This article was originally published on Prohealth.com and is being reprinted with permission from the editor.
It’s been more than a decade since the U.S. Food and Drug Administration (FDA) has approved any new pharmaceutical treatments for fibromyalgia. While there are at least four new fibromyalgia drugs in the pipeline, it could take years before any of these treatments are available to patients.
In the meantime, the fibromyalgia community desperately needs relief from their daily pain and other symptoms! Fortunately, there are a few researchers who are looking for ways to repurpose older drugs for fibromyalgia.
These drugs will likely never be the subject of big clinical trials because there’s little profit to be made given their age. However, that doesn’t mean they aren’t effective.
In fact, all of the pharmaceuticals mentioned below perform just as well or better than the three drugs currently approved by the FDA to treatment fibromyalgia. But since none of these drugs are considered first-line treatments for fibromyalgia, it does take both an open-minded doctor and patient to give them a try.
(Read more: Why your fibro meds aren’t working)
Ketamine
FDA approved: 1970
Original use: Surgical anesthesia
A growing number of pain clinics are now offering ketamine infusions for chronic conditions like fibromyalgia, but do they actually work? Early research suggests they may – at least temporarily.
In a small Swedish study, 11 fibromyalgia patients were randomly selected to receive either a low-dose ketamine infusion or a placebo infusion. Eight of those patients experienced at least 50% less pain using ketamine.
“There was a significant reduction in pain intensity with the ketamine infusion compared to the saline infusion during and 20-80 minutes after the test period,” reads a research review. “There was a decrease in tenderness and increased endurance.”
Two additional small studies carried out by some of the same researchers verified that ketamine is effective at reducing fibromyalgia pain. Altogether, 57% of the fibromyalgia patients in these three studies experienced at least a 50% reduction in pain from ketamine infusions.
That finding mirrors what I’ve heard from my readers here and at Prohealth.com. Anecdotally, ketamine seems to work really well for fibromyalgia pain, but unfortunately the relief doesn’t last. The pain-relieving benefits of ketamine infusions tend to wear off within a few days or weeks, requiring the ongoing expense of another infusion.
But if someone has the disposable income and seeks temporary relief from their pain, ketamine infusions could definitely be an option.
Another alternative is taking ketamine in pill form.
“The use of oral ketamine for [the] treatment of fibromyalgia has not been widely studied; however, one study reported clinically meaningful responses in a small number of patients,” reads this review.
(Read more: Ketamine infusions for chronic pain | A systematic review and meta-analysis of randomized controlled trials)
Memantine
FDA approved: 2003
Original use: Alzheimer’s disease
Sometimes the brain fog caused by fibromyalgia literally can feel like early-stage dementia so it isn’t surprising that an Alzheimer’s drug might be helpful in treating fibro.
Memantine is frequently used for moderate-to-severe Alzheimer’s disease, but two small Spanish studies have shown it may benefit those with fibromyalgia, too.
In 2014, researchers from the University of Zarogoza reported memantine significantly reduced fibromyalgia pain when administered to 63 patients at a dosage of 20mg per day.
Five years later, a second study involving some of the same University of Zarogoza researchers found memantine improved cognitive function, depression and illness severity among 10 fibromyalgia patients.
So how does an Alzheimer’s drug improve fibromyalgia symptoms? Patients with fibromyalgia and Alzheimer’s both have been found to have elevated levels of the neurotransmitter glutamate in the brain. Excess glutamate also is associated with increased pain. Memantine works by preventing glutamate from adhering to brain receptors, thereby reducing fibromyalgia symptoms.
(Read more: Alzheimer’s drug shows promise for treating fibromyalgia pain)
Metformin
FDA approved: 1995
Original use: Type 2 diabetes
One of the biggest fibromyalgia-related news stories during 2019 was a University of Texas study that proposed using metformin, a popular type 2 diabetes drug, as a fibro treatment.
That study has since been retracted by the journal that published it, but the results still hint at a possible link between blood hemoglobin A1c levels and fibromyalgia pain. As part of the study, patients were given 500mg of metformin twice a day in combination with “standard treatment” of either an antidepressant (amitriptyline, duloxetine or milnacipran) or an anticonvulsant (gabapentin or pregabalin).
“The subgroup of patients who had undergone pharmacological treatment of [insulin resistance] with metformin, in combination with the [standard treatment], experienced a dramatic decrease in pain scores,” reads the study. “Response to metformin plus [standard treatment] was followed by complete resolution of pain in eight of 16 patients who had been treated with metformin, a degree of improvement never observed before in such a large proportion of fibromyalgia patients subjected to any available treatment.
“In contrast, patients treated with [standard treatment] alone improved, but complete resolution of pain was generally not observed,” the study continues. “Interestingly, some patients responded only to metformin and not to [standard treatment] with [antidepressants] or membrane stabilizing agents.”
Although this study was small, the results are definitely promising! After years of reading fibromyalgia research, I believe this is the first time I’ve ever seen a study claim 100% pain relief, so the results definitely caught peoples’ attention.
Hopefully, the researchers behind the study can fix the issues that caused their work to be retracted and repeat their finding with a new trial.
Low-dose naltrexone
FDA approved: 1984
Original use: Alcohol and drug dependence
Low-dose naltrexone (LDN) is the dark horse of the fibromyalgia community. Very few patients and doctors know about it, and yet I frequently hear from persons with fibromyalgia who say LDN has changed their lives for the better.
An opioid receptor antagonist, naltrexone has been used to treat alcohol and drug dependence since the 1980s at full doses of 50mg or higher.
At low doses of 1-9mg, however, “it is hypothesized that [LDN] causes [a] transient blockade of opioid receptors centrally resulting in a rebound of endorphin function which may attenuate pain in fibromyalgia,” reads a 2018 University of Southern California study.
In 2009, then Stanford University researcher Jarred Younger, Ph.D., conducted the first clinical trial of LDN as a fibromyalgia treatment. While the study only involved 10 patients, LDN “reduced fibromyalgia symptoms in the entire cohort, with a greater than 30% reduction of symptoms over placebo,” reads the study. “Side effects (including insomnia and vivid dreams) were rare and described as minor and transient.”
A second, slightly larger Stanford study involving 31 fibromyalgia patients confirmed the results of the initial pilot study.
Since then, a growing number of people are successfully treating their fibro pain with LDN. Anecdotally, I am continually amazed by how well LDN works in some fibromyalgia patients. It’s not unusual for me to hear LDN users say “it’s given my life back to me.”
(Read more: Review of therapeutic utilization of low dose naltrexone)
Now it’s your turn: Have you tried ketamine, memantine, metformin or low-dose naltrexone as a fibromyalgia treatment? Share your experience in the comments below!
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I’m Donna, a longtime newspaper reporter, health writer and chronic illness thriver! Fed Up with Fatigue provides weekly news, research, treatments and more to help you live better with fibromyalgia and/or Lyme.
Hi Donna;
I started with metformin 500mg 2x/da about 2 months ago, after coming across a report about an early study. I don’t think that it has been long enough yet to see results–and maybe not a high enough dose. And it may not be a high enough dose. I had to change PCPs this month, and am in a new health care program. They are open to further exploration of this avenue. I also take LDN and have for about 2 1/2 years. I take only about .5mg every third day, and am not taking for fibromyalgia, but for nerve damage pain secondary to a car accident, for which it is very effective.
For me most effective has been a combination of Fibroplex and loratadine–a long acting anti-histamine. If I do not take these daily, I am essentially bed-ridden. Taking these buys me a day-to-day pain level about 4 -6, and 4-6 functional hours a day vs no real functional time at all. I have used these for about 12 years with enough benefit not to have tried opioids or gabapentin, offered many times over the years. (Using acetyl-l-carnitine very effectively for polyneuropathy as well) Upping my game with metformin and or naltrexone may be a game changer. I will have to talk with my new PCP….
Also, for those trying metformin and having the common side effect of diarrhea that often occurs, I would like to suggest adding a probiotic complex 3-7 days a week. (8-10 strains and at least 10 billion CFUs–not just acidophilus). I have been taking this type of probiotic for years, and was told to take Imodium for diarrhea when I started –but no problem. My husband has been on metformin for his diabetes for more than 20 years, with diarrhea most days. We started him on probiotics, and the diarrhea subsided in 4 days, with him eventually developing constipation. Stopping probiotics and diarrhea resumed in about a week. His balance is 3 days week. So the probiotic may need to be adjusted to find the sweet spot dosage for each individual. But his has been a game-changer for him as far as diarrhea. Wile he does not have fibromyalgia-it does address a common side effect of metformin.
Thank you for bringing together all these studies. I have been doing the to some degree for myself for years, but gave up a few years ago. Then I came across your blog. I also have Chronic Lyme, and will explore more with your suggestions.
Judy
(PS: my background is RN, BSN, MPHN with focus on Chronic Disease Management)
Im.going to mention.them to my Dr mect time i see him, im desperate for some respite from the pain im in as effecting my life dramatically
I’ve been using LDN for about 2 years. Usually 3 mg dosage, taken in the morning. My pain management doc writes a prescription for 50 mg tablets that I crush and mix with distilled water and draw up in a syringe. It is bitter but a quick swallow and some follow up liquid does fine. There are a number of FB groups about using LDN that can help educate for dosage and use. If your insurance will cover compounded meds you could get capsules made. My husband (post 5 back surgeries) also takes it, although at 4.5 mg daily. I find that it does help the pain somewhat, but as with most drugs, not a miracle cure. My husband finds it helps with both pain relief and his mood. Worth a try if your doc is open to it.
I have fibromyalgia and have been on nortriptyline and gabapentin for years and still have pain. About a year ago my Rheumatologist added Savella and that has helped with the daily fatigue for sure. Now I do not have elevated A1c but I have been on Metformin for about 6months now (850mg twice a day). I’m on it as part of a drug trial for breast cancer research. The theory is that the metformin will decrease the number of A typical cells that turn into breast cancer. I have not felt a decrease in pain since I have been on Metformin as yet but I can always hope.
Donna, Did those who took metformin for fibromyalgia pain have elevated A1c numbers? I’m remembering that an LDN study found those with higher Sed (ESR) rates had greater pain relief from LDN. Wonder if that’s true with A1c and metformin? Metformin is cheap, has anti-cancer properties, and is being used (off label) for longevity, so it’s hopeful news that this safe medication might also provide pain relief.
Hi Margaret, I can’t remember the specifics of the study off hand, but the study is linked in the article so you should be able to find the answer there.
Hi;
I started with metformin 500mg 2x/da about 2 months ago. I don’t think that it has been enough yet to see results. And it may not be a high enough dose. I had to change PCPs this month, and am in a new health care program. They are open to further exploration of this avenue. I also take LDN and have for about 2 1/2 years. I take only about .5mg every third day, and am not taking for fibromyalgia, but for nerve damage pain secondary to a car accident, for which it is very effective. For me most effective has been a combination of Fibroplex and loratadine–a long acting anti-histamine. If I do not take these daily, I am essentially bed-ridden. Taking these buys me a day-to-day pain level about 4 -6, and 4-6 functional hours a day vs no real functional time at all. Upping my game with metformin and or naltrexone may be a game changer. I will have to talk with my new PCP….
Thanks for this post! I’ve been using duloxetine for fibromyalgia relief for about 10 years. Four years ago I was diagnosed with Type 2 diabetes and started taking Metformin. I have indeed had less pain the last few years, but I wouldn’t have thought it may be due to this!
I tried LDN, but didn’t find that it helped. Maybe I wasn’t on the right dosage. I’m not sure. Every medication I’ve tried for fibromyalgia has either caused such severe side-effects that I couldn’t continue, or hasn’t helped. I’m trusting that one day something will.