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.

FibroMAGIC Sex

If you have FM, you may also be having problems with your sex life or relationships (if you have one!). You could be experiencing loss of libido or having difficulty with sexual performance. It’s also possible your libido is healthy, but the pain and stiffness of FM stops you from enjoying sex the way you used to.

It’s not unusual for people with any chronic illness to complain about having problems with their sex life. But a healthy sex life is important for many reasons:

  1. Not only does sex strengthen an intimate relationship, but sexual intercourse boosts endorphins. Those are the body’s natural opioids that help decrease pain and increase well-being.
  2. From my point of view (and many single FM sufferers), you are very lucky to have one – so you need to keep it up!

Talking openly with your doctor and following a few practical tips can help you resolve problems associated with FM, pain, and sex. Then you can begin to enjoy this aspect of your life again.

What Causes Loss of Libido With FM?

Some of the medications, such as Paxil and Zoloft, used in our treatment may cause reduced sex drive. If you take an antidepressant and have problems with libido, talk to your doctor. A simple change of medication or a reduction in dose may improve your sex drive and allow you to enjoy your relationships more.

Further, for some of us, having to deal with the uncomfortable symptoms of FM, including the ongoing pain, fatigue, anxiety, and stiffness, is difficult enough without thinking of being physically active with sexual activity. Learning to self-manage these symptoms with medications, exercise, and lifestyle habits may help to boost your sex life.

How Can I Have Sex if I Hurt all Over?

Some FM patients give up romantic aspirations for fear of further injury and pain. Yet being intimate with your partner is still possible. With FM pain and tender points, you need to work with your partner to find the most comfortable position during sexual intercourse. For instance, if you have FM with low back pain, you may find that having your partner on top or lying on his or her side is most comfortable for you. Or, if you’re a woman who has FM and hip pain, you might use a pillow between your knees to stabilize your body during sexual intercourse.

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(FYI: In the next issue of LIVING WELL with FIBROMYALGIA, there will be a ‘sealed’ Valentines’ Day section, showing specific positions (don’t worry, they are NOT photos of me!) that may help with different pains)

Just because you have always had sex in a particular way does not mean that’s the only way. You need to be patient, take it slowly, and find the best sexual positions that allow you to be intimate without causing further pain. Keep in mind, there is no right or wrong way to be intimate with your partner. It may be time to bring out that 1970s copy of the Karma Sutra that you have hidden at the back of your bookcase or night table – find the positions that work for you.

Can Soaking in a Warm Bath Before Sex Help?

Moist heat, including soaking in a warm bath, can help ease FM pain and may allow you to enjoy sexual intercourse – or any exercise – without added pain. Heat increases blood flow to the site and decreases stiffness.

When using moist heat, make sure it is not too warm or you can burn your skin. You might soak in a warm bath for at least 15 minutes before sexual intercourse or other physical activity to get the full benefit. You may also soak in a warm bath after sexual intercourse or other physical activity. Other popular types of moist heat include a warm shower (sit on a chair, if needed), warm whirlpool or hot tub, heated swimming pool, and a moist heating pad.

Is Stress Linked to Sexual Problems and FM?

Stress may trigger FM symptoms. Yet managing stress may help control your symptoms and balance your daily life, which can boost your libido. Stress management may include a combination of exercises, relaxation techniques (deep breathing or meditation exercises), a good sleep routine, and proper nutrition.

Exercise (including sex) releases endorphins, which are the body’s natural stress-fighting hormones, so any type of physical exercise is a good stress-control measure. Relaxation therapies such as deep abdominal breathing, visualisation or guided imagery, and meditation are also helpful in managing stress.

What Else May Help my Sex Life With FM?

If you have FM, talk to your doctor and see if medications can boost libido and/or sexual performance. Improving your overall health by treating any other medical problems may also help.