Fibromyalgia

Amitriptyline as a Treatment Choice for Fibromyalgia: A Help or Hindrance?

Amitriptyline for fibromyalgia

There are numerous treatments available for the symptoms associated with fibromyalgia.

Fibromyalgia is classified as a disorder of pain processing due to abnormalities in the ways in which pain signals are processed in the central nervous system.

Patients suffering from fibromyalgia often complain of depression, insomnia,irritable bowel syndrome, painful and tender points or “trigger points.”

Tender points are pain points or localized areas of tenderness around joints, but not the joints themselves.

These areas of tenderness or sensitivity can be felt just below the skin in specific parts of the body.

In contrast to tender points, trigger points are firm nodules that can be felt in tight, rope-like muscles and when pressure is applied on a trigger point, the pain is felt in the area and can shoot pain to other body parts.

This is not the same as the feeling associated with pressing on a tender point as it is felt in a localized area only.

The types of pain associated with fibromyalgia is believed to be caused by a “glitch” or “disconnect” in the way in which pain is processed by the body.

This glitch and its repercussions occur when a person has a hypersensitivity to stimuli that are not normally painful.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) has reported that their research has shown that people who suffer from fibromyalgia have reduced blood flow levels to the parts of the brain that normally allow the body to deal with pain.

This increase in sensitivity to pain and the inability of the brain to manage pain creates the conditions of a chronic pain concern.

Patients with fibromyalgia most often report symptoms associated with chronic pain.

As neurochemical changes in one’s body increases one’s sensitivity to pain, the chronic pain worsens.

Sufferers begin to have pain in other parts of the body that do not normally hurt.

This spread of tender points and the intensity and duration of pain results in additional stress on a patient’s ability to sleep well, and the cycle of pain and the inability to ease that pain can spiral a person into deep depression.

Below are approaches to easing some of the symptoms of fibromyalgia. Some approaches note the importance of medication while other combine medication with alternate methods to ease pain, increase one’s quality of sleep, and reduce depressive thoughts and feelings.

Amitriptyline is considered to be the most common medication prescribed to treat fibromyalgia.

Its efficacy has been demonstrated in controlled studies, and it is known to enhance stage three and stage four sleep (these stages are also known as deep, slow-wave, or delta sleep).

As sleep deprivation and insomnia are often-cited complaints by sufferers with fibromyalgia, Amitriptyline is an excellent choice for these patients to consider.

 

What is Amitriptyline?

Amitriptyline is a tricyclic antidepressant, and it is widely used to treat chronic neuropathic pain (i.e., any pain due to nerve damage) and fibromyalgia.

These types of chronic pain can be treated very successfully with antidepressant drugs in small doses.

The dosage amount is noteworthy as it is below dosage sizes at which Amitriptyline acts as an antidepressant.

Amitriptyline works by increasing amounts of natural substances in the brain that are necessary for the brain to maintain mental balance.

Amitriptyline may also used to alleviate post-herpetic neuralgia (the burning and stabbing pains associated with shingles), treat eating disorders and is sometime prescribed to prevent migraine headaches.

For patients with multiple sclerosis, Amitriptyline is used to treat painful paresthesias in the arms and legs (e.g., burning sensations, stabbing pains, “pins and needles”) caused by damage to the pain-regulating pathways of the spinal cord and brain.

What the Studies Sayfibromyalgia-pain-relief

In one study, researchers found that a 25 mg dose of Amitriptyline (Elavil) (Note: Elavil is a brand name drug that is no longer available in the U.S. by this name.

Generic versions are available) or a 20 mg dose of fluoxetine (Prozac) reduced symptoms of fibromyalgia, the combination of the two medications was twice as effective as either agent when taken on its own.

This study’s report also noted that dosages used are slightly lower than those needed to treat depression.

Older agents, such as Amitriptyline, may be used at a daily dosage rate of 10 mg taken two to three hours before bedtime.

This dosage schedule allows for the peak sedative effect to be realized when the sufferer is sleeping.

Taking this small dose earlier than at bedtime may also allow the user to avoid undesired carry-over sedation upon awakening. Moreover, administration time can be adjusted depending on individual patient’s response to its effect.

A significantly improved quality of sleep was reported in patients who participated in a study that evaluated the efficiency of Amitriptyline (50 mg doses).

In another study, results were somewhat disappointing. In 2012, results were reported from a larger study involving over 1400 participants.

No supportive unbiased evidence for a beneficial effect of treating fibromyalgia with Amitriptyline was found.

The authors noted, however, that its research findings must be balanced against decades of successful treatment in numerous patients suffering from neuropathic pain or fibromyalgia who have relied on anti-depressants, such as Amitriptyline.

In the end, the use of Amitriptyline by fibromyalgia sufferers appears to help them.

The side effects are often minimal, and while the benefits may not be quantifiable in studies, its success in the treatment of fibromyalgia symptoms for decades cannot be ignored.

Small Doses, Good Results

The dosage of antidepressants, such as Amitriptyline must be individualized. This is particularly true when using tricyclic agents, given their variable rates of absorption, metabolism and excretion.

It is strongly recommended that dosages should be gradually increased so as not to exceed the recommended maximum dosage for the drug. Even those patients who are able to tolerate very small amounts of these types of medications may derive benefit from them.

There are some side effects of using Amitriptyline to treat fibromyalgia. These side effects may include morning sedation (a feeling akin to having a hangover), dry mouth, confusion, and urinary retention.

Amitriptyline + Exercise = More Benefits

The 2012 study noted above suggests that Amitriptyline should be used as part of the treatment of neuropathic pain or fibromyalgia, even though only a small number of patients achieve satisfactory pain relief with it alone.

Let’s explore how exercise and Amitriptyline can work together to allieviate symptoms of fibromyalgia.

Non-medical approaches to treating fibromyalgia include stress-reducing activities, such as aerobic exercise and strength training. Combined with the properly managed use of Amitriptyline, patients noted a decrease in symptoms, more effective sleep, reduced joint pain, and reduced feelings of fatigue.

One type of exercise that has demonstrated a high degree of relief is long-term aquatic-based exercise.

Since they combine cardiovascular exercise with resistance training, swimming, water aerobics, and other types of aquatic-based exercise programs are very efficient types of exercise for patients with fibromyalgia.

As fibromayalgia sufferers also are very sensitive to cold temperatures, it is recommended that they seek out warm water pools in climate-controlled environments for water aerobics and other activities.

This way the water temperature and air temperature outside the pool will not adversely affect the patient and this piece of the treatment puzzle.

Fibromyalgia can be treated in children and teens with intense physical and occupational therapy programs too.

Many of these therapies are suggested for other amplified musculoskeletal pain syndromes (AMPS), such as localized or diffuse idiopathic musculoskeletal pain and myofascial pain syndrome.

These therapy programs suggest that regular physical exercise will benefit the sufferer, even if at times they must work through the pain.

Once these exercise regimens are practiced with physical or occupational therapists, they can be completed in the home and provide fibromyalgia sufferers with long-term relief.

Amitriptyline + Therapy = Even More Benefits

A variety of other types of therapies can also be used in tandem with Amitriptyline. Counseling, art therapy, and music therapy have shown great results with children.

These types of programs can be found at Boston Children’s Hospital (in association with Harvard University), The Children’s Hospital of Philadelphia (associated with the University of Pennsylvania), and many other American children’s hospitals.

These types of programs are evidence-based, and some report total pain resolution rates close to 88%.

The efficacy of a treatment regimen that includes counseling, art therapy, and music therapy for adults with fibromyalgiahas not been studied.

More often, adults incorporate cognitive behavioral therapy (CBT) and related behavioral and psychological therapies in conjunction with antidepressants, such as Amitriptyline.

Relaxation exercises, such as guided imagery and deep-breathing exercises are shown to provide some comfort and pain alleviation.

These types of therapies appear to have a small to moderate ability to reduce or minimize the symptoms of fibromyalgia.

Based on the research and study findings, it is determined that a multidisciplinary approach, often including CBT, is sometimes considered to be the “gold standard” of treatment for chronic pain syndromes such as fibromyalgia.

Combining the positive effects of Amitriptyline with exercise and therapy improve the pain management and overall quality of life for fibromyalgia sufferers.

As noted above, each type of treatment is part of a puzzle, and once assembled can make fibromyalgia less painful and more easily managed.

Comments

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4 Comments

  • I like this article because of it’s thorough and unbiased style. My own experience with amitryptyline was a disappointment. At high doses it turned me into a zombie by day. At lower doses it did nothing to speak of – day or night. Perhaps the “decades of successful treatment” referred to by the authors could simply be down to a placebo effect. Do many of these patients simply take it and make do because they see nothing better coming down the line? If so, from whose perspective is this treatment successful?

  • I use 125mg of Amytriptyline per night. I take them with 1, Nitapazem 5 mg. 1 Quetapine. Taken at 7.30pm.
    I have had Fibromyalgia for 24 yrs and Amitriptyline has been one of my main pain relief meds for that long. I am starting to be able to sleep through the night without waking, clawing at the blankets to try and turn over for half an hour.
    I am so thankful that we can still get Amitriptyline in New Zealand.

  • I thought this article was very helpful and fairly balanced.After 22 years of fibromyalgia and essentially creating my own health care protocol through trial and error (and good doctors, practitioners and an early diagnosis) I have learned that one person’s amazing response to a drug, or remedy, or diet may not work for anyone else. Just as the symptoms can vary day to day, or at least vary in degree, so do the treatments. For me, Ultram, Amitriptyline and Aleve work really well. There are a lot of things I have to stay on top of, like how much energy I can expend, and how much rest I need on the weekends. I also have prescriptions for other issues and take some vitamins and other remedies. Besides fish oil, my favorite is Zyflamend, which is a capsule with many anti-inflammatory herbs in it like turmeric, ginger, etc. I have not been tempted to try Lyrica or any of the other “new” fibro drugs, as what I am doing now works well.

  • This med is not recommended for the elderly. I took it for a while many years ago but decided to get off of it because I had too many falls and didn’t like the other side effects either.

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