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Fibromyalgia The Problems with Prescription Drug Treatment: The need to utilize alternatives

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Fibromyalgia diagnosis is increasing (McLean, 2005)

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Why? Has Prescription Drug Use in fibromyalgia Patients become a Problem Diagnosis is difficult Physicians awareness of alternatives Pharmaceutical companies promote Adverse side effects

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The problem with The Diagnosis Characterized by 11/18 major tender points Mimicking conditions=Multiple Tests No known cure Treatment involves managing symptoms McLean, 2005)

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Patients trust their doctors ( Teitelbaum, 2006) Prescriptions based on initial complaint Physicians and research = The Gap (Saperia & Swartzman, 2012) Lack of referrals The problem with The Physicians

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The problem with Pharmaceutical Companies Visit physician's office Attractive staff Bring Free samples Easy for physicians (Johar, K., 2013) Fibromyalgia Medications (Arnold et al., 2012) Fibromyalgia medications include: LYRICA Pfizer Rx CYMBALTA Lilly Rx SAVELLA Forest and Cypress Rx

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Adverse Side Effects Outweigh benefits (Roskell, et al., 2011) May lead to further health problems (Bergman, 2005)

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The problem: Prescription drugs and the risks Serious side effects Drug dependence Birth defects Monetary effects Patients become frustrated and often discontinue use due to adverse side affects (Huser, et al., 2012)

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Side Effects Lyricas side effects include muscle aches (Phizer, 2013) Limited information on long-term side effects (Traynor et al., 2011) More effective = More side effects

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Drug Dependence Narcotics to treat the pain (Saperia et al., 2012) 30% of fibromyalgia patients use prescription opiods (Fitzcharles et al., 2013)

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Birth Defects 2/3 women take medications during pregnancy (National Birth Defects Prevention Month, 2012) Miscarriage Malformations Neonatal toxicity or withdrawal Low birth weight Functional abnormalities (Alwan & Friedman, 2009) Women of all ages need to advocate for themselves for different options

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Monetary Effects Create a financial burden for the sufferer (Burke et al., 2012) Burden on the family Expense 3X higher (Traynor et. al., 2011) Low productivity Loss of employment

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Alternatives to Prescription Drugs Important but rarely utilized interventions (McLean, 2005, p.663 ). Move away from traditional prescription drug treatment

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Diet and Supplements Vegetarian or vegan diet Blue-green algae SAMe Super Malic (Burckhardt, 2004) Magnesium supplements (Bagis et al., 2013)

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Cognitive therapy Coping skills for the illness Stress management Distraction Relaxation techniques Equally effective (Saperia, et al., 2012)

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Individual Exercise Programs Regular aerobic exercise (Fitzcharles et al., 2013) Aquatic exercise therapy 20 minutes three times per week for adults (Lima, et al., 2013) Yoga (da Silva et al., 2007)

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Physical therapy Directed towards trigger points Myofascial release techniques Stretching (Donnelly, 2002)

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Acupuncture & Trigger Point Injections Acupuncture on the trigger points 50% improvement in overall pain Various solutions (Minty et al., 2007) (Chou, 2008)

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Alternatives to Prescription Drugs Dietary changes & supplements Cognitive therapy Individual exercise programs Physical therapy Acupuncture & trigger point injections

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References Alwan, S., & Friedman, J. M. (2009). Safety of selective serotonin reuptake inhibitors in pregnancy. CNS Drugs, 23(6), 493-509. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19480468http://www.ncbi.nlm.nih.gov/pubmed/19480468 Arnold, L. J., Crofford, L. J., Stanford, S. B., & Welge, J. A. (2012). Development and testing of the fibromyalgia diagnostic screen for primary care. Journal of Women's Health, 21(2), 231-239. doi: 10.1089/jwh.2011.3029 Bagis, S., Karabiber, M., As, I., Tamer, L., Erdogan, C., & Atalay, A.(2013). Is magnesium citrate treatment effective on pain, clinical parameters, and functional status in patients with fibromyalgia? Rheumatology International. 33(1), 167-172. doi: 10.1007/s00296-011-2334-8 Burckhardt, C. S. (2004). Fibromyalgia: Novel therapeutic aspects. Journal of Musculoskeletal Pain, 12(3/4), 65. doi:10.1300/J094v12n0310 Burke, J. P., Sanchez, R.J., Joshi, A.V., Cappelleri, J.C., Kulakodlu, M. & Halpern, R. (2012). Health care costs in patients with fibromyalgia on pregabalin vs. duloxetine. Pain Practice, 12(1), 14-22. doi: 10.1111/j.1533- 2500.2011.00470.x Chou, L.W., Hong, J. Y., & Hong, C.Z. (2008). A new technique for acupuncture therapy and its effectiveness in treating fibromyalgia syndrome: A case report. Journal of Musculoskeletal Pain, 16(3), 193-198. doi: 10.1080/10582450802161978 da Silva, G. D., Lorenzi-Filho, G., & Lage, L. V. (2007). Effects of yoga and the addition of tui na in patients with fibromyalgia. Journal of Alternative & Complementary Medicine, 13(10), 1107-1114. doi:10.1089/acm.2007.0615 Donnelly, J. M. (2002). Physical therapy approach to fibromyalgia with myofascial trigger points: A case report. Journal of Musculoskeletal Pain, 10(1/2), 177-190. Fitzcharles, M., Ste-Marie, P., & Pereira, J. (2013). Fibromyalgia: Evolving concepts over the past 2 decades. CMAJ Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne, 185(13), E645-E646. Retrieved from http://dx.doi.org/10.1503/cmaj.121414http://dx.doi.org/10.1503/cmaj.121414 Huser, W., Wolfe, F., Tlle, T., eyler, N., & Sommer, C. (2012). The Role of antidepressants in the management of fibromyalgia syndrome. CNS Drugs, 26(4), 297-307.

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Johar, K. (2013). An insiders Perspective: Defense of the pharmaceuticals industrys marketing practices. Albany Law Review, 76(1), 299-334. Retrieved from http:// www.albanylawreview.orgwww.albanylawreview.org Lima, T. B., Dias, J. M., Mazuquin, B. F., da Silva, C. T., Nogueira, R. M. P., Marques, A. P. Lavado, E. L. & Cardoso, J. R. (2013). The effectiveness of aquatic physical therapy in the treatment of fibromyalgia: A systematic review with meta-analysis. Clinical Rehabilitation, 27(10), 892-908. doi: http://dx.doi.org/10.1177/0269215513484772 Minty, R., Kelly, L., & Minty, A. (2007). The occasional trigger point injection. Canadian Journal of Rural Medicine, 12(4), 241-244. Retrieved from http://www.cma.ca/cjrm McLean, S. J., & Clauw, D. J. (2005). Biomedical models of fibromyalgia. Disability & Rehabilitation, 27(12), 659- 665. doi: 10.1080/09638280400009048 National Birth Defects Prevention Month. (2011). MMWR: Morbidity & Mortality Weekly Report, 59(51/52), 1687. Retrieved from http:// www.cdc.gov/mmwrwww.cdc.gov/mmwr National Fibromyalgia Association (2009). National Fibromyalgia Association Retrieved from http://fmaware.orghttp://fmaware.org Phizer Inc. (2013). Important Safety Information. Retrieved from http://lyrica.com.m http://lyrica.com Saperia, N. J. G., & Swartzman L. C. (2012). Openness to psychological explanations and treatment among people with fibromyalgia versus rheumatoid arthritis. Psychology & Health, 27(3), 310-323. doi: 10.1080/08870446.2011.563852 Traynor, L. M., Thiessen, C. N., & Traynor, A. P. (2011). Pharmacotherapy of fibromyalgia. American Journal of Health-System Pharmacy, 68(14), 1307-1319. doi:10.2146/ajhp100322 Roskell, N. S., Beard, S.M., Zhao, Y., & Le, T. K. (2011), A Meta-analysis of pain response in the treatment of fibromyalgia. Pain Practice, 11(6), 516-527. doi: 10.1111/j.1533-2500.2010.00441.x Teitelbaum, J. E. (2006). Why bother with natural therapies? Total Health, 27(6), 28-30. Retrieved from http://totalhealthmagazine.com