If you’ve ever heard of “mysterious” illnesses that cause chronic pain fibromyalgia is one of them.
It is sometimes called an “invisible” illness because it shares similar symptoms to other health conditions but can be quite difficult to diagnose.
There is currently no cure for fibromyalgia also known as “fibro” and fibromyalgia syndrome (FMS).
Researchers are still trying to figure out what causes it to find an effective and reliable treatment. In the meantime, Neurontin (Gabapentin) is being used to treat this chronic pain syndrome.
What is Neurontin (Gabapentin)?
Neurontin is the brand name of the medication gabapentin. Gabapentin is an anti-seizure medication used to treat epilepsy and neuropathy or pain from damaged nerves.
Pain caused by fibromyalgia is similar to neuropathic pain, except, there is no never damage.
According to VeryWell Health, gabapentin is chemically similar to pregabalin (Lyrica), which is another drug used in the treatment of fibromyalgia.
Unlike pregabalin, the US Food and Drug Administration (FDA) has not approved gabapentin for treating fibromyalgia.
Doctors still prescribe gabapentin “off-label,” although questions arise about its effectiveness.
To understand how this drug works, you first need to understand what fibromyalgia is, what causes it, and what the symptoms are.
What is Fibromyalgia?
Fibromyalgia is a common and chronic pain disorder that causes fatigue and widespread pain and tenderness in the joints and muscles.
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), approximately 5 million adults in the US, 18 and older, trouble with this pain disorder or pain syndrome.
Women are more at risk for developing the condition and make up more than 80% of the total number of people affected.
Because of its symptoms, fibromyalgia is often confused with medical conditions such as osteoarthritis.
Tendonitis, bursitis, joint inflammation, and temporomandibular disorder (TMD) are other conditions often confused with fibromyalgia.
However, fibromyalgia does not cause damage to the joints or muscles similar to arthritis or damage the nerves the way other pain syndromes do.
What Causes Fibromyalgia?
It isn’t clear what exactly causes fibromyalgia, but researchers suspect it is due to an abnormal change in the way the nervous system (brain and spinal nerves) processes pain. This is according to the National Institutes of Health.
They also believe that certain events or preexisting circumstances, such as the following, can cause fibromyalgia:
- Certain diseases or illnesses (e.g., lupus, spinal arthritis, or rheumatoid arthritis)
- Repetitive injuries
- Stressful or traumatic events (e.g., a car accident)
What Are the Symptoms of Fibromyalgia?
Chronic pain in various parts of the body is the overarching symptom of fibromyalgia. Simple physical interactions like hugs and handshakes can turn painful.
The pain could be a dull aching, sharp stabbing, or throbbing pain in the joints, muscles, tendons, or ligaments. Pain could start at any moment, travel through the body, and come and go unpredictably.
Certain points around the joints may hurt when pressed with a finger. According to WebMD, these are called tender points or trigger points and are located at predictable parts of the body, e.g., under the surface of the skin.
People without fibro will feel no pain if similar pressure is applied to the same areas of their body.
In addition to muscle and joint pain and tenderness, the following are other common symptoms of fibromyalgia.
In fact, some of them are considered overlapping medical conditions. A person may not experience all the symptoms while some people will notice other symptoms not mentioned here.
The severity of the symptoms may also vary from person to person.
- Pain or stiffness in the jaw or other points of the body
- Morning stiffness in the muscles and joints
- Chronic fatigue
- Problem sleeping or unrefreshed sleep
- Painful menstruation
- Difficulty urinating
- Trouble concentrating or remembering things (“fibro fog”)
- Tingling or numbness in the arms, hands, legs, or feet
- Irritable bowel syndrome (IBS)
- Restless leg syndrome (RLS)
- Temporomandibular disorder (TMD) (face/jaw pain)
- Sensitivity to heat or cold
- Anxiety or depression
How is Fibromyalgia Diagnosed?
Even if you experience fibromyalgia symptoms, they may be linked to another medical condition. This makes it difficult for doctors, even those experienced with the illness, to accurately pinpoint this pain syndrome.
Furthermore, there is no special test, such as blood tests, x-rays, or other imaging scans, to diagnose this complex disorder.
According to FibroCenter, it could take years for a doctor to make an accurate diagnosis. Once other health conditions are ruled out this makes it easier to determine whether the symptoms are associated with fibromyalgia.
Your doctor will try to make a clinical diagnosis based on your feedback on the extent and severity of the pain and other symptoms.
You may eventually receive a positive diagnosis if the following applies to you:
- You experience widespread pain lasting 3 or more months
- You felt pain at various points of the body within the past week
- Pain, especially on both sides of the body and above and below the waist (the 4 quadrants of the body)
- You wake to feel fatigued and have problem thinking, concentrating, or remembering things
- Pain or tenderness in at least 11 of the 18 tender points
Fibromyalgia Tender Points
The tender points also called tender spots or trigger points, are found at specified areas of the body that hurt when pressure is applied.
There are 18 of them and are found in these parts of the body:
- Upper buttocks
- Lower back
- Upper Back
- Front of the neck
- Back of the neck
In this YouTube video, Chief Medical Officer Freda Lewis-Hall, M.D. explains how this complex and often misunderstood medical condition affects people and how it is diagnosed.
Medications Used to Treat Fibromyalgia
Pain medication including over-the-counter (OTC) painkillers and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, are used to treat fibromyalgia.
Narcotic pain relievers, antidepressants, such as duloxetine and milnacipran, and anti-seizure drugs, such as pregabalin, are also used.
Even though it has not been approved by the FDA, doctors also prescribe gabapentin to patients.
How Gabapentin Works in Treating Fibromyalgia
Glutamate is an important neurotransmitter released in the brain by nerve cells. This excitatory neurotransmitter helps with learning and memory. It also helps to send messages to the brain and nerves.
It is believed that excess glutamate is released by the brain in people with fibromyalgia. This interrupts the balance of glutamate resulting in pain and other symptoms.
Too much glutamate can lead to hyperalgesia, a condition described as making the body more sensitive to pain—as if it “turns up” the volume on pain.
According to Cochrane, gabapentin works by changing the way the nerves send messages to the brain.
Further, doctors believe the drug works by reducing the amount of glutamate the brain releases. This calms the nerve cells and helps the brain function better.
Gabapentin is frequently prescribed to treat the symptoms of fibromyalgia. It is supplied as a tablet or liquid and may be taken with or without food. Dosage may depend on age and severity of the symptoms.
According to VeryWell Health, doses are typically between 900 mg and 1800 mg and are divided into three doses.
Your doctor may start you on a low dose to reduce the side effects. Your dose may be increased once your body gets used to the medication.
Side Effects of Gabapentin
Most, if not all, drugs cause some side effects. There is a list of side effects to be expected from taking gabapentin.
Some of them are potentially serious. If you notice any of them, as follows, you should call your doctor right away:
Serious side effects in adults
- Chest pain
- Sore throat
- Burning sensation in the eyes
- Difficulty breathing
- Severe tiredness or weakness
- Pain in the upper stomach
- Cough that worsens or is accompanied by fever
- Severe numbness or tingling feeling
- Rapid eye movements
- Pain or difficulty urinating, or urine stoppage
- Swelling of the tongue or face
Less serious side effects in adults
The following side effects are less serious and may go away on their own. You should talk to your doctor if they get worse or do not go away.
- Weight gain
- Abnormal sleepiness
Behavioral side effects in adults
Tell your doctor immediately if you experience any of the following behavioral changes that typically show within the first week of taking gabapentin:
- Suicidal thoughts
- Extreme worry
- Irritability or restlessness
- Feeling depressed
- Panic attacks
- Unusual excitement
- Acting recklessly
Gabapentin may interact with other drugs and increase the risk of certain side effects. Tell your doctor about all medications you are taking before using this fibromyalgia medication.
Your doctor may also warn you against taking certain medications while taking gabapentin.
Or, your doctor may decide to treat you with gabapentin but may reduce your dose or change the dose of other medications you are taking.
Warnings When Taking Gabapentin
- Take gabapentin only when prescribed by your doctor.
- Let your doctor know if you are pregnant or breastfeeding or are allergic to gabapentin or any of its inactive ingredients.
- To avoid drug interactions, tell your doctor about all prescription or over-the-counter medicines, opiates, herbal products, or vitamins you are taking or plan to take.
- Follow all dosage directions given by your doctor, pharmacist, and the prescription label.
- Do not suddenly stop taking the drug.
- Ask your doctor for instructions on how to properly and gradually wean off the medication.
- Avoid taking alcohol as it could increase the risk of side effects.
- Patients over age 75 should not take gabapentin unless directed by a doctor.
How Effective is Gabapentin for Fibromyalgia?
Gabapentin is a widely prescribed anticonvulsant used in the treatment of neuropathic pain. Its effectiveness led doctors to believe that it can also effectively treat fibromyalgia.
They considered that since the drug treats nerve pain caused by other conditions, and fibromyalgia is linked to problems with the way the brain and the nerves interact, then that same mechanism of action may work in fibromyalgia patients.
The National Institutes of Health’s National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) supports this finding that gabapentin can effectively treat pain and other symptoms associated with this complex pain disorder.
This is despite findings are unclear on how gabapentin reduces pain or improve other symptoms, such as trouble sleeping.
According to the National Institute of Health, in its publication, “Gabapentin Shown Effective for Fibromyalgia Pain,” studies on animals conclude that the drug has little or no effect on acute pain. But it appears to have a robust effect on pain in animals that have a low tolerance for pain.
Is Gabapentin Right for You?
Your doctor will need to examine and evaluate you to determine if gabapentin is right for you. Once you show enough of the symptoms and have at least 11 of the 18 tender points, your doctor may decide to treat you.
If you’ve been treated with other fibro drugs that failed, your doctor may decide that this antiseizure drug is suitable for you. Besides, gabapentin is less expensive than the drug, Lyrica, approved by the FDA to treat fibromyalgia.
Fibromyalgia pain and symptoms can be very frustrating for those affected as well as their relatives.
Because they are always in pain, but trips to the doctor show no signs of a medical problem, their family and friends sometimes believe they’re not really sick.
Pain management using OTC or narcotic painkillers, diet, exercise, or acupuncture may provide some relief.
Additionally, one of the three types of medications (duloxetine, milnacipran, or pregabalin) approved for treating fibromyalgia may be prescribed.
Although gabapentin is prescribed off-label, it provides patients with another treatment option—especially patients who tried other drugs that failed. It can also effectively relieve the symptoms on a long-term basis.
Finally, in spite of split reviews on the efficacy of Neurontin for fibromyalgia and the fact that it is not FDA-approved for treating this condition, there isn’t enough evidence to support or contradict the findings that it can reduce pain symptoms.