Expert: Daniel Clauw, MD, professor of medicine at the University of Michigan and executive director of the university’s Chronic Pain and Fatigue Research Center and the Center for the Advancement of Clinical Research.
Q: The approval of pregabalin (Lyrica) has been hailed as an important advance for fibromyalgia. Why is that?
A: By approving a drug for fibromyalgia, the FDA has legitimized fibromyalgia as a real entity. The new approval may broaden the number of fibromyalgia patients for whom doctors will use Lyrica, meaning more people with chronic pain may find relief.
Q: Is there any way to avoid the negative side effects of Lyrica?
A: Many doctors suggest breaking the dose up so the lion’s share is taken at night. If you are taking 300 mg a day, your doctor may suggest taking 100 mg in the morning and 200 mg at night, since it doesn’t really matter if you are tired or light headed while you are sleeping.
Q: Is Lyrica the first of many new fibromyalgia treatments to come?
A: Two more new drugs may get nods for FDA approval in the next year. Two of the drugs showing benefit for people with fibromyalgia are members of a new class of drugs known as norepinephrine serotonin reuptake inhibitors (NSRIs). These drugs affect levels of two brain chemicals, norepinephrine and serotonin, which play a role in pain and mood. Milnacipran is one of those NSRIs. The other – duloxetine (Cymbalta) – already is prescribed off-label for fibromyalgia and has FDA approval for major depression, generalized anxiety disorder and nerve pain.
Q: How will having a treatment option that is specific for fibromyalgia improve treatment of the condition overall?
A: When we use drugs, exercise, cognitive behavior therapy and education, we can manage fibromyalgia in a significant number of patients, but unfortunately that’s not what has been done in routine care. Many physicians haven’t known what to use to treat fibromyalgia. They’ll use non-steroidal anti-inflammatory drugs and opioids, but we know that they don’t work well for fibromyalgia. Having a drug whose FDA-approved label indicates it is intended for the treatment of fibromyalgia takes away some of the guessing involved in treating this difficult-to-treat condition.
Susan said
Dear Dr. Clauw,
I have had fibromyalgia for more than 15 years (that I know of). Massage therapy used to be my godsend but after a while it hurt too much to be touched almost anywhere. I have been under the same doctor’s care for the past 8 years. After a year of trying to convince her to perscribe Cymbalta, she finally agreed and perscribed 30MG twice daily (in addition to 3-Xs-daily Vicodin at 5/500). When Lyrica was approved she was happy to let me try it. For weeks I stumbled around my back yard (I am an avid gardener and have continued in spite of my FM pain) like a drunk! I still get “woozy” several times a day, but I take great care when I am in that state, as I was tripping and stumbling so much. What I have observed (other than that) is that I have recently started having what I would call “spasms” (little jerky movements), a kind of numbness in my left forearm, and now I seem to be losing motor control in the fingers of my left hand along with tremors and an inability to bring my fingers together without them trembling and with great effort. Also, I can’t hold on to things very well. I am taking 300MGs of Lyrica three times daily. Could these symptoms be related to the Lyrica (which I have been taking now since it was approved? Thank you so much! Susan