Cut The Pain Of Fibromyalgia By 1/3

First of all, let’s make one important note about fibromyalgia: fibromyalgia is less of a useful diagnosis and more of a rubber stamp, much like the role historically often fulfilled by “heart failure” as an official cause of death (because certainly, that heart sure did stop beating). It’s a way of answering the question without answering the question.

It’s what doctors write down when they’ve ruled out possible causes they’re aware of, and don’t want to admit they don’t know why your body is doing what it is.

It’s saying “I diagnose you with tired hurty syndrome, good luck, that’ll be [astonishing sum of dollars for the privilege of receiving this nothingburger answer] thank you”.

To be clear, while we are disparaging fibromyalgia as a useful diagnosis, we’re not dismissing the actual effect it has on people.

So while fibromyalgia has some potential use as a placeholder descriptor, it’s not an actionable answer, and it means that if that’s the diagnosis you’re handed, it can be beneficial to keep looking for the cause (because fibromyalgia is a result, not a cause).

For more on that, see: Why Fibromyalgia Is Not An Acceptable Diagnosis (and what to look for instead)

That covered, let’s move on to a new option for managing the symptoms:

A first-in-class, non-opioid approach

We’ll get straight to it: Tonmya (cyclobenzaprine hydrochloride), a once-daily sublingual tablet, received FDA approval all so recently, becoming the first new FDA-approved fibromyalgia medication in more than 15 years (the only others before that being pregabalin, duloxetine, and milnacipran, all of which have their faults and none of which produce great results*), and is now available in US pharmacies.

*In a survey of 800 patients with fibromyalgia, 70% reported using one of those medications as prescribed by their doctor, but only 19% reported being very satisfied with their current treatment (source)

Importantly, this new drug works independently of opioid pathways by modulating 5-HT2A, α1, H1, and M1 receptors*; as such, it improves sleep quality as well as central pain processing, addressing both pain and nonrestorative sleep—which are both very common, very serious problems associated with fibromyalgia, and certainly both things make the other hard to deal with, so having a medication that addresses both is truly a big deal.

*For more detail/clarity, we’ll quote from a paper on the topic:

❝Cyclobenzaprine antagonizes serotonin 2A (5-HT_2A), 5-HT_2B, and 5-HT_2C; histamine 1 (H₁); α_1A-, α_1B-, α_2B-, and α_2C-adrenergic; and muscarinic 1 (M₁) acetylcholine receptors, as well as relatively weakly inhibits activity at the norepinephrine transporter (NET) and serotonin transporter (SERT)❞

Read in full: Efficacy and Safety of Sublingual Cyclobenzaprine for the Treatment of Fibromyalgia: Results From a Randomized, Double-Blind, Placebo-Controlled Trial ← this is actually a very interesting read in its entirety, by the way, so if you have the time, we recommend it!

The most recent trials, with nearly 1,000 participants, showed statistically significant reductions in daily pain; most achieved at least a 30% pain improvement or greater, after three months.

Now, the very most recent paper hasn’t been officially published yet so we can’t link it at this time, but you can read the press release here:

First new fibromyalgia drug in 15 years, Tonmya (cyclobenzaprine HCl) gains FDA approval and hits pharmacy shelves

Want to learn more?

You might like this book that we reviewed a while back:

What Your Doctor May Not Tell You About Fibromyalgia – by Dr. R. Paul St Amand

We’ve also written quite a bit about pain management, including:

• Before You Reach For That Tylenol…
• How To Stop Pain Spreading
• How To Dial Down Your Pain
• Managing Chronic Pain (Realistically!)
• Get The Right Help For Your Pain
• The 7 Approaches To Pain Management
• Science-Based Alternative Pain Relief (When Painkillers Aren’t Helping, These Things Might)

Take care!