‘Number Needed to Treat’ for Fibromyalgia Medication Success Same as for Adverse Reactions
Using SNRIs for fibromyalgia pain, which can include neck pain, is now fairly commonplace but this Cochrane review may lead physicians to reconsider prescribing such drugs as the benefits appear minimal. This review concluded that eleven people need to be treated for just one to have a good outcome, figures mirrored by the number of people needed to be treated for an adverse event to occur. Higher doses of the drugs were not found to have a more significant effects but did increase the risks of adverse reactions and people stopping taking the drugs.
Side-Effects of Cymbalta and Savella
Duloxetine and milnacipran (sold under the brand names Cymbalta and Savella) are known to have a number of adverse effects, including nausea, dry mouth, constipation, headache, dizziness and insomnia. As these drugs were found to offer only minor relief in terms of fatigue and sleep problems in patients with fibromyalgia the evidence suggests that they are overused and that physicians rely on them too much when treating patients with fibromyalgia. The slight pain relief that patients do get may also only be temporary and improvements in quality of life for those with fibromyalgia syndrome appear limited with such drugs.
Cymbalta and Savella Give Little Relief for Fibromyalgia Pain
The author of this new study, Brian T. Walitt, MD, associate professor, medicine, Georgetown University, Washington, DC, noted that fibromyalgia is more than just a pain syndrome and that the value of Cymbalta and Savella for fibromyalgia is small when looking at all the symptoms of this condition and how these medications help patients. It may be that patients are better served by having non-pharmaceutical treatment for fibromyalgia, such as cognitive behavioural therapy, but the evidence supporting (or criticising) these kinds of interventions is still minimal, making decisions over treatment difficult.
SNRIs Little Better than Placebo
This new Cochrane review looked at ten studies, amounting to over six thousand patients, half of which observed patients taking either placebo or milnacipran and the other comparing placebo to duloxetine over a period of six months. Most of the patients were women and most fell between the ages of 47 and 51, making the conclusions difficult to extend to other patient groups. The review found that there was a small pain reduction for both duloxetine and milnacipran but almost as many patients in the placebo group reported a 50% pain reduction as in the treatment groups.
Lyrica, Cymbalta and Savella
Of the two drugs for fibromyalgia, duloxetine appeared to offer better pain relief but relief of fatigue and improvements in quality of life were insignificant compared to placebo. Neither drug helped more than placebo with patients’ sleep problems and although duloxetine and milnacipran are approved for use in the US, neither have been approved in Europe. Pregabalin (Lyrica) is also approved by the US Food and Drug Administration but there have been a number of reported side-effects since its approval.
Causes of Fibromyalgia
One promising avenue of fibromyalgia research is in the area of small fiber polyneuropathy, with a recent study finding around half of all patients diagnosed with fibromyalgia were suffering from this potentially treatable nerve condition. Understanding the neuroanatomical basis of the syndrome appears key to finding appropriate treatments, but this will take time and patients have little to fall back on in the interim.
“The truth is that nothing really works.”
The study’s author, Walitt, said of fibromyalgia symptoms: “These problems don’t go away. The truth is that nothing really works.” Instead of relying on drugs, he suggests that patients with fibromyalgia do best when they accept their condition and the limitations it places on their life and get on with things as well as they can. Of course, prescribing stoicism makes pharmaceutial companies no money and these drugs do offer some patients some pain relief at least so it is unlikely that patients taking Cymbalta or Savella for fibromyalgia symptoms such as neck pain will stop being prescribed the drugs to relieve that pain.
Cochrane Library. 2013, Issue 1. Abstract
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