Effective treatment options for Fibromyalgia

There are many options available to treat Fibromyalgia. It depends on patient condition as which treatment would work best for him/her. Let us have a look at some treatment options available for treating Fibromyalgia.

Gabapentin is used to help control partial seizures (convulsions) in the treatment of epilepsy. This medicine cannot cure epilepsy and will only work to control seizures for as long as you continue to take it.

Gabapentin is also used in adults to manage a condition called postherpetic neuralgia, which is pain that occurs after shingles.

Gabapentin works in the brain to prevent seizures and relieve pain for certain conditions in the nervous system. It is not used for routine pain caused by minor injuries or arthritis. Gabapentin is an anticonvulsant.

This medicine is available only with your doctor’s prescription.

This product is available in the following dosage forms:

  • Capsule
  • Tablet
  • Solution
  • Suspension

Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals.

Symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event.

Women are much more likely to develop fibromyalgia than are men. Many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression.

While there is no cure for fibromyalgia, a variety of medications can help control symptoms. Exercise, relaxation and stress-reduction measures also may help.

In general, treatments for fibromyalgia include both medication and self-care. The emphasis is on minimizing symptoms and improving general health. No one treatment works for all symptoms.

Medications

Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include:

  • Pain relievers. Over-the-counter pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) may be helpful. Your doctor might suggest a prescription pain reliever such as tramadol (Ultram, Conzip). Narcotics are not advised, because they can lead to dependence and may even worsen the pain over time.
  • Antidepressants. Duloxetine (Cymbalta) and milnacipran (Savella) may help ease the pain and fatigue associated with fibromyalgia. Your doctor may prescribe amitriptyline at night to help promote sleep.
  • Anti-seizure drugs. Medications designed to treat epilepsy are often useful in reducing certain types of pain. Gabapentin (Neurontin, Gralise) is sometimes helpful in reducing fibromyalgia symptoms, while pregabalin (Lyrica) was the first drug approved by the Food and Drug Administration to treat fibromyalgia.

Therapy

Talking with a counselor can help strengthen your belief in your abilities and teach you strategies for dealing with stressful situations.

for more information, please check here

Drugs associated with Fibromyalgia

 

Allopathic

Allopathic physicians basically prescribe the medicines listed below for Fibromyalgia patients

Antidepressants: Antidepressants are prescribed to individuals suffering with depression. The medication works to maintain the Serotonin levels in your brain.

NSAIDs: They are OTP pain relievers helpful to reduce stiffness and pain that occurs as a result of Fibromyalgia and its effectiveness differs with individuals.

Narcotics: Narcotics aren’t usually recommended by physicians for treating Fibromyalgia because of its addictive nature and dependency.

Muscle Relaxants: if patients take muscle relaxants prior sleeping, it helps reduce spasms and pain

Chiropractor

Chiropractic treatment works on the fact that restricted movement in your spine can result in reduced pain and function. Spinal therapy is a type of therapy that the chiropractor implements to treat the restricted mobility in spine. The target is to restore movement of spine and thus decrease pain and improve function.

Exercise

Fibromyalgia exercise proves to be the most powerful remedies in treating Fibromyalgia. Research and scientific evidences has proved that exercising for at least 20 minutes on a daily basis can work well for patients suffering from Fibromyalgia and is a natural treatment that works. Exercise becomes the important factor in Fibromyalgia Treatment and a properly planned exercise routine can help improve your body tissues, increase mobility and decrease pain. The exercise program designed for Fibromyalgia should be gradual and slow.

Massage Therapy

Massage therapy includes various manipulative techniques used to move the soft tissues and body’s muscles. The goal of massage therapy is to enhance the circulation in your muscles, eliminate body’s waste products and enhance the flow of nutrients in your body. Massage helps relaxing your muscles, improve joint mobility and increase the body’s production of natural painkillers. It also helps in reducing anxiety, stress in patients who suffer from pain.

Osteopathy

Osteopaths perform therapies which are similar to what Allopathic physicians perform and osteopaths are licensed to perform various therapies. One sector where osteopathy is different from conventional medicine and is similar to chiropractic medicine is that both chiropractic medicine and osteopathy focus on manipulating and finding out the problems related to spine and joints. The treatment is effective to treat the symptoms of Fibromyalgia.

Physiotherapy

Physical therapy is part of health care which helps the patient to regain the strength in bones, muscles and nervous system. The basic therapies included in this treatment are electric stimulation, ultrasound, heat and ice. Manual therapy, therapeutic massage, hydrotherapy, therapeutic massage is used to help patient get rid of pain.

Self Care

Reduce stress- Avoid emotional stress and overexertion. Give yourself some time to relax and practice techniques that are helpful in reducing stress like meditation, deep breathing etc as part of Fibromyalgia treatment. Sleep- sufficient amount of sleep is important to avoid being fatigue. Make sure that you allot time for your sleep wherein you go to bed at the same time and wake at the same time the next morning. Taking short naps is helpful to restore energy.

Is it painful all over your body? It can be Fibromyalgia

Is it painful all through your body? And it doesn’t end? It could be Fibromyalgia. The symptoms are such that you cannot recognize it as a disease. It affects joints, muscles, ligaments and your body pains even with a single touch. You may be suffering from Fibromyalgia. Let us know more about Fibromyalgia.

Fibromyalgia is basically not a disease but a chronic condition. There are solutions to treat the condition, but many treatments leave long lasting side effects. Let us have a look at negative and positive sides of treatments available for Fibromyalgia.

In case you are suffering from Fibromyalgia, you feel hurt through entire body and feel exhausted as well. Your doctor might not be able to detect the condition even after several lab tests. The actual cause of this condition is still not known, but studies say that the nerves present in muscles tissue get irritated because of inflammation and send painful signals to the brain and a person then recognizes it as a pain condition.

One test that helps doctor to detect Fibromyalgia symptoms is to identify the locations on the body that get sensitive to severe pain even with slight pressure. The tender points for Fibromyalgia pain are

  • Around neck’s lower vertebra.
  • Middle of your knee joint
  • Upper back and neck muscles
  • Mid back muscles
  • On elbow side
  • Outer and upper buttock muscles
  • At second rib insertion
  • Around thigh bone’s upper part
  • In muscles that are connected to skull base

Fibromyalgia can also occur in children. Many people suffering from Fibromyalgia can also have

  • Headaches
  • Fatigue syndrome(chronic)
  • Lupus
  • Endometriosis
  • Osteoarthritis
  • Restless leg syndrome
  • Rheumatoid arthritis
  • IBS
  • Depression
  • Stress disorder

The Fibromyalgia symptoms can vary with certain changes in weather, stress, physical activities or sometimes just any time of the day. The pain exists both below and above your waist. You also suffer from fatigue due to disturbance in sleeping pattern. You feel tired when you awake as you couldn’t get enough sleep. This condition hardly allows people to get sound sleep without disturbances in order to refresh their soul and body. The sleeping disorders often lead to other problems like restless leg syndrome and sleep apnea.

The condition is hereditary too that means if anyone in your family has this condition, you have an increased risk of developing Fibromyalgia. Fibromyalgia develops more in women than children or men. It starts in middle adulthood or during early adulthood as well.

People suffering from lupus or rheumatoid arthritis they are at increased risk of getting Fibromyalgia. Treatments for this condition include required medication and self care. The treatment involves improving overall health of the person and reducing the symptoms of Fibromyalgia.

There are many herbal treatments available to treat Fibromyalgia and these treatments do not lead to any side-effect too. The natural supplements also help in relieving pain caused due to Fibromyalgia.

Fibromyalgia-Gabapentin- New study about Brain Fog occurrence

Many people who suffer from chronic fatigue or Fibromyalgia use prescription drug like Gabapentin (Neurontin) to aid and manage symptoms of pain and epileptic seizure. the disturbed epileptic seizure results in sleep apnea, sleep dysfunction or restless leg syndrome.

The new study shows that due to thrombospondin and unnatural function of brain the possible results seen are brain dysfunction. If you are suffering from brain fog related to Fibromyalgia or deficiency of immune system related to chronic fatigue syndrome, then Gabapentin may not be the best choice or first line choice of drug.  It proves to be logical that it adds to the existing symptoms if you continue using this drug(prescription).

Let us know how and why?

By using Gabapentin, you might disturb the important brain connection that is important for you for cognition and proper memory. Most of us are aware of how delicate our brain is. If anything goes wrong with this delicate part of our body, it can be life-threatening. Too much of drug interactions or anesthesia and you might lose your senses. In simple words anything that leaves a negative impact on the normal functioning of our brain should be researched, suspected, avoided and reported, if possible.

New study shows that an individual who is suffering from chronic fatigue syndrome or fibromyalgia can show the following symptoms if using this drug

  • Not able to think properly or not able to think only
  • Couldn’t recollect memories of say a week before even if the brain is recessed.
  • Mentally incapable of thinking even below normal level, unable to think and feel numb.
  • Not being able to do logical reasoning even simple ones like solving a financial problem or not able to judge what needs to be spoken in a discussion.
  • Not able to think or care what will happen in a stressful situation or vice versa like not bothered about what will be the result. This even leads to emotional detachment. These results in like a person who is least bothered about living his life and in turn it creates suicidal thoughts or chronic depression.

Brain fog is a situation that pulls you down and is incredibly tough and scary symptom to handle as compared to other symptoms.

This is something to explain how powerful the drug is and can affect your loved one. If the brain has stopped functioning normally, then how would you know what the reason is or cause behind it?  What might be happening? So if you notice such symptoms it is better to consult your health care person to take actions immediately. There are many people who lose connection to life while taking the drug and if they get well, they see a new life as the brain becomes functional and live again and body follows the brain.

Make sure you consult your doctor before taking this drug as the symptoms can be scary and you might lose your connection with life. Better start with right medication and speak to your doctor.

Complementary and Alternative Therapies for Fibromyalgia

Fibromyalgia can be difficult to treat. Not all doctors are familiar with fibromyalgia and its treatment, so it is important to find a doctor who is. Many family physicians, general internists, or rheumatologists (doctors who specialize in arthritis and other conditions that affect the joints or soft tissues) can treat fibromyalgia.

Fibromyalgia treatment often requires a team approach, with your doctor, a physical therapist, possibly other health professionals, and most importantly, yourself, all playing an active role. It can be hard to assemble this team, and you may struggle to find the right professionals to treat you. When you do, however, the combined expertise of these various professionals can help you improve your quality of life.

You may find several members of the treatment team you need at a clinic. There are pain clinics that specialize in pain and rheumatology clinics that specialize in arthritis and other rheumatic diseases, including fibromyalgia.

Only three medications, duloxetine, milnacipran, and pregabalin are approved by the U.S. Food and Drug Administration (FDA) for the treatment of fibromyalgia. Duloxetine was originally developed for and is still used to treat depression. Milnacipran is similar to a drug used to treat depression but is FDA approved only for fibromyalgia. Pregaballin is a medication developed to treat neuropathic pain (chronic pain caused by damage to the nervous system).

Doctors also treat fibromyalgia with a variety of other medications such as Gabapentin developed and approved for other purposes.

Complementary and Alternative Therapies

Many people with fibromyalgia also report varying degrees of success with complementary and alternative therapies, including massage, movement therapies (such as Pilates and the Feldenkrais method), chiropractic treatments, acupuncture, and various herbs and dietary supplements for different fibromyalgia symptoms. (For more information on complementary and alternative therapies, contact the National Center for Complementary and Alternative Medicine.

Although some of these supplements are being studied for fibromyalgia, there is little, if any, scientific proof yet that they help. FDA does not regulate the sale of dietary supplements, so information about side effects, proper dosage, and the amount of a preparation’s active ingredients may not be well known. If you are using or would like to try a complementary or alternative therapy, you should first speak with your doctor, who may know more about the therapy’s effectiveness, as well as whether it is safe to try in combination with your medications.

Besides taking medicine prescribed by your doctor, there are many things you can do to minimize the impact of fibromyalgia on your life.

These include:

  •  Getting enough sleep. Getting enough sleep and the right kind of sleep can help ease the pain and fatigue of fibromyalgia. Even so, many people with fibromyalgia have problems such as pain, restless legs syndrome, or brainwave irregularities that interfere with restful sleep. It is important to discuss any sleep problems with your doctor, who can prescribe or recommend treatment for them.
  • Exercising. Although pain and fatigue may make exercise and daily activities difficult, it is crucial to be as physically active as possible. Research has repeatedly shown that regular exercise is one of the most effective treatments for fibromyalgia. People who have too much pain or fatigue to do vigorous exercise should begin with walking or other gentle exercise and build their endurance and intensity slowly.
  • Making changes at work. Most people with fibromyalgia continue to work, but they may have to make big changes to do so. For example, some people cut down the number of hours they work, switch to a less demanding job, or adapt a current job. If you face obstacles at work, such as an uncomfortable desk chair that leaves your back aching or difficulty lifting heavy boxes or files, your employer may make adaptations that will enable you to keep your job. An occupational therapist can help you design a more comfortable workstation or find more efficient and less painful ways to lift.
  •  Eating well. Although some people with fibromyalgia report feeling better when they eat or avoid certain foods, no specific diet has been proven to influence fibromyalgia. Of course, it is important to have a healthy, balanced diet. Not only will proper nutrition give you more energy and make you generally feel better, it will also help you avoid other health problems.
  • Take Nu Skin Products especially Nu skin lifepak nano for balanced nutrition.

Fibromyalgia is a chronic condition, meaning it lasts a long time, possibly a lifetime. However, it may be comforting to know that fibromyalgia is not a progressive disease. It is never fatal, and it will not cause damage to the joints, muscles, or internal organs. In many people, the condition does improve over time.

 

Foods Said to Cause Fibromyaligia Flares

A sudden attack of intense pain and stiffness in the muscles is known as Fibromyalgia Flares. There are certain foods that you need to avoid because these 6 foods are said to cause Fibromyalgia Flares.

  • Nightshade Vegetables  A class of vegetables known as nightshades are known to cause aching and pain in the joints and muscles as well as weakness and fatigue for people who are sensitive, Ygoy.com reports. The nightshades contain a compound called solanine that is responsible for this reaction. Anecdotal evidence points to these items being the culprits: peppers, tomatoes, paprika, eggplant, white potatoes and tobacco. The reaction can happen quickly or within days. Some people become completely crippled during a reaction to nightshades. Smoking cigarettes and using other tobacco products, even when they are not ingested, may produce symptoms.
  • Gluten-containing Grains Gluten-containing grains such as wheat, barley, rye and possibly oats have been shown to produce a myriad of symptoms in those who are sensitive, The Savvy Celiac website explains. For people who have gluten allergies and are gluten intolerant, the entire body can react immediately or within several hours or days. Some of the symptoms experienced may be severe inflammation, swelling, headaches, respiratory problems, weakness, fatigue, and extreme body pain. There is also an issue of cross-contamination for those who are sensitive, and close attention must be paid to reading labels and eating foods that have not been in contact with other foods containing gluten. By eliminating all gluten-containing foods, starting with processed white flour, you will likely see a difference in your pain level and other symptoms.
  • Artificial Sweeteners and Food Additives Certain food additives and artificial sweeteners may create serious side effects, worsening fibromyalgia in those who are sensitive. All artificial sweeteners should be eliminated as well as foods containing them, such as sodas and other diet foods.  Monosodium glutamate (MSG) is the most common food additive, Laura A. Coleman and R. Roubenoff explain in their book, “Nutrition and Rheumatic Disease (Nutrition and Health).” Used as a preservative and flavor enhancer, MSG is found in one form or another in just about every packaged or canned food on the market unless labeled otherwise. An wide range of symptoms have been reported that mimic or aggravate fibromyalgia such as dizziness, headaches, stomach upsets, nausea, body aches and joint pain especially in arms and hands, difficulty thinking, mood changes and more. Unless the label on the package says “MSG free,” assume what you are buying includes MSG. Most Asian restaurants also include MSG in their preparations, so ask for it to be eliminated or don’t eat at that restaurant.
  • Foods Containing MSG Keep a list of these common foods available so you recognize which are the culprits. Anything with soy sauce, soy protein, bouillon, broths and soup stock, foods labeled with “natural flavoring,” textured protein, TVP, barley malt or whey protein are on the “avoid” list.
  • Monosodium Glutamate (MSG) Pseudonyms MSG is a chemical and known by many names. Here is a list of most of those names to keep with you so you recognize them when you shop. They include sodium caseinate, yeast nutrient, calcium caseinate, hydrolyzed protein, autolyzed yeast, yeast extract, yeast food, hydrolyzed corn gluten, natrium glutamate, monopotassium glutamate, carrageenan, maltodextrin,  citric acid, soy protein isolate, malt extract, whey protein protease, malt flavoring. Foods labeled “enzyme modified” has MSG. Food labeled as protein fortified, whey protein isolate and protease enzymes, should be avoided. Beware of flavorings and fermented foods, enzymes, natural flavor and seasonings.
  • Caffeine: Caffeine intake can trigger headaches and also interfere with sleep patterns. It stays in your system for several hours which can further result to fatigue. It can also increase your heart rate and blood pressure.
  • Refined Sugar: Sugar can increase blood sugar swings associated with adrenal fatigue. Too much sugar can also leaving fibro patients in even more pain and drops in blood sugar can cause flaring of muscle tightening and anxiety.
  • Aspartame (Also Known as NutraSweet): This could increase or stimulate pain receptor of the nervous system that can lead to pain. This can also turn to chronic pain from acute pain.
  • Saturated Fats: It inhibits circulation and increase the sensitivity of nerve endings to pain.
  • Red Meat: Red meats are high in saturated fats. It interferes with proper circulation of blood and thus leads to fatigue and pain.
  • Alcohol: Alcohol promotes inflammation, which increases pain because the toxins produced from alcohol don’t process well by Fibromyalgia patients.

food2fib

What Causes Fibromyalgia and what may be the reasons of Fibromyalgia

The causes of fibromyalgia are unknown, but there are probably a number of factors involved. Many people associate the development of fibromyalgia with a physically or emotionally stressful or traumatic event, such as an automobile accident. Some connect it to repetitive injuries. Others link it to an illness. For others, fibromyalgia seems to occur spontaneously.

Many researchers are examining other causes, including problems with how the central nervous system (the brain and spinal cord) processes pain.

Some scientists speculate that a person’s genes may regulate the way his or her body processes painful stimuli. According to this theory, people with fibromyalgia may have a gene or genes that cause them to react strongly to stimuli that most people would not perceive as painful. There have already been several genes identified that occur more commonly in fibromyalgia patients, and NIAMS-supported researchers are currently looking at other possibilities.

fibromyalgiacause

fibreasons2

Fibromyalgia can run in families. It’s likely that there is an unidentified genetic abnormality that makes certain people more at risk for fibromyalgia. The National Institute of Arthritis, Musculoskeletal and Skin Diseases (NIAMS) states that certain genes may regulate the way that the body regulates pain responses. Scientists speculate that people with fibromyalgia may carry one or more genes that cause them to react strongly to stimuli that another person may not perceive as painful.

Fibromyalgia Triggers

For many patients, symptoms begin after emotional or physical trauma or a bout with an infectious disease. These do not likely cause fibromyalgia by themselves, but may trigger the onset in people who are already at risk for it.

Sleep Disturbances

Problems with getting enough sleep, or spending enough time in the deepest stages of sleep, are common in this disorder. However, doctors are not sure if this is a symptom or a cause of the disorder. Improper sleep patterns can affect the levels of some of the brain chemicals listed above.

Risk Factors

There are several factors that indicate an increased risk of fibromyalgia. However, their presence doesn’t mean one will certainly be diagnosed with the syndrome.

Gender

According to the NIAMS, Women are eight to nine times more likely than men to have fibromyalgia.  Scientists believe female reproductive hormones may play a role in the pain disorder.

Age

According to the NIAMS, the most common age to be diagnosed with fibromyalgia is early to middle adulthood, between 20 and 50 years old.

Family History

If you have a close family member with fibromyalgia, you are more likely to be diagnosed yourself.

Sleep Disorders

It is not known if sleep problems are a symptom or a cause of fibromyalgia. However, people who have disorders affecting sleep such as sleep apnea and restless leg syndrome are more likely to have the pain disorder.

Other Rheumatic Diseases

Rheumatic diseases affect the joints, muscles, and bones. People who have another rheumatic disease are more likely to have fibromyalgia as well. These diseases include:

  • rheumatoid arthritis
  • osteoarthritis
  • lupus
  • ankylosing spondylitis

 

Who Gets Fibromyalgia? How Can You Tell if You Have Fibromyalgia?

overview tenderpoint diagram for fibromyalgia

Fibromyalgia is an often-misunderstood form of rheumatoid disease. It’s usually classified alongside other forms of rheumatic disorders, such as arthritis, but the exact cause of fibromyalgia remains unknown.

Scientists estimate that fibromyalgia affects 5 million Americans age 18 or older. For unknown reasons, between 80 and 90 percent of those diagnosed with fibromyalgia are women While anyone can get fibromyalgia, hormones are thought to be a possible explanation for this gender bias; however, men and children also can be affected. Most people are diagnosed during middle age, although the symptoms often become present earlier in life.

How Can You Tell if You Have Fibromyalgia?
Your doctor will ask about your pain symptoms and then press on a series of anatomically-defined soft tissue body sites called “tender points.” There are 18 tender points on the body that will usually be highly sensitive to pressure in people with fibromyalgia as specified by the American College of Rheumatology criteria. People who do not have fibromyalgia are much less tender to pressure applied at these tender points.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases estimates that about five million adults in the United States have fibromyalgia. It can technically develop in anyone at any age, but fibromyalgia most typically develops in middle-aged adults. The disorder primarily occurs in women, so being female is a risk factor.

Other risk factors also increase the risk of developing fibromyalgia. These risk factors include:

  • a personal or family history of fibromyalgia or other rheumatoid disease
  • recurring injuries in the same part of the body
  • anxiety or long-term stress
  • neurological disorders
  • going through a major physical event, such as a car accident
  • history of serious infections

Having a history of any of the above factors doesn’t necessarily mean you’ll develop fibromyalgia. You should still be aware of these risks and discuss them with your doctor if you’re concerned.

 


1Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, Gabriel S, Hirsch R, Hochberg MC, Hunder GG, Jordan JM, Katz JN, Kremers HM, Wolfe F; National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008 Jan;58(1):26-35.

People with certain rheumatic diseases, such as rheumatoid arthritis, systemic lupus erythematosus (commonly called lupus), or ankylosing spondylitis (spinal arthritis) may be more likely to have fibromyalgia, too.

Several studies indicate that women who have a family member with fibromyalgia are more likely to have fibromyalgia themselves, but the exact reason for this—whether it is heredity, shared environmental factors, or both—is unknown. Researchers are trying to determine whether variations in certain genes cause some people to be more sensitive to stimuli, which lead to pain syndromes.

 

Neurontin can be used to prevent Migraine, treat Nerve Pain and control the pain of fibromyalgia.

Neurontin is the trade name for the generic drug gabapentin. It is useful as an anti-epileptic drug and as an analgesic, particularly for pain of the neuropathic or neurogenic type. (pain from irritation or inflammation of nerves). When used for controlling epilepsy, it is usually used in conjunction with another anti-epileptic drug. It is used much more extensively in the medical field to treat pain than it is to treat epilepsy.

You can also buy Neurontin to treat attention deficit hyperactivity disorder (ADHD), alcohol withdrawal, chronic neuropathic pain, cocaine addiction, diabetic peripheral neuropathy,generalized anxiety disorder (GAD), fibromyalgia, menopause, migraine prevention, panic disorder, post-traumatic stress disorder (PTSD), social phobia, trigeminal neuralgia.

The chemical structure of gabapentin is related that of gamma-aminobutyric acid (GABA) which is a neurotransmitter in the brain. The exact mechanism as to how gabapentin controls epilepsy and relieves pain is unknown, but it probably acts like the neurotransmitter GABA.

Animal studies show that gabapentin prevents the development of allodynia (a normally non painful stimulus which is perceived as painful) and hyperalgesia (an exaggerated response to a painful stimulus).

Gabapentin 800 mg Tab-IVAInternational and domestic studies that have evaluated Neurontin for migraine prevention suggest that it is effective. In a study of 63 patients with migraine (with or without aura), gabapentin significantly reduced migraine frequency and intensity among 30 patients who received it. In this study, adverse events were mild to moderate in severity.

Similarly, in a large study, 143 people with migraine received daily doses of Neurontin or placebo for 12 weeks. At the end of 12 weeks, the migraine rate had declined from 4.2 migraines before treatment to 2.7 migraines after treatment in those who received this drug. This decrease was significantly greater than the decrease from 4.1 migraines to 3.5 migraines among those who received placebo. Of the 56 gabapentin recipients, 46% had at least a 50% reduction in the four-week migraine rate. Drug-related adverse events (sleepiness and dizziness) led to drug withdrawal in 13% of patients in the gabapentin group compared with 7% in the placebo group. The researchers concluded that this medication is an effective and well-tolerated preventive for migraine.

Gabapentin can be very helpful in controlling the pain of trigeminal neuralgia (tic doloreaux), post herpetic neuralgia (the lingering pain after a bout of shingles), the pain of diabetic neuropathy and other neuritic pains such as pain from nerve irritation due spinal arthritis or disc disease and occipital neuralgia. Occasionally it seems to be helpful in controlling migraine and other headaches. It has also been reported to be helpful in controlling the pain of fibromyalgia.

Gabapentin is generally well tolerated. The main side effects are dizziness and drowsiness. Occasionally there maybe some fluid retention, unsteadiness or G.I upset, mainly diarrhea.

The effective dose of gabapentin varies greatly. Some persons need only 200-300 mg a day whereas others may need 3000 mg or more a day. It may take several weeks to become effective, so it is important to stay on it for an adequate length of time.

Gabapentin for chronic neuropathic pain and fibromyalgia

This review is an update of a review published in 2011, itself a major update of previous reviews published in 2005 and 2000, investigating the effects of gabapentin in chronic neuropathic pain (pain due to nerve damage). Antiepileptic drugs are used to manage chronic neuropathic pain and fibromyalgia.

OBJECTIVES:

To assess the analgesic efficacy and adverse effects of gabapentin in chronic neuropathic pain and fibromyalgia.

SEARCH METHODS:

We identified randomised trials of gabapentin for chronic neuropathic pain or fibromyalgia by searching the databases MEDLINE (1966 to March 2014), EMBASE (1980 to 2014 week 10), and CENTRAL in The Cochrane Library (Issue 3 of 12, 2014). We obtained clinical trial reports and synopses of published and unpublished studies from Internet sources, and searched Clinicaltrials.gov. Searches were run originally in 2011 and the date of the most recent search was 17 March 2014.

SELECTION CRITERIA:

Randomised, double-blind studies reporting the analgesic and adverse effects of gabapentin in neuropathic pain or fibromyalgia with assessment of pain intensity, pain relief, or both, using validated scales. Participants were adults.

DATA COLLECTION AND ANALYSIS:

Three review authors independently extracted efficacy and adverse event data, examined issues of study quality, and assessed risk of bias. We performed analysis using three tiers of evidence. First tier evidence derived from data meeting current best standards and subject to minimal risk of bias (outcome equivalent to substantial pain intensity reduction, intention-to-treat analysis without imputation for dropouts; at least 200 participants in the comparison, 8 to 12 weeks duration, parallel design), second tier from data that failed to meet one or more of these criteria and were considered at some risk of bias but with adequate numbers in the comparison, and third tier from data involving small numbers of participants that were considered very likely to be biased or used outcomes of limited clinical utility, or both.For efficacy, we calculated the number needed to treat to benefit (NNT), concentrating on at least 50% pain intensity reduction, and Initiative on Methods, Measurement and Pain Assessment in Clinical Trials (IMMPACT) definitions of at least moderate and substantial benefit. For harm we calculated number needed to treat for harm (NNH) for adverse effects and withdrawal. Meta-analysis was undertaken using a fixed-effect model. We emphasised differences between conditions now defined as neuropathic pain, and other conditions like masticatory pain, complex regional painsyndrome type 1 (CRPS-1), and fibromyalgia.

MAIN RESULTS:

Seven new studies with 1919 participants were added. Another report (147 participants) provided results for a study already included, but which previously had no usable data. A further report (170 participants) used an experimental formulation of intrathecal gabapentin. Thirty-seven studies (5633 participants) studied oral gabapentin at daily doses of 1200 mg or more in 12 chronic pain conditions; 84% of participants were in studies of postherpetic neuralgia, painful diabetic neuropathy or mixed neuropathic pain. There was no first tier evidence.Second tier evidence for the outcome of at least 50% pain intensity reduction, considered valuable by patients with chronic pain, showed that gabapentin was significantly better than placebo in postherpetic neuralgia (34% gabapentin versus 21% placebo; NNT 8.0, 95% CI 6.0 to 12) and painful diabetic neuropathy (38% versus 21%, NNT 5.9, 95% CI 4.6 to 8.3). There was insufficient information in other pain conditions to reach any reliable conclusion. There was no obvious difference between standard gabapentin formulations and recently-introduced extended-release or gastro-retentive formulations, or between different doses of gabapentin.Adverse events occurred significantly more often with gabapentin. Persons taking gabapentin could expect to have at least one adverse event (62%), withdraw because of an adverse event (11%), suffer dizziness (19%), somnolence (14%), peripheral oedema (7%), and gait disturbance (9%). Serious adverse events (3%) were no more common than with placebo.There were insufficient data for direct comparisons with other active treatments, and only third tier evidence for other painful conditions.

AUTHORS’ CONCLUSIONS:

There was no top tier evidence that was unequivocally unbiased. Second tier evidence, with potentially important residual biases, showed that gabapentin at doses of 1200 mg or more was effective for some people with some painful neuropathic pain conditions. The outcome of at least 50% pain intensity reduction is regarded as a useful outcome of treatment by patients, and the achievement of this degree of pain relief is associated with important beneficial effects on sleep interference, fatigue, and depression, as well as quality of life, function, and work. About 35% achieved this degree of pain relief with gabapentin, compared with 21% for placebo. Over half of those treated with gabapentin will not have worthwhile pain relief. Results might vary between different neuropathic pain conditions, and the amount of evidence for gabapentin in neuropathic pain conditions except postherpetic neuralgia and painful diabetic neuropathy, and in fibromyalgia, is very limited.The levels of efficacy found for gabapentin are consistent with those found for other drug therapies in postherpetic neuralgia and painful diabetic neuropathy.