Why NSAIDs for Patients With Fibromyalgia?

How effective are NSAIDs in the treatment of fibromyalgia?
- Warner W. Carr, MD
El Paso, Tex

As monotherapy, NSAIDs are no different from placebo in the treatment of fibromyalgia.¹ The only documented successful use of NSAIDs in this setting has been as combination therapy- an NSAID with either a muscle relaxant (naproxen and cyclobenzaprine²) or an anxiolytic agent (ibuprofen and alprazolam³). However, NSAIDs have consistently produced pain relief comparable to that of narcotic analgesics in studies of patients with other chronic rheumatic conditions, such as rheumatoid arthritis and osteoarthritis; soft tissue complaints, such as bursitis and tendinitis; and pain such as that produced by dental surgery.⁴ Since there is no effective treatment of fibromyalgia, we typically prescribe NSAIDs in the hope that they will provide some pain relief-and to avoid the habituation seen with narcotic analgesics. Tramadol, an analgesic with minimal narcotic properties, is somewhat effective in patients with fibromyalgia.⁵ However, its benefits are not dramatic.

-- Peng Thim Fan, MD
Clinical Professor of Medicine
Division of Rheumatology
University of California, Los Angeles,
School of Medicine

References:

REFERENCES:

1.

Goldenberg DL, Felson DT, Dinerman H. A randomized, controlled trial of amitriptyline and naproxen in the treatment of patients with fibromyalgia.

Arthritis Rheum.

1986;29:1371-1377.

2.

Simms RW, Relson DT, Goldenberg DL. Development of preliminary criteriafor response to treatment in fibromyalgia syndrome.

J Rheumatol.

1991;18:1558-1563.

3.

Russell IJ, Fletcher EM, Michalek JE, et al. Treatment of primary fibrositis/fibromyalgia syndrome with ibuprofen and alprazolam. A double-blind, placebocontrolled study.

Arthritis Rheum.

1991;34:552-560.

4.

Katz N. The impact of pain management on quality of life.

J Pain Symptom Manage.

2002;24:938-947.

5.

Biasi G, Manca S, Manganelli S, Marcolongo R. Tramadol in the fibromyalgia syndrome: a controlled clinical trial versus placebo.

Int J Clin Pharmacol Res.

1998;18:13-19.