Blurred Vision After Trigger Point Injections
Typically the first choice in drug treatment of fibromyalgia has consisted of an antidepressant or a muscle relaxant. The goal has been to improve sleep and pain tolerance. Medications from other drug classes (such as sleeping aids and pain relievers) may also be prescribed. Patients receive drug treatments in combination with exercise, patient education, and behavioral therapies. In 2007 the Food and Drug Administration approved Pregabalin as the first drug for the treatment of fibromyalgia.
Targeting Pressure Points and Stretching Techniques
Trigger-Point Injections.
In some cases, “trigger-point injections” of an anesthetic such as lidocaine may be used for particularly painful tender points as an aid to stretching.
* The injection causes intense, transient pain in the trigger point. After the medication has taken effect, however, the ability to stretch the muscle is greatly enhanced.
* There is some soreness afterward, which can be severe. After an injection, spraying the whole muscle with cooling agents may inactivate less severe tender points.
* In some cases, injections may be needed two or three times over six to eight weeks.
The benefits of this treatment may not be apparent immediately.
Although antidepressants do not work for all fibromyalgia patients, a 2001 analysis of 10 studies reported that antidepressants can also help relieve pain, fatigue, and insomnia in about 25% of patients. None have been well researched for fibromyalgia, however. It should be noted that some patients report worse symptoms with antidepressants.
The two main classes of antidepressants used for fibromyalgia are the tricyclics and selective serotonin-reuptake inhibitors (SSRIs). Tricyclics are better at reducing pain and the SSRIs for relieving depression. Doses used specifically for fibromyalgia in nondepressed patients are often lower than for depression, so combinations may be an option. In fact, benefits may be strongest with combinations of the tricyclics and SSRIs.
Tricyclics not only help relieve depression but they also have properties that reduce sleeplessness and muscle pain. The tricyclic drug most commonly used for fibromyalgia is amitriptyline (Elavil), which produces modest benefits with pain, but which can lose effectiveness over time. Other tricyclics include desipramine, doxepin, imipramine, amoxapine, and nortriptyline.
Generally only small doses are necessary for relief of fibromyalgia, so, although tricyclics have a number of side effects, they may occur less frequently in fibromyalgia patients than in those taking tricyclics for depression. Side effects most often reported include dry mouth, blurred vision, sexual dysfunction, weight gain, difficulty in urinating, disturbances in heart rhythm, drowsiness, and dizziness. Like all medications, tricyclics must be taken as directed; overdose can be life threatening.
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