Generally when we think of pain meds for Fibromyalgia we think of pills, and typically we think of opioids (because they are all the rage and all the news of late). But, there are more options in the sea than just pills. A 2013 review in Pain Physician Digest looked at the various intravenous drug options and their effect on chronic pain conditions, including Fibromyalgia. I won’t bore you with the whole review, but I will share what’s relevant to Fibromyalgia.
Intravenous Lidocaine and Fibromyalgia
The first IV drug that the review looked at was lidocaine. Lidocaine is a sodium calcium channel blocker that has been used to reduce post-op pain for over 50 years. IV lidocaine works to decrease neuropathic pain associated with diabetes (neuropathic pain is also common in Fibromyalgia). Two doses (4 hours each) were administered four times a week. Not only did the lidocaine significantly reduce the pain, but the reduction was still there at 14 and 28 days post-infusion.
In Fibromyalgia patients, a single 30 minute infusion significantly reduced pain for 4-7 days. Another larger study involved 6-hr infusions over 6 days where the dosage was increased each day, reaching a maximum dose of 550mg. Some patients saw relief for up to 36 weeks. That’s an amazing amount of relief.
Intravenous Ketamine for Fibromyalgia
I’m not even going to try to explain how Ketamine works. It works on several neuro-receptors and it’s commonly used during surgery to create the “twilight” sedation.
In the review of how Ketamine affected neuropathic pain, Jorum et el found that Ketamine patients had reduced hyperalgesia to cold pain. It reduced the radiation of the pain from the initial site of cold stimulation. Another small study of patients with peripheral neuropathic pain found that patients treated with Ketamine reported a significant reduction of spontaneous pain. They also saw reduction at the site of the neuropathic pain.
Chronic Regional Pain Syndrome (CRPS) is like Fibro but worse (from what I hear). A study looked at giving CRPS patients 5-day infusions of Ketamine. 30 patients were sedated for the entire 5 days. At one month beyond treatment all patients were still in complete remission from CRPS, with 17 patients still in complete remission at 3 months. In another study 60 CRPS patients were treated with sub-anesthetic level Ketamine for 4.2 days. Patients saw significant reduction of spontaneous pain for up to 11 weeks.
Studies examining the effects of various levels of Ketamine injections on Fibromyalgia have generally found that it significantly reduces muscular pain at rest, reduced pressure point threshold, pain tolerance at tender points, and muscle endurance.
From the various studies it seems that Ketamine is less likely to work for any lengthy time at the lower levels. Basically, you’ll have the best results if you are out for a couple of days (or at least a few hours). Some people report having great relief from their Fibromylagia pain following unrelated surgeries where they are put under with Ketamine. As a result more and more studies are being conducted to look at Ketamine as a potential treatment for drug-resistant Fibromyalgia pain.
Have you had the experience of your Fibromyalgia pain being reduced for a time after a surgery where Ketamine was used?
Boleslav Kosharskyy, M. D., Wilson Almonte, M. D., & Naum Shaparin, M. D. (2013). Intravenous infusions in chronic pain management. Pain Physician, 16, 231-9.