Drugs for Fibro: How Good Are They?

by Dr. John Quintner from NationalPainReport.Com

john-quintner-300x300John Quintner, MD, is a rheumatologist and pain medicine specialist in Australia who recently retired from clinical practice.
He has published numerous articles on chronic pain in Pain Medicine, Clinical Journal of Pain, The Lancet and other medical journals.

Most fibromyalgia sufferers will at some stage be offered a prescription for one or more of the officially approved drugs – Lyrica, Cymbalta, and Savella.

Many will ask their doctors two important questions: How good are these drugs and what harm can they cause me?

Many would be surprised by the answers they get – if the doctor is willing and able to provide them.

bigstock-Out-of-focus-woman-extending--34477478The concepts of NNT/NNH

One way to assess the effectiveness of drugs for pain management is by looking at the Number Needed to Treat (NNT) value.

The NNT value for drugs used to treat specific painful conditions is derived from large clinical trials that record the number of patients who report 50% or more reduction in their pain, compared to results from a placebo. The lower the NNT, the better the drug.

For example, if 10 patients with a specific condition are prescribed a drug and only one of them reports relief of pain, the NNT value for that drug is 10. This means that the other 9 patients will find the drug to be ineffective.

Continuing on the same theme, the potential for drugs to cause harmful side effects is expressed by another value – the Number Needed to Harm (NNH).

The NNH values for the three fibromyalgia drugs gives us an indication of how many patients need to be treated before one of them will report a harmful side effect. The higher the NNH, the safer the drug is.

By the way, it is well known that people taking placebo drugs can report adverse events.

NNT for Fibromyalgia Drugs

For Fibromyalgia patients, the NNT for Lyrica is 10for Cymbalta it is 6; and for Savella it is around 8-10.

This means that only one out of 10 patients taking Lyrica (Preglabin) will have pain relief of 50% or more. Only one out of 6 taking Cymbalta (Duloxetine) will have relief of pain and only about one out of 8 taking Savella (Milnacipran).

NNH for Fibromyalgia Drugs

The overall values for side effects of each drug, when compared to placebo, and expressed as NNH are as follows: between 6 -18 for Cymbalta; between 7-14 for Savella 7-14; and around 6 for Lyrica.

This means for every 6 patients with fibromyalgia treated with Lyrica, one of them will report a harmful side effect. There is a wide range of NNH’s for both Cymbalta and Savella.

Some adverse effects are relatively minor and will not deter a person from taking an effective drug. Other adverse effects are more serious and can be a reason for discontinuing the drug.

In the case of Lyrica, randomized controlled trials have shown that doses of 600 mg daily produce drowsiness in 15-20% and dizziness in 27% to 46%.

Other side effects include dry mouth, weight gain, peripheral oedema (swelling). In another important review, it was found that treatment was discontinued due to adverse events in one out of 4 patients.

In summary, a minority of patients will report substantial benefit with Lyrica, and more will have moderate benefit. Many will have no or trivial benefit, or will discontinue the drug because of adverse events.

Is this the sort of information that patients would like to have given to them?

In my experience, the answer is a resounding YES. But as each person is a unique individual, it is impossible to accurately predict who will and who will not like a particular drug.

Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing.”

These oft-quoted words by the French philosopher Voltaire [1694-1778] still have a ring of truth about them. We now know much more about the drugs we prescribe, and about the various diseases we have uncovered and classified. But we still have much to learn about the responses of individual human beings.

Those who have been awarded a diagnosis of fibromyalgia find themselves in a “double bind.”

On the one hand, the very diagnosis can arouse disbelief at all levels of society and, on the other hand, the available drugs afford most of them little, if any, relief of pain.

Take Control!

Mommy came to the doctor with me today – actually she comes to every doctors’ appointment with me. It’s very helpful having her there: she remembers to tell the doctor things that I forget; she remembers things the doctors say that I forget; and when I’m just too tired, she can tell the doctor everything that needs to be said.

(Mind you, today, I was VERY vocal: I asked Dr B his age & if he was married! He is…but, hey! a girl’s gotta try!)

We often lose our voice, when we are tired and not feeling good – and instead let other people take control. I know how easy it is to let that happen – I let Mommy take control a lot of the time. Sometimes, it’s just easier.

It is difficult to cope with doctors, specialists, alternative health practitioners, boyfriends/girlfriends/spouses, parents, bloggers, employers (if you’re still working), etc. Everyone has an idea of how or what you should be doing. Guess what people, they don’t know everything. No one knows you better than you.

It’s not easy to get back some independence, when we have let others take on what we should be able to do for ourselves. You CAN speak up.

If you are troubled with how you are being treated, you CAN say so. Tired of taking drugs that aren’t helping? You CAN say no to them (and your doctor). Your boyfriend thinks you are being lazy? You CAN tell him he is wrong. Your parents think you are ‘just depressed’ – you CAN say ‘no, please listen to me’ (whether they listen to you is another thing, though).

So, how do you start taking back control? Firstly, start saying no to the things that aren’t working in your life. When the stressors, depressors, and all round toxic forces have been eliminated (or at least reduced)….then you can return to ‘yes.’

So what will you say ‘no’ to today?