An empty-nester and a mother of three young adults, Meredith should be thrilled during the holidays. Unfortunately, things are not as merry as they could be as Meredith suffers from nearly constant muscle pain, preventing her from enjoying some of life’s simplest pleasures. Meredith has fibromyalgia and has been living with the disease for ten years; she suffers from daily symptoms that include muscle tenderness, fatigue and concentration difficulties. This pain has interfered with her ability to function both at home and at work. Lately, the frustration of dealing with an often-misunderstood condition has resulted in depression and health-related anxiety.
Fibromyalgia affects almost five per cent of Canadians and women account for approximately 80 per cent of cases. The disease is difficult to diagnose, and its causes are unknown. Often, because there is no generally definitive diagnostic test for fibromyalgia, doctors may conclude a patient’s pain is not real, sometimes telling their patient that there is little to be done. Additionally, fibromyalgia is difficult to treat, and many sufferers find common pain medications to be ineffective and worry about the risk of addiction if they were to rely on opioids.
For years, Meredith has relied on water-based exercises like aqua-fitness and “natural” treatments such as meditation, yoga and massage therapy to successfully diminish the daily symptoms associated with her disease. Although these treatments have safely relieved stress and reduced pain, their effectiveness has been slowly wearing off. Particularly troubling for Meredith are the tender points on her upper shoulders and neck, which give her grief while sitting and trying to sleep. These tender areas are actually key to how her arthritis specialist, a rheumatologist confirmed the diagnosis.
Recently, her doctor has suggested trying medications that have now become commonly prescribed for fibromyalgia and other conditions associated with chronic pain. These drugs began their journey as treatments for epilepsy, but are now being used mostly as treatment for chronic nerve pain, fibromyalgia, post-shingles nerve pain or neuralgia and painful diabetic neuropathy. There are two agents in question; the first to appear on the scene was gabapentin, sold as Neurontin and the newer of the two is pregabalin or Lyrica.
Despite their approval and availability for over two decades, more complete research evidence on their risks and benefits in fibromyalgia has emerged more recently. Specifically, the Cochrane Collaboration has weighed in on these treatments for fibromyalgia. Cochrane is an international network of researchers and patients dedicated to finding, analyzing and summarizing the most reliable research on a vast array of research questions in health care.
In September, a Cochrane team published their latest findings on pregabalin. With a focus on five studies that recruited 3,300 subjects comparing this medication to a placebo, the combined findings suggested that one in ten sufferers experienced more than a 50 per cent reduction in pain by the third to sixth month of treatment and one in seven saw a more modest 30 per cent reduction. Sadly, this suggests that most patients who take it will not see a substantial benefit. Furthermore, the dose used in these studies was 300 to 600mg, which is above the starting dose for this medication. Side-effects were common and affected more than 70 per cent of subjects and could consist of dizziness, drowsiness, weight gain and swelling. Despite these symptoms, only 10 per cent more than the placebo stopped taking the medication because of side-effects.
The Cochrane story on gabapentin is a lot less clear as far fewer studies using this medication have been looked at in fibromyalgia. If one were to consider how gabapentin works in other painful conditions, it is possible that a similar story would unfold.
Chronic pain sufferers like Meredith are increasingly common today, perhaps related to factors in our environment, culture or health-care system. Many suffer on a continuous and daily basis in ways you probably would not wish upon your worst enemy. For the moment, medications may offer relief for some but we can only hope for more effective treatments to arrive before next year’s holidays.
Dr. Eddy Lang is a professor and department head for emergency medicine at the Cumming School of Medicine, University of Calgary, Alberta Health Services, Calgary Zone
