2 Fibromyalgia Therapies Used in Combination Seen in Study to Offer Superior Relief

2 Fibromyalgia Therapies Used in Combination Seen in Study to Offer Superior Relief

QueensUlogo2A team of researchers at Queens University in Ontario, Canada, report discovering a more effective technique for treating fibromyalgia. Results of a trial led by the scientists suggest that combining Lyrica (pregabalin), an anti-seizure drug, with Cymbalta (duloxetine), an antidepressant — drugs that have been proven, individually, to treat fibromyalgia pain — can safely improve patient outcomes.

GilronI3“Previous evidence supports added benefits with some drug combinations in fibromyalgia,” Dr. Ian Gilron, a professor of Anesthesiology, and Biomedical Sciences, and Director of Clinical Pain Research at the Queen’s Centre for Neuroscience Studies, said in a university press release. “We are very excited to present the first evidence demonstrating superiority of a duloxetine-pregabalin combination over either drug alone.”

The study’s findings are published in the PAINcovercurrent edition of the journal Pain, in the paper Combination of pregabalin with duloxetine for fibromyalgia: a randomized controlled trial.

The investigators explain that their randomized, double-blind, four-period crossover trial compared a pregabalin–duloxetine combination to each drug respectively as a monotherapy. Study participants received maximally tolerated doses of placebo, pregabalin, duloxetine, and the pregabalin–duloxetine combination for six weeks, with results finding that combining pregabalin and duloxetine for fibromyalgia not only provided pain relief, but also improved physical function and overall quality of life. The research team recommends that further research should compare this and other drug combinations to monotherapy for treating fibromyalgia.

While fibromyalgia was initially thought to be a musculoskeletal disorder, according to Gilron and his colleagues, recent research suggests it’s more a central nervous system disorder based in the brain and spinal cord, theorizing that fibromyalgia amplifies painful sensations by altering levels and activity of the brain chemicals responsible for processing pain signals. The syndrome is characterized by chronic widespread pain frequently accompanied by chronic fatigue, disordered sleep, and mood and memory issues.

“The condition affects about 1.5 to 5 per cent of Canadians – more than twice as many women as men. It can have a devastating on the lives of patients and their families,” Gilron said. “Current treatments for fibromyalgia are either ineffective or intolerable for many patients.”

GilronI lab
Dr. Ian Gilron in his laboratory. (Photo courtesy of Queens University)

This study, funded by the Canadian Institutes of Health Research (CIHR), is the latest in a series of clinical trials conducted by Gilron and his team on combination therapies to treat chronic pain conditions, with a primary objective to show how physicians can optimize use of current treatments available to patients. “The value of such combination approaches is they typically involve drugs that have been extensively studied and are well known to health-care providers,” Gilron said.

Gilron has co-authored neuropathic pain treatment guidelines for the Canadian Pain Society (2014) and the Neuropathic Pain Special Interest Group of the International Association for the Study of Pain (2015) . He is a councillor of the International Association for the Study of Pain and also serves on the executive committee of the Analgesic “ACTTION” partnership. He and his research team at Queen’s are also members of the SPOR Network on Chronic Pain, a national network funded under Canada’s Strategy for Patient-Oriented Research, that directs new research, trains researchers and clinicians, improves access to care for chronic pain sufferers, and speeds up the translation of the most recent research into practice.

Queens University


    • Steve Carrington says:

      hear hear
      Unfortunately the pharmaceutical companies are not interested in developing new medication for either management of symptoms or a cure what they are seeking is to get off label approval (based on very questionable testing results) for drugs that have gone out of patent for their original intention in order to shore up revenue streams

    • jill coop says:

      omg ..no more drugs is right. What about Low dose naltrexone?? or the use of Glutithione and supplements. No one talks of the pain of lactic acid burn after any exercise/. I have had fibro for 18 years. I have been in crazy pain. I cant sleep and all the drugs make me fat, constipated or bring on IBS not to mention eyesight,balance and depression issues. I think all the drugs make me feel more depressed and sicker .I Now figure how to fix myself now. I read everything about this illness. I have found most doctors are so ignorant on the symptoms and how to help you. I urge you all to read up on low dose naltrexone and read about supplements. Check out the web site Pro Health. Its the bomb..

  1. Steve Carrington says:

    Ive tried both of these drugs individually and in combination the side effects individually weere bad enough and with absolutely no improvements in fibromyalgia symptoms but the combination is just a doubling down of the side effects to an unbearable level if you want to be a permanent zombie and spend 23 hours in bed every day this might be the way to go !. some people get good results from these two drugs but for me I can conclude that they don’t work and cause more harm than good.

    • Lorraine Bradley says:

      I agree 100%. Cymbalta and Lyrica caused me to be very debilitated and depressed, which is the opposite of what they should do. The side effects are far worse than any possible reduction of pain. On Lyrica I almost got in a serious car accident from dosing off. I wonder why big pharma and doctors prescribe it and still allow people to drive. I also gained over 10 lbs. of water weight. The inflammation only made the pain worse.

  2. I have tried both Lyrica and cymbalta and I believe the Lyrica did work but I was dizzy and spacey all day. Cymbalta dulled all of my emotions and I just didn’t care that I was in pain. Perhaps the dosages were too high for me.

    • Mary Ann Chase says:

      I have the same thing with Cymbalta…..it dulls everything. I’ve taken it for years and other anti depressants before that. I had hope for Naltrexone but if it’s side. effects are bad, I won’t try it. Depression for me came before Fibro. I also won’t take Lyrica. And I have the Epstein Barr Virus. Wheee….so much fun. My Dr. Keeps trying…even had a 7 day pain patch. Didn’t do much over several weeks so gave up. Pain pills, Norco, help but then I have itching, no rash, but scratching causes purple ones.

  3. Kim Allen says:

    I have had fibromyalgia for about 25 years now and I have tried every drug and all different combinations of these drugs. I have found no relief, only side effects. My Dr is very patient and willing to try anything. The pain has gotten progressively worse every year, even researchers say fibromyalgia is not progressive. And now I have had Lyme disease twice In The last six months, which has left me unable to do most anything because my muscles fatigue so quickly. Has anyone else found their fibromyalgia progressive?
    Kim Allen

    • Bronwyn Pease says:

      Hi Brenda and others; I feel that I have probably trialled Most of the recommended drugs/therapies advocated for Fibro and ME. However, with regards to Lyrica and Cymbalta, neither helped me at all. Lyrica did not touch my pain (I feel though that it may be useful for those who are just starting out on their path of Fibro, as I do know of others who have taken this drug and found results.). With Cymbalta, it actually had the opposite effect for me (I was told it was in the family of anti-depressants ?? However, it actually had me in tears all day, and for no reason. I found I just could not live this way, and with no effect on my pain. I have found other medications that help me through most days (but NOT in a bad flare). I agree with the theory that we need a combination of meds that work together (not against each other).
      I, too, would just love for someone to find a cause that can be treated with the medications that are already on the market: therefore stop spending the monies available on these trials, but on finding the cause, first.

  4. Keney says:

    I am so happy to know that finally fibro is a known condition. I am 81 and when I got it at age 25, I thought I should be in a mental institusion, as I did not know what my problem was.Or should I say what my PROBLEMS were.because of taking generic pain pills daily to survive, I ended up with a stage 3 kidney condition.and since I never smoked, or used alchohol, am sure that is what caused it, finally at age 54after menopause and quitting my job and moving out of the cold,to a sunny state,I am 99% better.living in a senior community and aerobics 3 times a wk, etc. I could go on and on. but thanks for addressing the issue.

  5. Shannon says:

    I have taken both Lyrica and Cymbalta since being diagnosed in 2010. Being the only two Canadian approved medications for Fibromyalgia, of course my GP started me on them.

    Unfortunately, they did not address all of my pain. I was still on opioids. I note that Nucynta had my pain *very well managed* until my health insurance was switched to the gov’t when I got ODSP (ontario disability). It was no longer covered. So now I’m on Morphine, which masks the pain, but does not satisfactorily manage the pain. I have to take way more Naproxen than I or my doctor would like. Morphine does not have an anti-inflammatory like Nucynta does. So.. I keep taking the Naproxen when I must. Despite having ample instant release morphine for breakthrough pain.

    Personally? I don’t think Cymbalta does screw all for pain. However, my mood is fine. So perhaps it keeps me sane and out of depression. Plus I have read it is a real bitch to get off of. Just Google “Cymbalta withdrawals” and you’ll see. If you haven’t started Cymbalta, I’d recommend not to. Had I known about the withdrawal issues before starting it, I’d have said no thank you.

    Lyrica does help my nerve pain. Of that I am very sure. I am T2 diabetic, so it helps with typical diabetic foot and leg pain too.

    Just piping in with my personal experience in hopes it helps someone.

    Keep up the good fight Fibro Warriors!

  6. Merf says:

    Cymbalta 30 mg was absolute magic for me with regard to my very worst symptom – that awful sick severe flu like feeling where every single part of your body including your skin aches at the same time.i hated to touch myself let alone touch someone else! Since five hours after my first dose six months ago I have not had that pain once.
    I do have the post exertion exhaustion and other fibro pain but not that all over ‘I must be getting a really bad flu’ feeling I lived with for years. It has made a world of difference to my ability to cope with the rest of fibro issues. My doctor told be the optimum dose for fibro pain relief is 60 mg and would have been happy to increase mine to that but right now 30 is great. Maybe in the future I will try a higher dose to see if even more symptoms can be alleviated but right now am just grateful for what is has already helped. No emotion numbing, no side effects at all except for a bit of manageable nausea the first week. Good to know this double therapy with Lyrica has shown results should I need it in the future. Alwa S good to know your options! Thank you for the article.

  7. Cindy Cirlincione says:

    Stupid two drugs for fibromyalgia, they don’t work for chronic pain. What works is a gluten, sugar, soy, diary-free food plan, medical medium’s guide, celery with coconut juice on a empty stomach in the morning, exercise, walking, doing kundalini yoga, breath and meditation, clear light therapy with Julia Moton which has helped me most with reduction with pain, amazing therapy, being around positive people and yes stronger drugs which they don’t prescribe anymore at least took away the pain, even though it was only masked, but at least one could function. Big Pharm does not care about us or others with chronic illnesses, you have to be your own best doctor and talk with others about what works. I opened this article and thought I would see something positive, but they are pushing these two drugs for fibro that don’t work, screw them.

  8. Maria Elizabeth van Niekerk says:

    I found a book an American doctor wrote who himself had FM, he claimed to have cured himself and his patients. Unfortunately I do not have the above details any longer.

    However I can testify that the medication for Altzeimers – Pexola (generic for the US drug)
    worked wonders for my pain. I did the test in conjunction with my GP, increasing the dosage and then keeping it at the specific level for dopamine levels. Hope this might help someone out there.

    • Pennese Valeria says:

      Dear all,
      I was prescribed Cymbalta for my pains in the legs. However, as I had just come out of an aernia crisis I had some doubts. Therefore consulted an allergolog who detected a very severe lack of vitamine B12. This lack can provoke such pains he said and he did put me on the ancestral diet, with vitamin B supplements:

      – breakfast begin with a proteinate product – an egg or ham and then after 10 minutes have your normal breakfast.
      – 10:00 fruit
      – lunch eat normally
      – 4:00 as you feel – sugar or salted-
      – dinner – after 6:00 – avoid any type of sugar: only vegetables and protein.

      Gluten and lactose are supposed to contribute to inflammation and thus should be reduced if not avoided (for those allergic). Reduction is better as the body continues to work normally.

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