Fibromyalgia is the new Low Back Pain

I take Gabapentin 100mg 3x daily; how does this stuff work? I took all sorts of stuff (including ibuprofen) for this pain I have in my leg (it feels like my skin is on fire); no dice. I take Gabapentin and the burning is gone.

Then I talk to other people that say it has no effect on pain at all. How is it possible that something that seems to just turn the nerves off for me gives no escape to others? Are they all just addicts (which is what I suspect), or is the drug really just hit-and-miss?

Gabapentin works because it mimics the body's natural substance, GABA, which is the brain and nervous system's primary means of shutting off nerve signaling. Giving gabapentin basically helps keep your nerve fibers from firing too frequently/too intensely. It gets a lot more complicated than that, but that's the basic idea.

It's like any other class of drugs - some things work for some people, and others work for others.

My mother was diagnosed nearly twenty years ago with Fibro and her pain is in her hips and the left side of her ribcage. I remember as a little girl (before Lyrica, and we couldn't afford copays for brand Neurontin back then) massaging her and telling her everything would be okay. It was awful, being a kid and doing most of the housework and cooking for my dad and younger sisters because my mother hurt so much she simply couldn't do it sometimes. After being in retail pharmacy for four years now (I miss long term care-sigh) it really pisses me off to see these crackheads come in and use this disease as an excuse to get fucked up or make their Escalade payments. I want to scream and sometimes I'm so infuriated I make my coworkers wait on these assholes because I don't trust what would come out of my mouth.

Thanks for this post, TAP! Fatsomyalgia was priceless...

Yeah, the few people I've met with fibro have the same things in common. They're overweight and they're very focused on themselves. Oh, yeah, and they're all women. I'm a woman, and I could stand to lose about 15 pounds, and after a 12 hour day I feel so crippled I can barely stagger to the fridge to grab a beer before putting my feet up. Does that mean I have fibro? Or is it just because I'm getting older and that's the way it is?

Are you sure gabapentin mimics GABA? My sources say MAO is unknown.

Fibromyalgia is like bipolar disorder or ADD/ADHD in that so many people use it as an excuse for bad behavior or irresponsibility, people are less likely to take it seriously when somebody really does have those conditions, for which no X-ray or blood test exists.

I have chronic fatigue syndrome. Another totally fake diagnosis when doctors have no fucking clue why you feel like shit.

I have adderal and provigil scrips. What would you think if I came through the door?

Dear Angry Pharmacist,
Thank you for distilling my concerns in this area....
It gets even worse when only "pethidine" or only "injectables" or only "oxycotton candy*" works... We don't tend to use much Vicodin "down under".

Benedict

* See Placebo Magazine - also Doug Farago uses the diagnosis SLS or "shitty life syndrome"

When I was working at the personal injury firm, you could pretty well guarantee (given the same kind of crash) that the person who was on welfare was going to be in a lot more treatment for a lot longer with claims of far more pain, when compared to the person who had a job.

It didn't take all that long to see that people who had a job and a life would basically suck it up - yeah, it hurt, but they had to earn the paycheck. So they took the pain pills, concentrated on their work, and did what they could to feel better as soon as possible. They didn't really dwell on the pain, because they didn't have time.

The people who had nothing but time, on the other hand, would dwell on that pain. And within a fairly short time after a fairly minor crash, the person who was already unemployed at the time of the crash would be blaming their crash injuries for everything that was bad in their life - including their lack of a job.

*swoons*

Oh AP, how do I love thee?

GREAT POST!

I have fibromyalgia and am one of the good people you refer to, I take Lyrica and have never asked for drugs early. I am involved in my care and behave responsibly, and politely to healthcare professionals.

I agree with you about the drug seekers. I hate the way they act. They damage and denigrate the responsible people with a diagnosis of fibro, making us a joke.

I wish they'd find some other malady to use as an excuse for drugs.

Great post TAP.

~Heather

In regards to low back pain. What would you recommend for L4-L5, L5-S1, compression back pain?

You were right when you said the amount of pain you are in is inversely related to your income. A WebMD blurb on a study ( http://www.webmd.com/pain-management/news/20080501/less-income-more-pain ) ... um... "proves it." Although I do believe they have their cause and effect slightly skewed...

My wife has fibromyalgia, and fits the mold perfectly. Lyrica, boats of motrin, and the occasional flexeril, but who would take valium for fibro? >.< I knew one patient who had "fibro" and the doc had pulled out all the stops: Per month, oxycontin 40 & 80, oxycodone 30, soma, ativan, duragesic 100 (2 patches at a time), ms cont 60, MSIR 15, valium and norco. Brand name EVERYTHING, per the doctor. She came in one time and said she hit a pedestrian on the way to the pharmacy. Apparently the "DO NOT DRIVE" stickers don't count for her.

But as for actual fibro, cox-inhibitors and gaba drugs seem to be working better than the lortab my wife takes once a week.

You are absolutely right about Fibromyalgia. I've been working in pharmacy for 6.5 years, and this past year fibro has really been BIG. I do believe it is related to weight. I know someone who was "diagnosed" with "fibromyalgia". The doctor suggested a "special diet" to help with the pain. Basically, this diet was low fat, low sugar, lots of fresh vegetables, lots of water.... You know a healthy diet. This doctor is a very smart guy, he knows telling people it's a "special diet" works. She ended up losing about 40 pounds and amazingly enough her "fibromyalia" is better. She is still convinced it's not the weight loss but the diet that cured her.

I have Lupus, which causes some pretty severe pain. I am a semi-frequent reader on here, but never have posted. I just have one question if you have time to answer it:

I always see your posts about the Vicodin/Soma addicts. I actually take Norco and Soma for the pain, along with tons of advil, Imuran, Plaquenil, and recently some Voltaren (I think it's called) cream to put on the most-sore joints. My point is, I seriously hurt, and my labs prove there is definitely something going on (high CPK, etc :)
And the norco/soma combo helps more than anything else I've tried; and I have tried a LOT of others. My doctor even prescribed the Fentanyl patches (which made me horribly sick), and Oxycontin (which is stronger, but still makes me sick). I've also gone through Skelaxin, baclofen, klonopin, robaxin, and a few other muscle relaxant type meds, but again, they just didn't help much. Point being, I "could" easily get stronger (or.....higher "street" value drugs if that were my goal), but I don't like them - I've at least for now settled on the ones mentioned.

If I could change 1 thing, it would be to make the Soma less tiring. To offset the fatigue, my doctor prescribes Ritalin (again, another more "off label" use I think, but it works). I am not "wired" or "high" from it, it just helps me get through the day.

I have private insurance and pay for all of my medicine and doctor visits, it is hard, but I do it. And yes, I go to 1 pharmacy for everything, and the same 2 pharmacists there are always nice and friendly. But, I do always wonder if they make jokes and such after I leave, I really have no idea honestly.

So my question is, do you look at someone like me as a horrible addict when coming into your store? With those 3 medicines (Norco, Soma, Ritalin), I know the red flags probably come up somewhat often. But I'm also doing everything in my power to knock down the root of the cause (with the Imuran and plaquenil mainly).

To the point, I would honestly like to know what you and the other pharmacists and techs that also read this think about people like me -- when I go in to pick these things up, do I have a nickname? :)
Do pharmacists mostly think that if you are filling both hydrocodone AND soma that there is no legitimate use? Again, I really am curious here, not mad or trying to start a war.

I can't speak for anyone else, but if you are like the other pain management patients/regular.. I probably would think no less of you than the patient getting Valtrex for the rest of their life, or a patient on Marinol. I don't judge them.. it's only the patients who are constantly harrassing their doctors, coming in early to refill, yelling at staff when they can't, always claiming "they lost/or had stolen" their Xanax, their dog died and thats why they have to take 4 a day, not 1.. yada yada.
We have several patients who always fill once a month, same time, are considerate, nice to talk too.. and happen to be on one or several pain medications. Do I think badly of them? No.

Izzyred, people do not take Imuran and Plaquenil for fun. We know that, and we know a person in legitimate pain when we see one.

The best description I heard of the difference between drug dependence and drug addiction came from a "60 Minutes" episode. If you are addicted to drugs, your quality of life goes down. If you are dependent on drugs, your quality of life goes up.

I've never forgotten that and tell people that all the time.

It broke my heart to see elderly people with arthritis or cancer or some other painful condition come in and ask if they were going to become a junkie because they take Oxycontin.

I'm still trying to find a doc who'll rx me narcs for my osteoporosis. Stingy bastards, the lot of them. :(

You have a valid point...and all the "frequent flyers" are a pain to us all...is Tramadol a controlled substance where you live? It's not, here, AND SHOULD BE!! WE ALL feel your pain! Just the fact that i have to answer the phone on average 20 times per day, per addict...waiting to see if their Soma has been approved is a HUGE waste of my time, and distraction from my work.

That being said,

I still can't figure out why you have to ridicule the children with 'special needs' to get your point across.

You seem like an intelligent young man, why can't you express yourself without calling someone a 'retard' or wondering if they 'got off the short bus'

In case you haven't noticed, our children are NOT drug addicts...they don't scream at you every month. They just go about their business trying not to hear the comments that NARCISSISTIC pharmacists use. What are you, A TWELVE YEAR OLD GIRL LIVING IN THE VALLEY?

Please don't compare MY CHILD to the general addicted public or the scum of the earth, who afford you a paycheck....she and others like her are undeserving of it. I don't see you using the N word..or any other hate word directed at a certain race, or group of people. Using the R word...falls into the same catagory...HATE CRIME!

Buy a Thesaurus! And if you don't want to deal with the Fibros...then DON'T! Send their business to another pharmacy...one that can handle things professionally. I mean, really...we are professionals, right?

The way angrier than you girl..
20 years in the biz AND a mom!

Pain/mind management--a tricky slope, especially for the weak minded or those stuck in an automated rut. I know this chick with tangible back injuries (happened with witnesses, x-rays show evidence) who doesn't take any pain medication at all. Some days are good (she doesn't walk with any signs of symptoms) and some days are bad (people ask her why she walks so painfully slow and disjointed).

...I've got no life story, but I'd like to fuck a Leprechaun--funny thing is, I'm afraid I'd get the short end of the stick--no offense to Leprechauns and all; I know it's not their fault they're so um, small...

izzyRed, if you have Imuran and Plaquenil in your profile, we know you have a "real" disease. It's the individuals who have pain meds/controlled rx's only and repeatedly try to get them filled early that draw a pharmacist's ire. No matter how much TAP rants about the anger landmine that is retail pharamcy, most pharmacists feel the same way but are actually quite reasonable individuals. It's just the repeated abuse that drives us over the edge :-)

My aunt had lupus, my 2nd cousin has lupus, I know it's a heavy burden and thus, seeing immunosuppressant drugs any reasonable pharmacist would never give you any crap, especially if you just *talk to us*. Pharmacists like to stay informed on their patients because, maybe... just maybe... we can pick up on something your doctor missed.

Quit with the disclaimers. You are "The ANGRY Pharmacist", not "The Politically Correct Unhappy Pharmacist".

Retard=Dee Dee Dee = Person not born with downs

quit being so PC
i know down's kids who use the term for people being stupid

Thanks for answering everyone. While I've never worked in a pharmacy, I came across this site once by accident and found it entertaining to hear from the other side of the counter. From the stories everyone posts on here, it sounds like a true nightmare that requires a lot of work that just shouldn't be needed - not by the pharmacy anyways...

I don't want to go totally off-topic here, but if the prescription writing process could just be more advanced with technology [not with faxes being sent back and forth, which I may be wrong, but it seems like that's the normal way the majority of stuff gets sent]...that pharmacists could use the huge amount of knowledge to actually HELP patients and not have to waste what seems to be a LOT of time sifting out bogus prescriptions, etc.

I've gotten more help from my pharmacist at times where I feel like I should be paying him just as a doctor; he should seriously at least be able to bill my insurance for personalized attention -- I usually get more advice from him/her than I do from my doctor, and my doctor makes $150 for 15 min or less of time.

But again, I have no clue what I'm talking about, and this probably sounds quite naive.

One thing I forgot to mention before is, I do refill most of my medicines around the 7-6 day mark. Mainly because at the end of the year, I get about a month's worth of 'free' medicine before my yearly copay restarts......even with my insurance, my copay is going up a lot every year and every little bit helps, helps me at least --- but I honestly never really thought [selfishly I guess] about if it causes a burden for the pharmacist?

The only exception to the reasoning above is for the angry-pharmacist-infamous Soma :)
I have been taking it for years, and with my condition the pain goes up/down. When it's bad, my neurologist said I can take 2 at once, with up to 6 per day. Yet, my prescription is only written for 4/day...which obviously causes it to run out early. And again from reading this blog, I know that this is just one of of those REALLY ANNOYING things...right?
[also for a reason unbeknownst to me, he always makes it for 100 tablets, which is 25 days...he doesn't do this with anything else, always has with this one -- is this some "rule"?]

Anyways, this is getting too long yet again, sorry :)
My point being that for the Soma, in the bad weeks/months when I take 6/day it runs out about 12-13 days early. This is one of those things that makes me feel really awkward and like a street addict -- when I have to call for the early refill. My pharmacists have always filled it, of course I have to pay cash with it being that early [but I don't know any alternative], but it makes me really stressed out to even ask and I always feel like I am doing something very wrong. And again, I don't know what they think, or if that is a huge 'red flag'? I am not taking more than what my doctor specifically told me I can when things get worse, but of course the pharmacist only knows and sees what is written on the paper. Is this a common problem? I have mentioned it to my doctor, and he always says "ok", but then the refill comes up and it's for the same thing....I honestly don't know how to handle this situation, or more directly for the people that are on this board -- how common and/or problematic is this?

Thanks everyone for the previous replies. I don't expect that anyone will read this far this time, but would love to hear any comments good or bad.

izzy Red,
Don't feel like a street addict. It IS actually a very common problem (doctors telling patients to take more than what has been prescribed). Just have your doctor write your prescription indicating the maximum amount of medication that you could possibly take per day. A sample prescription could look like this: Soma 350 mg 1 tablet 4 times a day or as directed (up to 6 tablets per day) "insert quantity here"...

to izzyred.... holy god! how can you take 6 or more of those things per day? do you realize that just because a script allows you to take that many, that you don't have to take that many? for things like soma (coma)... you really should taper down and try not to take more than 2 or 3 a day.

My doctor prescribed those for me once and I was only able to take half a soma at night before bed to ease the muscle spasms whilst I slept. It took me 4 months to get through the one small bottle, and even then I didn't finish them. I brought them back to the RX for disposal.

Do you know why I refused to get them refilled? Because when I would wake the next morning, I would feel as though I had been out drinking the night before. No thanks!

People on these somas and the like need to take better control over their health. If a doctor gives you a script for something, it doesn't mean that you have to take it. Read and research before getting yourself into a nice mess! Ask for alternatives. Ask more questions!!

As for fibro, it is a load of crap! I've seen so many people who claim to have this so called "disease" and it makes me throw up a little in my mouth to see these people ham it up with their pain. And yes, they act disoriented... they have drugs in their systems!!

izzyRed,

When you're at your appointment, when it's time for the doc to write that Soma out -- tell them right then and there to make it for 180, for 6/day. If you do that, and then have to have the pharmacy request more refills down the line, the correct quantity will be there, and it will be correct. Tell them to write it as 2 tablets every 4 hours as needed. You have to make it clear to them that if they instructed you that you may take up to 6 a day, that it's important to note that on the prescription so there's no problems for you when you need a refill. Tell them you frequently have to pay for it to be early when you're in your bad pain periods, and that it can be a financial burden. You have to make it plain to them that this is how it is going to be, because this is what you told me to do. Typically, it will end up sinking in, and the doc will fix the problem.

victoria,
Yes, I realize I don't have to take whatever is prescribed :)
But I do take their advice and at least give it a try if there is something wrong with me. In this case, it's the pain. I've gone through tens of different medications, including stronger painkillers [those have very bad side effects for me that unless things progress, I want to stay away from] and every other muscle relaxant type medicine my doctor knows of...

But in the end, those are the 2 that work for me. The soma does make me tired if taking it without food. Also as mentioned, I take Ritalin to help offset the tiredness part. I guess it's like nulling that part of the side effects out. I was leery at first [I always do lots of research online about the medicines before taking them to find out all I can] because I thought it was just used for hyperactive children. I am 34.

But after playing around with the dosage of the Ritalin to get it right, I just take it along with the Norco and Soma. While that may sound odd, as I don't know or think it's normally used like this -- it does work. The painkiller effects help a lot, without being tired. I am really thankful for these 2 medicines, like I said before, stronger pain medications like Oxycontin and Fentanyl made me quite sick and much stronger side effects. With the oxycontin, I held out for 3 days just to give it a fair shot. But at 40mg (was prescribed up to 60mg twice daily) -- it made me just useless. I couldn't work or do anything, plus the pain was still there for the most part. The fentanyl made me so sick, I didn't get past 1.5 days...
I have no clue why ANYONE would want to take that stuff for 'fun'. There was absolutely nothing fun about it at all. Nor is there with my current medicines -- but it lets me get through each day, and hope every morning when I get up that it will keep working.

I guess different medications are processed by different people differently, and give different effects. I can see what you mean about the tiring part, but choosing between being a bit tired sometimes versus hurting like hell; I'll take the tired any day :)

Victoria, did you read all of Izzy's post? S/he doesn't take 6 Soma daily all the time, just when s/he needs it.

I think that fibromyalgia can actually be caused by the seating position in an escalade, maybe that is why so many of these patients drive them. Its really a chicken or the egg type of scenario.

Damn, are we still debating the use of the word retard? Let me ask you have you ever uttered the phrase "that is so gay"? Honestly, lets not be a bunch of vaginas here!!! This isn't intended to be a PC site.

I totally agree with your post about fibromyalgia being a bogus diagnosis, and that doctors diagnose this "condition" when they have no idea what is causing the patient's pain.

However, I feel the need to remind you and other readers of this website, blog, whatever to realize that pharmacists are NOT doctors, they have nowhere near the education level needed to be a doctor, and they are NOT qualified to hand out medical advice neither at work nor the internet. It is the pharmacist's job to dispense the medications ordered by the physician, nothing more, nothing less. It is the doctor's ass on the line, not yours. You are merely doing your job.

Obviously, if there is an obvious error or a question regarding dosage or frequency, then a call should be made to the doctor's office to verify the prescription. Other than that, it is not your job to try and diagnose patients from behind your retail sales cash register.

I think that maybe some of my opinion on this matter might center around some of the news stories I have read regarding some pharmacists decisions to not sell the "morning after" pill, which personally offends me. It is not my pharmacist's job to push his/her religious beliefs on anyone seeking a legal drug, no matter what it is or what it is used for. In my opinion, if a pharmacist refuses and/or tries to impede my access to a certain drug based on their beliefs then they are in the wrong profession and need to find a new one STAT.

My dad works in a pain department where about half of the staff are all obsessed with "fibro," and the remaining half continue to do real research and refer to fibromyalgia as "bored housewive's disease." I've always found it apt. "I'm sore, things hurt, ibuprofen doesn't help. I need the attention and the shiny diagnosis of an Official Disease!"

You hit some nails on the head, for sure. And you were totally prepared for what would come your way. I just found this blog in the midst of a particularly disillusioning segment of my pharm tech training, and well... it's (perhaps perversely) comforting to know that I'm not the only one that's pissed.

I'm damn glad you're not my pharmacist. Your palpable joy in belittling ill people sickens me. With your your surplus of contempt and obvious lack of compassion for your customers, perhaps you'd do well to choose another profession. Oh, the money's too good? I thought so.

You, sir, do a great disservice to those who are truly ill by lumping them in with those not sick but engaged in drug seeking behaviour. It's telling that you can't tell the difference.

There are many legitimate reasons why people who are truly are ill with Fibromyalgia would come to your Angry Pharmacy to get any of the 'scripts you in your infinite and angry wisdom have deemed inappropriate to dispense.

1. Their 'script for pain meds i.e. Vicodin et al was written by a doctor who, like the vast majority doctors, has no idea how to properly treat Fibromyalgia. Vicodin, Oxycontin and the like do not work for Fibro.

2. They are in a tremendous amount of constant pain.

3. Their often frustrated and assuredly harried doctor gives them pain meds to shut them up.

4. See #2.

5. Because frequently (and understandably) folks with Fibromyalgia are extremely anxious, some Doctors prescribe Valium and other tranquilizers to these patients. You'd be scared too upon learning you have a largely misunderstood, highly debilitating illness that is both highly variable and extremely difficult to treat. You may not have ever even heard of Fibro.

5. When the treatment and drugs don't work, anxiety kicks into a higher gear.

6. See #2. Again.

Get a grip, Angry. Your ignorance is astonishing. And blaming the sick is a coward's move. It's also wildly misdirected animosity. Isn't it the doctor who actually writes the prescriptions and not the patient?

I think it's interesting that rheumatologists, the people who have far more expertise, education and knowledge than you could ever dream of having, do believe that fibromyalgia exists. Yet you attempt to dazzle us with your superior knowledge of a disease you don't know enough about to even describe competently. And please, go on blaming other people for your nasty attitude; it's always fun to watch adults pretend to be back in grade school with the "they started it!" excuse for their behavior.

Eric, I work with a pharmacist who sometimes does relief in a nearby college town, and he said that the Planned Parenthood affiliate there writes for Plan B with 11 refills. He has a MAJOR ethical problem with filling that; it was NEVER meant to be used as a method of birth control! He does not profess any religious beliefs that I'm aware of.

I personally don't even think it should be sold in pharmacies; it should be dispensed out of a doctor's office or ER. JMHO.

I worked in retail when that and Preven came out, and we ordered a couple of them and they just sat on the shelf and expired.

And what's this about vaginas? I happen to have one!