Muscle Relaxants for Fibromyalgia
What is fibromyalgia?
Fibromyalgia is known as a muscle-related pain syndrome or myofascial pain syndrome. It can be due to a general type of pain such as muscle pain or back pain, and certain tender areas in the body. Individuals suffering from fibromyalgia would have various tender spots in the body called as tender points. These tender points include the hips, neck, arms, shoulders, legs, and back.
When there is slight pressure applied on these points, they tend to hurt. This medical condition commonly affects middle-aged women who otherwise look very healthy. However, it can also affect women of other ages as well as children and men.
Symptoms
The symptoms of fibromyalgia may include the following:
- Mild to moderate levels of fatigue (in some cases, it can turn out to be severe)
- Decreased energy levels due to fatigue
- Lack of sleep leading to insomnia
- In the morning, one would feel very tired after waking up and the same as before going to bed.
- Chronic muscle pain
- Stiffness in the body after waking up or the feeling of staying in one position for longer durations.
- Headache due to tension or migraines
- Irritable bowel syndrome (IBS)
- Abdominal pain or feeling bloated
- Poor concentration
- Finding it difficult to perform simple day-to-day activities
- Mental changes leading to depression
- Feelings of anxiety
- Tingling sensations in the arms, hands, legs, and face
- Constipation that can alternate with diarrhea
- Frequent urination
- Getting sensitive to one or more triggers such as noise, certain odors, bright light, certain types of foods, or cold temperature.
Treatment
There are various classes of medications available for a fibromyalgia patient. However, the doctor would first evaluate the condition and then decide the best course of treatment required. Treatment for fibromyalgia symptoms include:
- Corticosteroids
- NSAIDs (Nonsteroidal anti-inflammatory drugs)
- Tricyclic antidepressants
- Muscle relaxants
- Hypnotics or sedatives
Muscle Relaxants
Certain muscle relaxants have shown to be effective when it comes to treating the symptoms of fibromyalgia. Having low doses of cyclobenzaprine at bedtime have shown to help people suffering with the condition. It provides better sleep and reduces pain. Hence, it was proven that taking low doses of muscle relaxants at bedtime was a safer option and also appeared to be effective.
Cyclobenzaprine has been marketed at higher doses by brands such as Amrix, Flexeril, and Fexmid. It has also been widely used off-label for patients suffering from fibromyalgia. The term “off-label” usually refers to the practice of prescribing certain medications, which have not been specifically got an approval from the FDA. Tonix Pharmaceuticals is known for developing a lower dose of this medicine along with improving its formula. There have been higher doses of muscle relaxants but they often lead to an excessive case of drowsiness at daytime.
Muscle relaxants are medications that help mask off the pain and provides relaxation to the muscles. It also prevents the muscles from twitching and blocks painful sensations in the brain. Hence, the use of muscle relaxants eases this pain and provides a peaceful sleep, so that there is fewer aches and pain when the person wakes up in the morning.
The lack of proper sleep has been thought to worsen the symptoms of fibromyalgia. Thus, once a person's sleep is restored with proper doses of muscle relaxants, it would lead to an improvement of the symptoms throughout the day.
The side effects of muscle relaxants are not severe. People have only complained of mild headaches as a common side effect. For other individuals, there have been cases of mouth dryness and drowsiness.
Common Brands of Muscle Relaxants
Cyclobenzaprine (Flexeril)
Cyclobenzaprine is a muscle relaxant that blocks the nerve impulses or pain-causing sensations, which are sent to the brain. Cyclobenzaprine should be used along with some kind of physical therapy and lot of rest. This medicine can help treat skeletal muscle conditions such as muscle pain or injury.
However, do not take cyclobenzaprine if you have thyroid-related problems, a heart block, heart disease, or when you recently had a heart attack. Cyclobenzaprine should not also be used if you had taken MAO inhibitors such as tranylcypromine, phenelzine, or rasagiline for the past 14 days.
Before starting the treatment, you should inform the doctor if you are pregnant or planning for a pregnancy. You also have to inform your doctor if you are breastfeeding, had a heart attack or blockage in the heart, or if you have any heart-related disorders. To ensure that cyclobenzaprine is safe for you, make sure to tell your doctor if you have existing medical conditions such as glaucoma, urination problems, liver disorders, or an enlarged prostate.
The elderly would be more sensitive towards the side effects of this medication. Hence, you need to talk with the doctor about any risk of side effects before starting the medication. Cyclobenzaprine should be orally taken once a day. This medicine should only be taken for 2-3 weeks. Follow all the instructions provided by the doctor. You can also check the label of the medicine for further dosage instructions.
Do not change the dosage of the medicine to avoid unpleasant side effects. This medicine should be taken at the same time on a daily basis for better improvement of the symptoms. Do not crush or chew this tablet. Apart from taking this medication, it is necessary to take adequate rest, have physical therapy, or pain-relieving measures provided by the doctor.
Store this medicine away from heat, light, and moisture. If you miss a dose, then taken one immediately as soon as you remember. However, if it is nearly time for the next dose, then skip the missed one or else it would lead to an overdose. An overdose of cyclobenzaprine can be fatal. The common side effects associated with cyclobenzaprine include:
- Dizziness
- Headache
- Feeling tired
- Having trouble when concentrating
- Blurry vision
- Drowsiness
- Throat and mouth dryness
- A change in the sense of taste
- Vomiting
- Nausea
- Constipation
- Stomach upset
The above-mentioned side effects are usually mild and tend to go away once the body is used to the medicine. However, if they still persist or get worse, then inform your doctor immediately. The severe side effects of cyclobenzaprine are:
- Irregular or fast heart rate
- Excessive drowsiness
- Shaking of the body or tremors
- A fluttering sensation in the chest
- Hallucinations
- Sudden fever
- Severe nausea and vomiting
- Lack of coordination
- Aggressive or agitated
- Fainting
Immediately inform your doctor if you experience any of the severe side effects.
In the case of adults, the initial dose would be 5 mg orally three times a day. Later, based on the body’s response to the treatment, the doctor can increase the dosage from 7.5 mg to 10 mg thrice a day. An alternative dose would be 15 mg to 30 mg extended-release capsule to be taken orally once a day.
However, the effectiveness of the drug's dose being tolerated by the elderly remains a big question. The doctor would carefully assess the condition and look at various factors before deciding the dose for an elderly patient. However, in most cases, the initial dose would be 5 mg. For children above 15 years of age, the initial dose would be 5 mg to be taken orally thrice a day. Later on, based on the patient's response to the treatment, the doctor can increase the dosage from 7.5 mg to 10 mg thrice a day.
Taking cyclobenzaprine along with other similar drugs could lead to drowsiness or slow breathing pattern, which can turn out to be fatal for one's health. Thus, inform your doctor if you are taking a sleeping pill, medicine for seizures, depression, anxiety, narcotic pain medicine, and cough medicine. Cyclobenzaprine can cause unpleasant withdrawal symptoms, which is why you should not stop taking this medicine without your doctor's advice.
Review
In a study conducted in 120 patients suffering from fibromyalgia, those who were receiving cyclobenzaprine for over a 12-week period showed a significant amount of improvement regarding pain and quality of sleep. There was also a trend, which was showing improvement in the symptoms related to fatigue. Moreover, there was a decrease in the number of tender points on various body parts and muscle tightness, which were all part of the illness.
Other medications that act as a muscle relaxant for fibromyalgia are listed below:
Orphenadrine
Orphenadrine is an analgesic muscle relaxant used as an addition to rest, physical therapy, and for the symptoms related to acute musculoskeletal pain. Individuals with fibromyalgia have shown significant improvement in the reduction of general pain when taking this drug. The usual short-term dosage of this medicine is one tablet at 100 mg.
Unlike other medications, which should be taken for a shorter duration, orphenadrine can be taken for a longer time. It comes in an extended-release tablet as well as the regular tablet. The standard dose of this drug is 100 mg twice daily or it can be 50 mg taken thrice a day. The doctor would be the best person to decide on the dosing based on various factors and the severity of the illness. The common side effects associated with orphenadrine are restlessness, weakness in the muscles, nervousness, lightheadedness, and enlarged pupils.
Carisoprodol (Soma)
Carisoprodol is a muscle relaxant specifically used to treat stiff muscles, injuries, any kind of pain, and muscle spasms, which are all common symptoms of fibromyalgia. Carisoprodol works by interacting with the pain receptors in the brain. Carisoprodol has not shown to be effective when used for a longer duration. Thus, you should not use it for longer periods without your doctor's advice. Carisoprodol can be taken thrice a day before going to bed. The doses can vary from 250 mg to 350 mg tablets.
The common side effects associated with carisoprodol use may include:
- Shaking
- Tremors
- Nausea
- Fast heartbeat
- Hot flashes
- Vomiting
- Dizziness
- Feeling agitated
- Headache
- Facial flushing
Tizanidine (Zanaflex)
Tizanidine is commonly used to treat tense muscles. It also helps soothe rigid muscles that lead to spasms. The dosage of tizanidine starts with an initial dose of 4 mg to minimize any side effects, and once the body responds positively to this medicine, the dosing can be increased by the doctor.
For most patients, the effective dose is 8 mg. However, you should not be taking this medicine more than three times a day. The maximum dosage limit should be 36 mg in a span of 24 hours. Most people who have taken this medicine have mentioned that this drug leads to drowsiness after taking it. Hence, you should stay away from carrying out any activities that require focus or concentration.
The following are common side effects of tizanidine:
- Low blood pressure
- Feeling lightheaded
- Dizziness
The drug's severe side effects may include:
- Having vision troubles or blurry vision
- Frequent urge to urinate or having trouble while urinating
- Runny nose
- Slurred speech
- Dry mouth and throat
- Nausea and vomiting
