Lyrica(l) Depression

Pregabalin (Lyrica®) can significantly improve FM pain in people who also are being treated for depression, according to research presented at the American College of Rheumatology (ACR) Annual Meeting in San Diego. And my recent slow tapering off of Lyrica, and then returning to it (after way too much pain) confirmed this to me.

chronic comic 189I also suffer from depression. In fact, 50 to 70 per cent of people with FM report a lifetime history of depression, and approximately 25 per cent have a history of taking antidepressants.

Pregabalin is approved for the treatment of FM in the United States, Japan, Australia and other countries. But, because prior studies excluded the use of antidepressants in treatment, information about the effectiveness and safety of pregabalin for the treatment of pain in people with FM who are also being treated with antidepressants for their depression is lacking.

“Depression is common in patients with fibromyalgia,” explains Lesley M. Arnold, MD; professor of psychiatry and behavioral neuroscience; University of Cincinnati College of Medicine, Cincinnati, Ohio; and lead investigator in the study. “Many patients present to their doctor for treatment of fibromyalgia pain already taking antidepressants for their depression. This is the first study to evaluate the efficacy and safety of pregabalin for treatment of fibromyalgia pain in patients who are also taking antidepressants for depression.”

288. rate your painWith this in mind, researchers completed a study to determine if pregabalin would affect pain levels in people with FM who were also being treated for depression. The study included 197 patients who were, on average, 50 years of age and overwhelmingly white females. To join the study, patients had to meet the 1990 ACR Criteria (including manual tender point exam), have an average pain level of at least four out of 10 on the Numeric Rating Scale, (0 = no pain and 10 = worst possible pain), have a documented diagnosis of depression and be taking a stable dose of an antidepressant medication — either a selective serotonin reuptake inhibitor (such as Celexa®, Lexapro®, Prozac®, Paxil® or Zoloft®) or a serotonin-norepinephrine reuptake inhibitor (such as Cymbalta®, Effexor®, or Pristiq®). The antidepressant treatment was continued throughout the study.

Patients were on study treatment for a total of 14 weeks. There were two six-week treatment periods when patients received either pregabalin or placebo, with a two-week break in between these periods. Each patient was randomly assigned to receive either pregabalin in the first six weeks, then placebo in the last six weeks, or to receive placebo first, then pregabalin. None of the patients knew which treatment they were receiving at any point in the study. Pregabalin was started at a dose of 150mg per day, and increased to 300-450mg per day, based on each patient’s response; this dose was continued for the rest of the treatment period.

Chronic Comic 157At the beginning of the study, the average pain score amongst participants was 6.7. The average pain score dropped to 4.84 after treatment with pregabalin and to 5.45 after treatment with placebo. Pregabalin treatment significantly improved patients’ pain compared to placebo.

Side effects were reported in 77.3 per cent of those on pregabalin and 59.9 per cent of those on placebo. For pregabalin treatment the most common events were dizziness (28.2 per cent) and drowsiness (19.9 per cent). A total of four serious adverse events were reported; however, the researchers concluded these events were not related to the treatment.

“The results of this study demonstrate that pregabalin is safe and effective in reducing fibromyalgia pain in patients who are also taking an antidepressant to treat their depression,” says Dr Arnold.

Cocktails on Lido deck!

FM patients who seem resistant to the more routine therapies have a new pain relief treatment available, according to a study presented at the ANESTHESIOLOGY™ 2013 annual meeting. Intravenous (IV) lidocaine infusion provided significant pain relief to patients, although the pain relief was much less for African-Americans and smokers.

IV cocktailStatistics were collected for sex, race, body weight, pain duration, pain relief duration after lidocaine infusion, and scores on the brief pain inventory scale, visual analog scale and pain interference scale before and after the infusion.

The study found an almost 10 per cent average decrease in the brief pain inventory scale score, which dropped from 83.18 before the infusion to 73.68 after the infusion. The average pain interference score dropped from 7.73 to 6.88. The brief pain inventory score was much lower for non-smokers than for smokers; non-smokers’ average score was 72.63, while smokers’ average score was 89.98.

Dr Huh, M.D., Ph.D., professor and medical director of the Department of Pain Medicine at The University of Texas MD Anderson Cancer Center, Houston, and adjunct professor of the Department of Anesthesiology at Duke University Medical Center, Durham, N.C., hypothesized that because smokers frequently have vascular damage that impairs blood circulation, the lidocaine may not reach the painful area because of poor blood flow. He also suggested that the benefit of lidocaine may be reduced because smokers have significant amounts of toxic chemicals in their blood.

The difference in pain interference scores for white patients and African-American patients was .028. For this test, a score less than .05 is considered statistically significant. Dr. Huh could not be certain about the reason for the difference, but noted, “Many drugs are more effective or less effective for certain ethnic groups. For example, some blood pressure medications are more effective for certain races. I think this finding is quite possibly related to genetic makeup.”

Further, I found no material stating how often or for how long this type of infusion would be required.

Where Have I Been?

So, I’ve been MIA (Missing In Action)…why?

I have been slowly weaning off my Lyrica (see posts below for previous updates) to see if we can find something else that will allow me to feel less pain but with less side effects.

dose last

And I have finally made it to Week 6…

No! I do not feel miraculously better – in fact, I feel horrible. I didn’t realise what the Lyrica had been protecting me from (although it didn’t feel like much at the time). Let’s work from the head down:

  • No respite from the permanent headache
  • Very lazy right eye
  • Cheekbones growing out of my face
  • (Even more) increased sound sensitivity
  • Everything smells pungeant
  • Sensitive teeth
  • Itchy face
  • Aching neck and shoulders
  • Swollen-feeling wrists and hands (without swelling)
  • Costochondritis
  • Stomach cramps
  • Acid reflux
  • Diarrhea (whether I eat or not!)
  • Taut calf muscles
  • Swollen-feeling ankles and feet (without swelling)
  • Inability to remain asleep
  • No inner temperature control

Sounds like everybody else, right? But it seems that the Lyrica had reduced the impact of some of that. I just hadn’t realised how much. But the Lyrica also brought complete and utter fog.

And now I’m back at square 1; ready to start again, in a couple of weeks, to see if we can find a more effective medication regime, that will still allow me to think like a normal person!

Related Reading:

♩♫ Lyric(a) Writing is an Interesting Process ♫♩

So Week 3 started today…my body aches just a little more each day, the fog is not lifting (which I really thought it would), and my face hurts beyond words.

doses

It doesn’t help that I had to go to the dentist for a Crown preparation so last night was spent with some frozen vegetables attached to my cheek.

And I’ve hit exhaustion – I think I have over-loaded myself with the Thunderclap campaigning (nagging), blogging every day, reminding contributors for the next issue of LIVING WELL with FIBROMYALGIA, tweeting, my shop and my FB page – it’ll all quiet down after May 12th but right now, I keep getting anxious that I’ve forgotten something to do. spireI’m also trying to get ‘them’ to light a spire (that we have in Melbourne) in PURPLE for May 12th (looking forward to a night-time picnic with Thais (did I tell you she’s back?) under the spire – anyone else coming? You can help by emailing the appropriate people)

I’m also trying for Sydney Harbour Bridge and the Opera House but I think I’ve left that one too late! (If you want to help with this one: tweet to @VividLive  Niagara Falls will B PURPLE from 10:15-10:30PM EST on May 12 for #Fibromyalgia Awareness: can we light up the Bridge & Opera House?

sydney opera house Sydney_Harbour_Bridge01

So I haven’t had a chance to FEEL anything. I just want to rest BUT I don’t feel I can as this is the lead-up to Awareness Day (I can rest afterwards, right?).

I try not to nap during the day (no matter how bad it gets) but today, I fell asleep for 4 hours.

My body just wants to stop – but, as you can see, I have no idea if it’s medication related or just life!

Sampling Side Effects

So, you know when you walk into the doctor’s office and there’s a ton of pens with the logos of different drugs, calendars sponsored by Big Pharma, and samples galore?

Pharmaceutical-(sm)x300Because of these visual reminders and visits from company representatives, doctors are more likely to prescribe these drugs. However, these drug company salespeople provide family doctors with little or no information about the harmful effects of medicines they are promoting, states a new study.

And, despite this lack of knowledge, doctors are still likely to start prescribing these drugs, according to the findings from questionnaires completed by American, Canadian and French doctors.

The study revealed that the reps failed to provide information about common or serious side effects or warn doctors about types of patients who should not use the medicine in 59 per cent of their promotions.

“Laws in all three countries require sales representatives to provide information on harm as well as benefits,” lead author Barbara Mintzes, of the University of British Columbia, said in a university news release. “But no one is monitoring these visits and there are next to no sanctions for misleading or inaccurate promotion.”

Serious risks were mentioned in only 6 per cent of the promotions, even though 57 per cent of the medicines involved in these visits came with the strongest types of drug warnings.

“We are very concerned that doctors and patients are left in the dark and patient safety may be compromised,” Mintzes said.

So, remember doctors do NOT know everything…be your own advocate, do your own research and ask questions!

La ♫ La ♪ La…Lyrica(l) Lullaby

So it’s been a week since Whatever…Nothing! – that means the first week of Lyrica weaning is over.

doses

I can’t say that I’ve noticed much change: I had some huge headaches and face pain but that can be blamed on a cracked tooth that now needs a crown (bloody! bloody!); I had a couple of totally fogged out days but that was nothing really different; and today, I had an amazingly great day – just because sometimes (and hopefully more often), that just happens.

I think tonight’s reduction may make more of a change because it’s a reduction of the night dose. If Lyrica is as good at helping us sleep as they say so, then I may start experiencing some trouble. Of course, I hope not and I’m really not expecting any trouble…yet!

Week 3 (and onwards) scares the hell out of me…and you’ll get to hear ALL about it (hee! hee! Lucky you!)

Whatever…Nothing!

Yesterday, I (with my Mommy) was running late for my pain specialist. I hate running late. It stresses me out. I think it is incredibly rude. But, yesterday, when my Mommy was apologising for making us late, I was just ‘whatever.’

Then I thought about it and I’ve been ‘whatever’ for quite a while. It’s not such a bad feeling – it’s stress-less, very laid back and unemotional. But it’s very nothing.

I also noticed that I haven’t been writing anything personal on this blog – it’s been all about research and studies. It’s because there is nothing.

I think I’m on too many drugs…

When I was first diagnosed, (other than a quick dose of steroids) I was immediately put on Lyrica. Anytime I felt more pain, the doctors increased my dosage…my current Lyrica dosage is 225mg both morning and night.

I also take 150mg of Sertraline for depression – it used to 100 mg but during this ‘whatever, nothing’ stage, I felt that I needed something extra. My GP was happy to increase the dose. There’s also 1100ʮg per week of Thyroxine for my under-active thyroid; the Pill (I went off it (because who’s having any sex?) but my periods were unbearable!); and, of course, there’s all the supplements that we’re supposed to take: vitamin D, Red Krill Oil, D-Ribose, Sam-E, CoQ10, and a multi-vitamin.

Anyway, my point is that no-one tried anything except the Lyrica…why not?

So, having visited the pain specialist yesterday, we’re trying something else: I’m running out of all the supplements at the moment, so I’m just going to stop them as the bottles empty; and I’m going to wean off the Lyrica:

doses

Because this ‘whatever, nothing’ just isn’t good enough. I want more. I NEED more!

Got Fibro? Now What?

Ok, you have a diagnosis…now what’s going to happen?

ae78c7c2bc0e5642e361bf001c101af9Most likely, your doctor is going to give you medication. There are many different medications used to manage FM, including pain medicines, sleeping pills, and antidepressants.  Some help ease pain. Others boost mood and improve sleep. Working with your doctor will help you find the right medication to add to your multi-faceted comprehensive treatment regimen. That way, you can begin to manage your symptoms effectively…

The first medication doctors will often try is an anti-depressant (this does NOT mean you are necessarily suffering from depression!), which helps relieve pain, fatigue, and sleep problems. Nonetheless, depression is commonly seen in people with FM.

Older anti-depressants, called tricyclics (including Elavil (amitriptyline) and Pamelor (nortriptyline)), have been used for many years to treat FM. They work by raising the levels of chemicals (neurotransmitters) in the brain.

Tricyclic anti-depressants increase levels of serotonin and norepinephrine in the brain. People with chronic pain often have decreased levels of these calming neurotransmitters. Tricyclics can relax painful muscles and heighten the effects of endorphins – the body’s natural painkillers. While these medications are often very effective, the side effects can sometimes make them difficult to take as they may cause drowsiness, dizziness, dry mouth, dry eyes, and constipation.

There are numerous types of anti-depressants and several of them have been shown to help relieve the pain, fatigue, and sleep problems in people with FM.

pillsThe most well-studied anti-depressants for FM include Cymbalta (duloxetine), Savella (milnacipran), and Effexor (venlafaxine). Cymbalta and Savella are specifically FDA-approved to treat FM. There is less medical research to show that Effexor helps FM. Other anti-depressants that have also been studied for FM and may help include Prozac (fluoxetine), Paxil (paroxetine), and Celexa (citalopram).

That’s a lot of different choices to work through and yes, it’s all trial and error to see what works for you. What works for one person with FM may not work for someone else. Different anti-depressants work differently in the body. That’s why you may have to try more than one anti-depressant to find the one that best relieves the pain, fatigue, and sleep difficulties. Your doctor may even want you to try a combination of more than one anti-depressant at a time.

Then, there are different types of pain relievers, sometimes recommended to ease the deep muscle pain and trigger-point pain that comes with FM. The problem is these pain relievers don’t work the same for everyone, either.

article-new_ehow_images_a05_sc_bu_can-nexium_-800x800Non-steroidal anti-inflammatory drugs (NSAIDs), when taken alone, don’t typically work that well for FM. However, when combined with other medications, NSAIDs often do help. NSAIDs are available over the counter and include drugs such as aspirin, ibuprofen, and naproxen. Further, the over-the-counter pain reliever acetaminophen elevates the pain threshold so you perceive less pain. Acetaminophen is relatively free of side effects. But avoid this medication if you have liver disease.

You also need to be careful taking aspirin or other NSAIDs if you have stomach problems. These medications can lead to heartburn, nausea or vomiting, stomach ulcers, and stomach bleeding. Don’t ever take over-the-counter NSAIDs for more than 10 days without checking with your doctor. Taking them for a prolonged period increases the chance of serious side effects.

Sometimes, your doctor will prescribe the muscle relaxant cyclobenzaprine. has proved useful for the treatment of FM. It has proved to be helpful with easing muscle tension and improving sleep. Muscle relaxants work in the brain to relax muscles; but you may experience dry mouth, dizziness, drowsiness, blurred vision, clumsiness, unsteadiness, and change in the colour of your urine. These medications may increase the likelihood of seizures, confusion and hallucinations.

Most recently, Lyrica, originally used to treat seizures, is being used to treat FM. Lyrica affects chemicals in the brain that send pain signals across the nervous system. So it reduces pain and fatigue and improves sleep.

Neurontin (gabapentin) is another anti-seizure medication that has also been shown to improve FM symptoms.

SMFM-278Other medications include pain relievers such as Ultram (tramadol) which is a narcotic-like medication that acts in the brain to affect the sensation of pain. However, it is not as addictive as narcotics.

In addition, doctors may prescribe benzodiazepines such as Ativan (lorazepam), Klonopin (clonazepam), Valium (diazepam), and Xanax (alprazolam) to help relax painful muscles, improve sleep, and relieve symptoms of restless legs syndrome. Benzodiazepines are addictive and must be used with caution on a short-term basis. Taking more than recommended increases the risk of serious side effects, including death.

Powerful narcotic medications, such as Percocet and OxyContin (oxycodone) and Vicodin and Lortab (hydrocodone), should only be considered if all other drugs and alternative therapies have been exhausted and there is no relief.

All of this seems quite daunting which is why you need to surround yourself with a team you trust, which may include doctors, friends and/or family. The most consistent treatment advice that all the experts in FM try to promote is a multi-faceted approach. So, as well as all these medications, you will need to explore a whole range of complementary treatments.

FCKI don’t mean to scare you; in fact, I am trying to help by blogging about research and my experiences with different activities (please explore the site). There is also a directory of other FM bloggers that allows you to find people who are going through the same stuff as you.

Preg(abalin)nant Pause

My normal dose of Lyrica (pregabalin) is 150 mg in the morning and 150 mg at night.

But I have been suffering from some major headaches so my Pain Specialist has decided we should up the dose…

So last night, instead of taking 150 mg, for the first time I took 225mg of Lyrica.

zombieToday, it took me 4 hours to THINK about getting about bed (after which, I took my 150 mg of Lyrica plus all the other crap I take) and I’ve been a zombie ever since. No pain but no anything else, either. I’m hoping, like the last increase, this ‘totally-out-of-it’ feeling only lasts 2 days.

The problem is, next week, I have to increase the morning dose, too.

Just hoping it works!

Do No Harm

pain-pills-690x388Some people swear by Cymbalta…while others swear at it!  I’m a fan of Lyrica. If you’re lucky, you have something that is working (at least, partially) for you.

A new review in The Cochrane Library looked at Cymbalta and Savella. Among FM patients taking either of the two drugs to reduce pain, 22 per cent report substantial improvement while 21 per cent had to quit the regimen due to unpleasant side effects!

The authors reviewed 10 high-quality studies comprising more than 6,000 adults who received either Cymbalta, Savella, or a placebo for up to six months.

“This is a very important study,” says Fred Wolfe, M.D. of the National Data Bank for Rheumatic Diseases. “There’s an enormous amount of advertising suggesting that these drugs really help, whereas the research data show that the improvement is really minimal.” Treatment with drugs alone “should be discouraged,” the reviewers added. Instead, the review authors recommend a multi-faceted treatment approach including medications for those who find them helpful, exercises to improve mobility and psychological counseling to improve coping skills.

“The medical field does poorly with the treatment of fibromyalgia in general,” says Brian Walitt, M.D., M.P.H., a co-author of the review and an expert in pain syndromes at Washington Hospital Center in Washington, D.C. “Chasing [a cure] with medicine doesn’t seem to work. The people who seem to me to do best sort of figure it out on their own by thinking about things, getting to know themselves, and making changes in their lives to accommodate who they’ve become,” concludes Walitt.

I’m looking forward to the review of Lyrica, planned by the Cochrane Library for later this year.

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