joints moving, lessens pain, and makes muscles around the joints stronger.

Three types of exercise are best if you have arthritis:

• Range-of-motion exercises, like dancing, might relieve stiffness, keep you flexible, and help you keep moving your joints.
• Strengthening exercises, such as weight training, will keep or add to muscle strength. Strong muscles support and protect your joints.
• Aerobic or endurance exercises, like bicycle riding, make your heart and arteries healthier, help prevent weight gain, and also may lessen swelling in some joints.

Other Things To Do

Along with exercise and weight control, there are other ways to ease the pain around joints. You might find comfort by using a heating pad or a cold pack, soaking in a warm bath, or swimming in a heated pool.

Your doctor may suggest surgery when damage to your joints becomes disabling or when other treatments do not help with pain. Surgeons can repair or replace some joints with artificial (man-made) ones.

Other Remedies

Recent studies suggest that acupuncture may ease OA pain for some people. Research also shows that two dietary supplements, glucosamine and chondroitin, may help lessen moderate to severe OA pain, but they seem to have no effect on changes to cartilage in the knee. Scientists continue to study these kinds of alternative treatments. Always check with your doctor before trying any new treatment for arthritis.

Many people with arthritis try remedies that have not been tested or proven helpful. Some of these, such as snake venom, are harmful. Others, such as copper bracelets, are harmless, but also unproven.

How can you tell that a remedy may be unproven?

• The remedy claims that a treatment, like a lotion or cream, works for all types of arthritis and other diseases.
• Scientific support comes from only one research study.
• The label has no directions for use or warning about side effects.
• The person recommending the treatment profits directly from your purchase of the medicine.
• People who are now completely well are presented to you as having the same problems you have (this is called anecdotal evidence).

Talk To Your Doctor

Pain and arthritis do not have to be part of growing older. You can work with your doctor to safely lessen the pain and stiffness and to prevent more serious damage to your joints.

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Combo Joint Health Supplements may be Mislabeled

The type and amount of active ingredients in a joint health supplement oftentimes dictate the efficacy and price of the product. But commercialism has heralded the arrival of fly-by-night manufacturers of joint health supplements who are armed with mislabeling and misrepresentation as their tools of trade.
It is with this premise that anyone out on the market in search of an effective joint health supplement should be wary of joint supplements that tout words such as “formula”, “blend” and “complex” especially when the amount by weight of each component is not indicated.
There is also a big possibility that these joint health supplements do not have the adequate levels of ingredients required to produce the desired effect on the patient.
The most common ingredients of joint health supplements are glucosamine and chondroitin. These are also the most common products that several manufacturers of joint health supplements toy around with, without consideration to the effects it may have on the users. They mistakenly often work around the principle that if both are good individually as joint health supplements, combining them together in one joint health supplement preparation would eventually bring out better results regardless of the amount and the form of ingredients used.
Independent tests have proven that there are joint health supplements in the market which claim to have combination preparations consisting of both glucosamine and chondroitin.
Since chondroitin is 10 times as expensive compared to glucosamine, these combination joint health supplements may contain less chondroitin, which oftentimes do not meet the required levels for a joint health supplement to be effective. The matter on the cost of chondroitin has given rise to concerns of the quality and quantity of chondroitin in joint health supplements.
The type of glucosamine will also dictate the efficacy and price of a joint health supplement. Different types of glucosamine do not perform the same function and not all are effective in treating joint pains. Among the different types, glucosamine sulfate is the best form for joint health supplements.
If you are taking the purest and correct form of glucosamine in a joint health supplement, you can be sure of the best benefits that you can derive from a supplement.
One should be a well-informed and intelligent consumer. Countless information on joint health supplements can be misleading. Getting your money’s worth will be rewarding in the end because, after all, it’s your health that you are dealing with.

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Dealing with Joint Pains Positively

People suffering constantly from joint pains live miserable lives.  Joint pains have become regular fixtures in their everyday lives so much so that they have learned to live with it.  If you suffer from joint pains, you need to educate yourself concerning the disease condition so that you will be able to learn how to manage it and live a better life where you are in control and not the joint pains controlling you.

Pains associated with arthritis include the severe pain from the inflammation of the joints, acute pain from damaged joints, and exacerbated pain brought by chronic suffering from joint pains.

People with arthritis will, in many ways. experience all these forms of pain. Without proper treatment, medical intervention and pain management, people will suffer for an entire lifetime.

When people who suffer from constant joint pains learn to arm themselves with the knowledge of the disease and how it can be effectively managed, then they are able to better control joint pains which will go a long way to living the life you desire and not a life which is handicapped by joint pains.

So what makes an effective management program to meet joint pains head-on?

Educate yourself. Read, ask, and understand the enemy, in this case, it’s your joint pain. Study how it works and what happens inside the body and why is there so much pain.  Arm yourself with coping and life management skills and learn methods on harnessing the power of your mind to promote wellness and comfort such as the one promoted by bio-feedback or cognitive-behavioral therapy.

Don’t wallow in self-pity. When joint pains strike, treat it as a call for action. Don’t give up and suffer in silence. You deserve to have a better life than the one you have now. Do something to help you for this can increase your self-confidence and determination to fight the disease condition.

There are also some tools to help you in your quest to effectively manage and eventually conquer joint pains.

Take pain relievers right on time before the pain will flare up. Be careful, though, of side effects which are linked to long term use of certain painkillers.

Do yoga and other activities that promote meditation to relax the body and mind. It can help relieve pain and reduce stress that is bombarding your body.

Keep busy.  Don’t dwell on the pain. Don’t let pain dominate you. Do something to keep your mind and body busy.

Have a heat and cold therapy as well as a good old massage. These are time-proven and tested treatments that can give you quick relief for joint pains.

Will Fish Oil Supplements Work for your Joint Pains?

Fish oils are good for the brain and heart.  But little do we know that this nutritious supplement, which is rich in omega-3 fatty acids, possess anti-inflammatory properties.

Joint pains are caused by an inflammatory process developing within the joints. Joint pain is one of the major manifestations of osteoarthritis which is a degenerative disease, accompanied with aching and subsequent immobilization of the body part because of the pain. Since fish oils have anti-inflammatory properties, these may be an ideal joint pain relief medication for joint pains.

Many people have already started using alternative medications for joint pains because of the increased incidents of adverse reactions to traditional painkillers particularly COX-2 inhibitors. Many people who have been using fish oil supplements for joint pains have reported promising results, saying that fish oil supplements actually work to relieve joint pains, particularly in mild to medium arthritis cases. For severe cases, there is really a need to seek professional help to pinpoint the cause of the joint pain in order to be able to prescribe the best medication.

Clinical researches and scientific studies have shown that fish oils with high Omega-3 Fatty Acid Concentrations are better in fighting inflammation than aspirin. Another plus factor is that fish oil supplements do not have the negative side effects typical with taking Aspirin.

Aside from the anti inflammatory properties of fish oil supplements, recent scientific research has shown that the anti inflammatory property is not limited only to alleviating joint pains but are also effective for inflammatory processes of other organs of the body which are chronically inflamed.

With these recent developments in the field of pain management, taking fish oil supplements will not only relieve your joint pains, but also improve your overall health and quality of life.

How Is Gout Diagnosed?

Gout may be difficult for doctors to diagnose because the symptoms can be vague, and gout often mimics other conditions. Although most people with gout have hyperuricemia at some time during the course of their disease, it may not be present during an acute attack. In addition, having hyperuricemia alone does not mean that a person will get gout. In fact, most people with hyperuricemia do not develop the disease.

To confirm a diagnosis of gout, a doctor may insert a needle into an inflamed joint and draw a sample of synovial fluid, the substance that lubricates a joint. The joint fluid is placed on a slide and examined under a microscope for uric acid crystals. Their absence, however, does not completely rule out the diagnosis.

The doctor also may find it helpful to look for uric acid crystals around joints to diagnose gout. Gout attacks may mimic joint infections, and a doctor who suspects a joint infection (rather than gout) may also culture the joint fluid to see whether bacteria are present.

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What Causes Gout?

A number of risk factors are associated with hyperuricemia and gout. They include:

• genetics. Twenty percent of people with gout have a family history of the disease.
• gender and age. It is more common in men than in women and more common in adults than in children.
• weight. Being overweight increases the risk of developing hyperuricemia and gout because there is more tissue available for turnover or breakdown, which leads to excess uric acid production.
• alcohol consumption. Drinking too much alcohol can lead to hyperuricemia, because alcohol interferes with the removal of uric acid from the body.
• diet. Eating too many foods that are rich in purines can cause or aggravate gout in some people.
• lead exposure. In some cases, exposure to lead in the environment can cause gout.
• other health problems. Renal insufficiency, or the inability of the kidneys to eliminate waste products, is a common cause of gout in older people. Other medical problems that contribute to high blood levels of uric acid include:
  • high blood pressure
  • hypothyroidism (underactive thyroid gland)
  • conditions that cause an excessively rapid turnover of cells, such as psoriasis, hemolytic anemia, or some cancers
  • Kelley-Seegmiller syndrome or Lesch-Nyhan syndrome, two rare conditions in which the enzyme that helps control uric acid levels either is not present or is found in insufficient quantities.
• medications. A number of medications may put people at risk for developing hyperuricemia and gout. They include:
  • diuretics, such as furosemide (Lasix¹), hydrochlorothiazide (Esidrix, Hydro-chlor), and metolazone (Diulo, Zaroxolyn), which are taken to eliminate excess fluid from the body in conditions like hypertension, edema, and heart disease, and which decrease the amount of uric acid passed in the urine
  • salicylate-containing drugs, such as aspirin
  • niacin, a vitamin also known as nicotinic acid
  • cyclosporine (Sandimmune, Neoral), a medication that suppresses the body’s immune system (the system that protects the body from infection and disease). This medication is used in the treatment of some autoimmune diseases, and to prevent the body’s rejection of transplanted organs.
  • levodopa (Larodopa), a medicine used to support communication along nerve pathways in the treatment of Parkinson’s disease.

Brand names included here are provided as examples only, and their inclusion does not mean that these products are endorsed by us.  Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

Gout Supplements

What Is Gout?

Gout is a painful condition that occurs when the bodily waste product uric acid is deposited as needle-like crystals in the joints and/or soft tissues. In the joints, these uric acid crystals cause inflammatory arthritis, which in turn leads to intermittent swelling, redness, heat, pain, and stiffness in the joints.

In many people, gout initially affects the joints of the big toe (a condition called podagra). But many other joints and areas around the joints can be affected in addition to or instead of the big toe. These include the insteps, ankles, heels, knees, wrists, fingers, and elbows. Chalky deposits of uric acid, also known as tophi, can appear as lumps under the skin that surrounds the joints and covers the rim of the ear. Uric acid crystals can also collect in the kidneys and cause kidney stones.

What Is Uric Acid?

Uric acid is a substance that results from the breakdown of purines. A normal part of all human tissue, purines are found in many foods. Normally, uric acid is dissolved in the blood and passed through the kidneys into the urine, where it is eliminated.

If there is an increase in the production of uric acid or if the kidneys do not eliminate enough uric acid from the body, levels of it build up in the blood (a condition called hyperuricemia). Hyperuricemia also may result when a person eats too many high-purine foods, such as liver, dried beans and peas, anchovies, and gravies. Hyperuricemia is not a disease, and by itself it is not dangerous. However, if excess uric acid crystals form as a result of hyperuricemia, gout can develop. The crystals form and accumulate in the joint, causing inflammation.

What Are the Four Stages of Gout?

Literally translated, arthritis means “joint inflammation.” It refers to more than 100 different diseases that affect the joints. Gout accounts for approximately 5 percent of all cases of arthritis. The disease can progress through four stages:

1. Asymptomatic (without symptoms) hyperuricemia – In this stage, a person has elevated levels of uric acid in the blood (hyperuricemia), but no other symptoms. Treatment is usually not required.
2. Acute gout, or acute gouty arthritis – In this stage, hyperuricemia has caused the deposit of uric acid crystals in joint spaces. This leads to a sudden onset of intense pain and swelling in the joints, which also may be warm and very tender. An acute attack commonly occurs at night and can be triggered by stressful events, alcohol or drugs, or the presence of another illness. Attacks usually subside within 3 to 10 days, even without treatment, and the next attack may not occur for months or even years. Over time, however, attacks can last longer and occur more frequently.
3. Interval or intercritical gout – This is the period between acute attacks. In this stage, a person does not have any symptoms.
4. Chronic tophaceous gout – This is the most disabling stage of gout. It usually develops over a long period, such as 10 years. In this stage, the disease may have caused permanent damage to the affected joints and sometimes to the kidneys. With proper treatment, most people with gout do not progress to this advanced stage.

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What Are Researchers Learning About Fibromyalgia?

Following are descriptions of some of the promising research now being conducted:

• Understanding pain – Research suggests that fibromyalgia is caused by a problem in how the body processes pain – or more precisely, a hypersensitivity to stimuli that normally are not painful. Therefore, several  researchers are focusing on ways the body processes pain to better understand why people with fibromyalgia have increased pain sensitivity.

Previous research has shown that people with fibromyalgia have reduced blood flow to parts of the brain that normally help the body deal with pain. In one new  study, researchers will be using imaging technology called positron emission tomography (PET) to compare blood flow in the brains of women who have fibromyalgia with those who do not. In both groups, researchers will study changes in blood flow that occur in response to painful stimuli.

Researchers speculate that female reproductive hormones may be involved in the increased sensitivity to pain characteristic of fibromyalgia. New research will examine the role of sex hormones in pain sensitivity, in reaction to stress, and in symptom perception at various points in the menstrual cycles of women with fibromyalgia and of women without it. The results from studying these groups of women will be compared with results from studies of the same factors in men without fibromyalgia over an equivalent period of time.

Another line of research involves developing a rodent model of fibromyalgia pain. Rodent models, which use mice or rats that researchers cause to develop symptoms similar to fibromyalgia in humans, could provide the basis for future research into this complex condition.

• Understanding stress – Medical evidence suggests that a problem or problems in the way the body responds to physical or emotional stress may trigger or worsen the symptoms of any illness, including fibromyalgia. Researchers  are trying to uncover and understand these problems by examining chemical interactions between the nervous system and the endocrine (hormonal) system. Scientists know that people whose bodies make inadequate amounts of the hormone cortisol experience many of the same symptoms as people with fibromyalgia, so they also are exploring whether there is a link between the regulation of the adrenal glands, which produce cortisol, and fibromyalgia.

Another NIAMS-funded study suggests that exercise improves the body’s response to stress by enhancing the function of the pituitary and adrenal glands. The hormones produced by these two endocrine glands are essential to regulating sleep and emotions as well as processing pain.

• Improving sleep – Researchers are investigating ways to improve sleep for people with fibromyalgia whose sleep problems persist despite treatment with medications. One team has observed that fibromyalgia patients with persistent sleep problems share characteristics with people who have insomnia, such as having erratic sleep and wake schedules and spending too much time in bed. This team is testing whether strategies developed to help insomnia patients will also help people with fibromyalgia achieve deep sleep, which eases pain and fatigue. Preliminary results show that sleep education, which teaches good sleep habits, and cognitive behavioral therapy, which includes sleep education and a regimen to correct poor habits and improper sleep schedules, both reduce insomnia.
• Looking for the family connection – Because fibromyalgia appears to run in families, one group of NIAMS-supported researchers is working to identify whether a gene or genes predispose people to the condition.

Another team is trying to determine whether fibromyalgia is more common in people with other conditions, such as serious mood disorders, that tend to run in families. Specifically, the group is studying the prevalence of psychiatric disorders and arthritis and related disorders in people with fibromyalgia and their first-degree relatives (parents, children, sisters, and brothers) as compared to people with rheumatoid arthritis and their relatives. The group is exploring whether clusters of conditions exist in families, which might shed light on shared risk factors or disease processes..

Scientists recognize that people with fibromyalgia often fall into distinct subgroups that adapt to and cope with their symptoms differently. They also realize that these subgroups may respond to treatments differently. One  team of researchers has divided people with fibromyalgia into three groups based on how they cope with the condition. Relative to other chronic pain patients, those in the first group have higher levels of pain and report more interference in their life due to pain. They also have higher levels of emotional distress, feel less control over their lives, and are less active. The second group reports receiving less support from others, higher levels of negative responses from significant others, and lower levels of supportive responses from significant others. Those in the third group are considered adaptive copers; they have less pain, report less interference in their lives due to pain, and have less emotional distress. Members of this last group feel more control over their lives and are more active. On the premise that the better you understand the subgroups, the better you can tailor treatments to fit them, the researchers now are trying to design and test different programs for each group, combining physical therapy, interpersonal skills training, and supportive counseling.

What Can I Do To Try To Feel Better?

Besides taking medicine prescribed by your doctor, there are many things you can do to minimize the impact of fibromyalgia on your life. These include:

• Getting enough sleep – Getting enough sleep and the right kind of sleep can help ease the pain and fatigue of fibromyalgia.  Even so, many people with fibromyalgia have problems such as pain, restless legs syndrome, or brainwave irregularities that interfere with restful sleep.
• Exercising – Although pain and fatigue may make exercise and daily activities difficult, it’s crucial to be as physically active as possible. Research has repeatedly shown that regular exercise is one of the most effective treatments for fibromyalgia. People who have too much pain or fatigue to do vigorous exercise should begin with walking or other gentle exercise and build their endurance and intensity slowly. Although research has focused largely on the benefits of aerobic and flexibility exercises, a new NIAMS-supported study is examining the effects of adding strength training to the traditionally prescribed aerobic and flexibility exercises.
• Making changes at work – Most people with fibromyalgia continue to work, but they may have to make big changes to do so. For example, some people cut down the number of hours they work, switch to a less demanding job, or adapt a current job. If you face obstacles at work, such as an uncomfortable desk chair that leaves your back aching or difficulty lifting heavy boxes or files, your employer may make adaptations that will enable you to keep your job. An occupational therapist can help you design a more comfortable workstation or find more efficient and less painful ways to lift.

If you are unable to work at all due to a medical condition, you may qualify for disability benefits through your employer or the Federal Government. Social Security Disability Insurance (SSDI) and Supplemental Security Insurance (SSI) are the largest Federal programs providing financial assistance to people with disabilities. Although the medical requirements for eligibility are the same under the two programs, the way they are funded is different. SSDI is paid by Social Security taxes, and those who qualify for assistance receive benefits based on how much they have paid into the system; SSI is funded by general tax revenues, and those who qualify receive payments based on financial need. For information about the SSDI and SSI programs, contact the Social Security Administration.

• Eating well – Although some people with fibromyalgia report feeling better when they eat or avoid certain foods, no specific diet has been proven to influence fibromyalgia. Of course, it is important to have a healthy, balanced diet. Not only will proper nutrition give you more energy and make you generally feel better, it will also help you avoid other health problems.

How Is Fibromyalgia Treated?

Fibromyalgia can be difficult to treat. Not all doctors are familiar with fibromyalgia and its treatment, so it is important to find a doctor who is. Many family physicians, general internists, or rheumatologists (doctors who specialize in arthritis and other conditions that affect the joints or soft tissues) can treat fibromyalgia.

Fibromyalgia treatment often requires a team approach, with your doctor, a physical therapist, possibly other health professionals, and most importantly, yourself, all playing an active role. It can be hard to assemble this team, and you may struggle to find the right professionals to treat you. When you do, however, the combined expertise of these various professionals can help you improve your quality of life.

You may find several members of the treatment team you need at a clinic. There are pain clinics that specialize in pain and rheumatology clinics that specialize in arthritis and other rheumatic diseases, including fibromyalgia.

Following are some of the most commonly used categories of drugs for fibromyalgia.

Analgesics

Analgesics are painkillers. They range from over-the-counter acetaminophen (Tylenol) to prescription medicines, such as tramadol (Ultram), and even stronger narcotic preparations. For a subset of people with fibromyalgia, narcotic medications are prescribed for severe muscle pain. However, there is no solid evidence showing that narcotics actually work to treat the chronic pain of fibromyalgia, and most doctors hesitate to prescribe them for long-term use because of the potential that the person taking them will become physically or psychologically dependent on them.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

As their name implies, nonsteroidal anti-inflammatory drugs, including aspirin, ibuprofen (Advil, Motrin), and naproxen sodium (Anaprox, Aleve), are used to treat inflammation. Although inflammation is not a symptom of fibromyalgia, NSAIDs also relieve pain. The drugs work by inhibiting substances in the body called prostaglandins, which play a role in pain and inflammation. These medications, some of which are available without a prescription, may help ease the muscle aches of fibromyalgia. They may also relieve menstrual cramps and the headaches often associated with fibromyalgia.

Antidepressants

Perhaps the most useful medications for fibromyalgia are several in the antidepressant class. Antidepressants elevate the levels of certain chemicals in the brain, including serotonin and norepinephrine (which was formerly called adrenaline). Low levels of these chemicals are associated not only with depression, but also with pain and fatigue. Increasing the levels of these chemicals can reduce pain in people who have fibromyalgia. Doctors prescribe several types of antidepressants for people with fibromyalgia, described below.

• Tricyclic antidepressants – When taken at bedtime in dosages lower than those used to treat depression, tricyclic antidepressants can help promote restorative sleep in people with fibromyalgia. They also can relax painful muscles and heighten the effects of the body’s natural pain-killing substances called endorphins. Tricyclic antidepressants have been around for almost half a century. Some examples of tricyclic medications used to treat fibromyalgia include amitriptyline hydrochloride (Elavil, Endep), cyclobenzaprine (Cycloflex, Flexeril, Flexiban), doxepin (Adapin, Sinequan), and nortriptyline (Aventyl, Pamelor). Both amitriptyline and cyclobenzaprine have been proven useful for the treatment of fibromyalgia.
• Selective serotonin reuptake inhibitors – If a tricyclic antidepressant fails to bring relief, doctors sometimes prescribe a newer type of antidepressant called a selective serotonin reuptake inhibitor (SSRI). As with tricyclics, doctors usually prescribe these for people with fibromyalgia in lower dosages than are used to treat depression. By promoting the release of serotonin, these drugs may reduce fatigue and some other symptoms associated with fibromyalgia. The group of SSRIs includes fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft).

SSRIs may be prescribed along with a tricyclic antidepressant. Doctors rarely prescribe SSRIs alone. Because they make people feel more energetic, SSRIs also interfere with sleep, which often is already a problem for people with fibromyalgia. Studies have shown that a combination therapy of the tricyclic amitriptyline and the SSRI fluoxetine resulted in greater improvements in the study participants’ fibromyalgia symptoms than either drug alone.

• Mixed reuptake inhibitors – Some newer antidepressants raise levels of both serotonin and norepinephrine and are therefore called mixed reuptake inhibitors. Examples of these medications include venlafaxine (Effexor) and nefazodone (Serzone). Researchers are actively studying the efficacy of these newer medications in treating fibromyalgia.

Benzodiazepines

Benzodiazepines help some people with fibromyalgia by relaxing tense, painful muscles and stabilizing the erratic brain waves that can interfere with deep sleep. Benzodiazepines also can relieve the symptoms of restless legs syndrome, which is common among people with fibromyalgia. Restless legs syndrome is characterized by unpleasant sensations in the legs as well as twitching, particularly at night. Because of the potential for addiction, doctors usually prescribe benzodiazepines only for people who have not responded to other therapies. Benzodiazepines include clonazepam (Klonopin) and diazepam (Valium).

Will Fibromyalgia Get Better With Time?

Fibromyalgia is a chronic condition, meaning it lasts a long time – possibly a lifetime. However, it may comfort you to know that fibromyalgia is not a progressive disease. It is never fatal, and it won’t cause damage to your joints, muscles, or internal organs. In many people, the condition does improve over time.

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